Underlying Illnesses Can Cause Insomnia and Fatigue
- Victoria Wermers, RN,MSN,FNP, PMHNP
- Oct 18, 2024
- 5 min read
Updated: Jul 9
Insomnia and fatigue can disrupt every part of life—from productivity and relationships to overall health and emotional well-being. That is why it is so important to meet this problem head-on. Both acute illnesses, like the flu, and chronic problems can cause insomnia. The following, Underlying Illnesses Can Cause Insomnia and Fatigue, addresses many medical and psychological causes and potential management strategies.
Acute Illness as a Cause of Sleeplessness and Fatigue
When you have an acute illness like a cold or respiratory infection...
When the body is using all of its energy to fight off an infection, a person can feel terribly fatigued. The cells of the body are laboring arduously to send off "warning" messages to the immune system, increasing white blood cells and other chemicals which travel to the site of infection to engage in battle with pathogenic microbes and repair tissue. We see this so often with the flu, COVID, and strep!" I am soooo tired". Sleep and normal daily activities are impeded by a congested nose, a sore throat, a cough, or body aches. What results? Fatigue. So treat your symptoms at night (people love to use Nyquil to help sleep through their symptoms - barring any contraindications, of course), and rest during the day. Have someone else watch the kids (sadly, moms aren't "allowed" to be sick), take a day or two off from work (and don't forget to ask the healthcare provider for a sick note for work. Whether you work at home or in the office, stress is there. Stress is bad for your immune system, bad for fighting illness and bad for recovery.
Acute Illness as a Cause of Insomnia and Fatigue
It is no surprise that chronic underlying illness can cause fatigue and sleeplessness. Some of the more common of these include the following:
Iron-deficiency anemia
Allergies (can cause inflammation)
Fibromyalgia, arthritis, multiple sclerosis and chronic pain from injury
Heart failure
Kidney disease
Addison’s disease
Parkinson’s disease
Dementia
Diabetes (hyperglycemia and hypoglycemia)
Sjogren's syndrome (immune deficiency)
Cancer
Liver disease
Chronic obstructive pulmonary disease (COPD)
Well-known causes of emotional and psychological causes of fatigue are stress, anxiety, and depression. I am sure there are more.
General Approaches to Insomnia
If an underlying condition is causing your sleeplessness, addressing it may significantly improve your rest. Otherwise, you may need symptomatic support—treating the sleep issue itself. Sometimes, a dual approach is best: targeting both the root cause and the insomnia directly. These options are outlined below.
If you're unsure what’s behind your fatigue, start by examining your lifestyle:
Are you under chronic stress?
Overworked or sleep-deprived?
Practicing good sleep hygiene?
Staying hydrated and well-nourished?
Taking daily vitamins?
Living with unmanaged pain?
If you answered “no” to any of these, it might be time to make supportive changes and prioritize self-care. And if no clear medical cause is found, you can still address the insomnia itself through the suggestions that follow.
Exercise: Exercise for 30 minutes every day - during the day (if you cannot work an upper extremity, work a lower extremity, and if you cannot use a lower extremity, use an upper extremity - just do something!). Sometimes you have to force yourself to get up and exercise: Once you have done that a few times, a routine starts to develop and it is easier to do.
Eat a healthy diet
Sleep hygiene - relaxation techniques (especially progressive muscle relaxation): maintain regular bedtimes, avoid napping, avoid stimulation before bed, avoid alcohol and caffeine before bed. Make your bed and pillow(s) comfy. Try music relaxation. If you cannot fall asleep in 20 minutes, get up and do something until tired.
Use non-pharmaceutical methods to reduce underlying anxiety and depression
Make your overall environment more conducive to rest and relaxation.
Consider cognitive behavioral for insomnia (CBT-I)
Over-the-Counter Approaches to Insomnia
Herbal and Supplemental Approaches
Tart cherry juice extract
L-theanine (may also help improve alertness during the day)
CBD (cannabidiol) glycine
Prescriptive Approaches
For sleep problems: Try Zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta), and others (these are all controlled, potentially addictive medications, but do work for insomnia. Ambien, in particular, can cause unusual complex sleep behaviors and/or amnesia and some preliminary studies point to a possible increase in the risk of developing dementia.
Neuroleptics for sleep (common: Trazodone and Seroquel)
Other Underlying Illnesses Can Cause Insomnia and Fatigue -
Sleep Apnea
When you have sleep apnea...
Imagine what happens to your lungs and tissues when you do not get enough oxygen to your tissues. People with sleep apnea don't get enough oxygen because of nighttime breathing difficulties. There are two types of sleep apnea: Obstructive and central sleep apnea.
Obstructive Sleep Apnea: Does your bed partner tell you that you snore or stop breathing for several seconds during the night, only to awaken with a very loud deep breath or "snort"? Obstructive sleep apnea may be causing this secondary to excess tissue in the upper throat or narrowing of the airway due to obesity or decreased musculature in the windpipe. Enlarged tonsils and adenoids can also cause obstruction.
Central Sleep Apnea: This is a condition where your brain does not stimulate the breathing muscles. This can be a congenital problem (which means you may be born with the problem), or brainstem damage from things such as an accident, stroke, or infection.
Sleep apnea is diagnosed by a sleep study that measures various parameters of breathing when you sleep, like the number of breaths you take and how much oxygen you are getting.
If you are diagnosed with sleep apnea, a pulmonologist will give you a breathing device - usually a CPAP (see photo above) which assures adequate breathing at night.
Restless legs syndrome (RLS)
This is a need to move your legs, usually when sleeping (but can occur when you are awake). Many different sensations can identify this problem. They are well delineated by Mayo Clinic as twitching, kicking, a deep "crawling, creeping, pulling, throbbing, aching, itching, or electric sensations. Leg movement helps decrease these sensations; therefore, it is not unusual for a person to awaken or partially awaken to relieve the symptoms. Interruptions in sleep cause fatigue.
There are many suspected causes of RLS: Heredity, obesity, stress, underlying medical conditions like diabetes, kidney disease, multiple sclerosis, Parkinson's, possibly changes in neurotransmission, vitamin and mineral deficiencies, peripheral neuropathy, and various medications, notably some antihistamines, melatonin, and antidepressants.
Treatment of Restless Legs Syndrome
There are no over-the-counter medications that are considered adequate for treating RLS.
Considered Natural Remedies and Approaches for RLS
Vitamin and Mineral Supplementation - Folate, magnesium, and iron supplements may help.
Some people respond to vibration or pneumatic compression applied to the leg(s).
Prescriptive Treatment
Anti-seizure Medications (Gabapentin), benzodiazepines, opioids, and others (see Drugs.com) - some of these are controlled substances.
Because there may be other, more concerning causes of leg discomfort, it would be prudent to consult with a healthcare provider regarding the problem.
If you cannot resolve your sleeplessness and fatigue, it may be time to visit a primary care provider to discuss your symptoms. The healthcare provider should get a thorough history, do an exam, and likely order some lab work. Let them know your thoughts: What you need and what you hope to accomplish. You are your advocate. Understand that many of these causes of fatigue and insomnia and fatigue are treatable.
See also Fatigue-General Overview for other approaches
