Edited by Eleonora Maria Vladimiriou, Well.cy
Waking up tired, feeling excessively sleepy during the day, or regularly struggling to fall asleep does not necessarily mean you simply need “a little more sleep.” In some cases, persistent fatigue can be linked to an actual sleep disorder.
Dr. Sarah Silverman, a psychologist specializing in behavioral sleep medicine who trained at Stanford, has pointed to an especially interesting phenomenon: many people become so accustomed to sleeping poorly that they eventually consider the consequences normal.
Permanent fatigue may be blamed on stress and a busy schedule, sleepiness at work on monotony, while falling asleep on public transportation may even be treated as a joke. But when these experiences happen regularly, they may be signs that sleep deserves closer attention.
Many sleep disorders remain unrecognized or are not diagnosed early enough. Four are particularly common.
1. Insomnia: when you want to sleep but cannot
Insomnia is not limited to tossing and turning in bed while waiting to fall asleep. It can involve difficulty falling asleep, frequent nighttime awakenings followed by trouble getting back to sleep, or waking up much earlier than intended.
When the problem occurs at least three times a week, lasts for at least three months, and affects daytime functioning, it may meet the criteria for chronic insomnia disorder.
An estimated 10% to 15% of the general population meets the criteria for chronic insomnia, with the condition occurring more often among women, older adults, and people who are also dealing with mental health problems.
It is not only sleepless nights that should raise a red flag. Signs can include exhaustion even after getting enough hours of sleep, irritability and mood changes, difficulty concentrating, and memory problems.
Another common feature is anxiety that begins to appear as bedtime approaches. Someone may feel exhausted throughout the evening, only to suddenly feel extremely “awake” once they gets into bed. This state of hyperarousal often accompanies chronic insomnia.
Cognitive behavioral therapy for insomnia, or CBT-I, is considered a first-line treatment for chronic insomnia. Depending on the individual case, a doctor may also consider other treatment options or medication.
2. Obstructive sleep apnea: when your sleep is interrupted without you realizing it
With obstructive sleep apnea, the upper airways repeatedly narrow or become blocked during sleep, temporarily limiting or stopping breathing.
The brain then triggers brief awakenings to restore normal breathing. The person usually does not remember these awakenings the next morning. When they happen repeatedly throughout the night, however, sleep becomes fragmented and is no longer truly restorative.
Loud snoring can be a possible sign, but not everyone who snores has sleep apnea.
Other symptoms worth investigating include excessive daytime sleepiness, waking up with a dry mouth or sore throat, morning headaches, memory and concentration problems, and repeatedly waking up during the night to urinate.
Mood changes, irritability, symptoms of anxiety or depression, and high blood pressure that is difficult to control may also occur.
Women deserve particular attention because sleep apnea does not always present with the “classic” combination of loud snoring and waking up feeling as though they are choking. It may instead appear as fatigue, insomnia, mood changes, or morning headaches, meaning the symptoms can sometimes be attributed to other conditions.
Treatment depends on the severity and cause of the condition. Positive airway pressure therapy, such as CPAP, is one of the main treatment options. For some patients, specially designed oral appliances or other interventions may be used, while surgery may be considered in selected cases. Managing body weight when someone is overweight and limiting alcohol consumption can also help.
3. Restless legs syndrome: when your legs “won’t let you” sleep
Restless legs syndrome, also known as Willis-Ekbom disease, is characterized by an intense and often difficult-to-control urge to move the legs and, less commonly, the arms.
It can be accompanied by unusual and unpleasant sensations such as tingling, burning, pulling, itching, pain, or an internal feeling of restlessness that can be difficult to describe.
A defining feature is that the symptoms appear or become more intense when the body is at rest, such as when someone is sitting or lying down, and they usually become worse at night. Walking, stretching, or movement in general can provide temporary relief.
This is also why the condition can turn bedtime into a genuine ordeal.
Studies have estimated that restless legs syndrome may affect approximately 7.2% to 11.5% of the population, although there are indications that many cases remain undiagnosed.
Treatment depends on the cause and severity of the symptoms. Checking iron levels is particularly important because iron deficiency can be associated with the condition. When a deficiency is present, a doctor may recommend iron supplementation. Specific medications are also available for some patients.
Regular physical activity, massage, hot or cold compresses, and avoiding factors that worsen symptoms, such as excessive caffeine, may also help.
Supplements, including iron or magnesium, should not be taken as treatment without first being evaluated by a healthcare professional, as they are not appropriate or effective for everyone.
4. Circadian rhythm disorders: when your biological clock runs on a different schedule
Some people can sleep normally, just not at the times their daily lives require.
With circadian rhythm sleep-wake disorders, the body's internal biological clock is out of sync with the external environment or with the schedule a person needs to follow.
The circadian rhythm does not only regulate sleep. It also plays a role in regulating body temperature, hormone release, and many other physiological functions.
As a result, someone may consistently be unable to fall asleep until very late at night and then have extreme difficulty waking up in the morning. In other cases, the opposite happens: sleepiness arrives very early in the evening and the person wakes up before dawn.
Research has estimated that these types of disorders may affect up to around 3% of adults, with higher rates among adolescents and young adults.
One telltale sign is a major change in someone's schedule when social obligations disappear. During vacations or weekends, for example, a person may naturally shift to a completely different schedule and sleep much better.
Similar problems can occur among people who work overnight or rotating shifts. They may be exhausted but still struggle to sleep during the hours available to them.
Another sign is persistent “insomnia” that does not improve with the usual advice for better sleep. In some cases, the problem is not that the body cannot sleep, but that the person is trying to sleep at a time that does not align with their biological clock.
When possible, adjusting the daily schedule to match the body's natural sleep window can help. When that is not possible, a specialist may use carefully timed exposure to bright light, melatonin at a specific time and dose, or behavioral interventions. Timing is particularly important because using light or melatonin incorrectly can shift the biological clock in an unwanted direction.
When does tiredness stop being “normal”?
The main message is that we do not have to get used to living permanently exhausted. An occasional bad night is normal. But when difficulty sleeping, daytime sleepiness, or exhaustion persist and begin affecting work, mood, concentration, or everyday life, it is worth looking for the underlying cause.
Particularly severe sleepiness in situations that require alertness, such as driving, should not be ignored.
And most importantly: Different disorders can cause similar symptoms, but they are not treated in the same way. A proper diagnosis from a doctor or qualified sleep specialist determines the appropriate treatment.
