When Sleep Problems Cause Fatigue
- Victoria Wermers, RN,MSN,FNP, PMHNP
- Oct 18, 2024
- 5 min read
Updated: Jul 29
Insomnia-Hypersomnia-Parasomnia-Narcolepsy
Insomnia
Insomnia, or difficulty sleeping, generally falls into two main categories:
Acute Insomnia – Lasting a few days to weeks, often triggered by environmental stressors such as family issues, trauma, work, or financial concerns. This can lead to a vicious cycle: less sleep increases anxiety, and anxiety worsens sleep.
Chronic Insomnia – Occurring at least three times a week for a month or more, this form is frequently linked to chronic stress, anxiety, depression, medical problems, poor sleep habits, or lifestyle factors like tech use, caffeine, and alcohol. It also follows a damaging cycle: sleep loss fuels mental distress, and mental distress disrupts sleep.
Subtypes of Insomnia
Initial (Sleep Onset) Insomnia – Trouble falling asleep, often tied to anxiety and worry.
Middle (Sleep Maintenance) Insomnia – Waking during the night and struggling to stay asleep, often associated with depression or anxiety.
Late (Early Waking) Insomnia – Waking too early and unable to return to sleep.
Mixed Insomnia – Combines difficulties falling and staying asleep.
Paradoxical Insomnia – Feeling as though you haven’t slept, even when you have
Next Steps: When sleep problems cause fatigue, the key is to identify the root cause (and most likely there is one). Once the cause is clear, it can guide you to the right solution, from lifestyle adjustments to medical interventions. Remedies can be put in place and, hopefully, sleep and energy restored. There is most likely an answer.
MANAGING SLEEP PROBLEMS
Whether it is a physical problem or a mental health problem, managing the underlying health problem is the key to treatment here. If that does not help or if it is impossible, other methods may be used together with medical or mental health treatments, or as standalone approaches.
There are many reasons why people do not sleep, like stress or pain. Explore other pages on this site if you are looking for answers to specific causes of insomnia.
Chronic Fatigue Syndrome
Fatigue due to underlying illness (including sleep apnea)
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 to 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.
Deep breathing exercises - This helps release endorphins in your brain, which are"feel good" hormones. This technique is practiced by taking a deep breath through your mouth using your diaphragm muscle located just beneath your lower ribs (instead of using neck, shoulder, and upper chest muscles), pausing and then releasing the breath through the mouth. Repeat this several times.
Progressive muscle relaxation - This helps a person relax. It is done by tightening muscle groups for eight seconds, then relaxing them for several seconds: Begin with facial muscles, with the face, moving to the scalp - tighten muscles for eight seconds, then relax; then the neck, doing with each muscle group of the chest, back, pelvis, extremities, and so on. This releases some tension and stress. If you do not have time to move through all of your muscle groups, do this with those muscles you believe have the most tension.
Meditation: Especially mindfulness, may help. Immerse yourself in the present moment, focus on your breathing and body processes without using judgment
Use non-pharmaceutical methods to reduce underlying anxiety and depression
Make your overall environment more conducive to rest and relaxation.
Consider cognitive behavioral therapy 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
Saffron
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)
SPECIFIC SLEEP PROBLEMS THAT CAN CAUSE FATIGUE
Hypersomnia
This is sleeping too much (even if you got enough sleep the night before). Sleeping late or napping during the day sometimes is not unusual for these people. It can be caused by substance abuse, is very often associated with depression. It can also be due to a Vitamin D deficiency.
Treatment and Support of Hypersomnia
General Approaches to Hypersomnia
There are no Over-the-Counter medicines specifically recommended
Therapy (CBT)
Lifestyle changes/sleep hygiene
Herbal Remedies
Prescriptive Treatment
Stimulants (these can also produce hypersomnia)
Antidepressants
Parasomnias
These are distressing interruptions to sleep. For example, walking in your sleep, talking in your sleep, eating in your sleep, night terrors, and unintentionally acting out during sleep (which can have a significant, sometimes dangerous impact on the sufferer or their bed partner). Parasomnias can be caused by sleep apnea, sleep deprivation, restless leg syndrome, mental health issues (particularly trauma), stress, neurologic problems, medications (especially antidepressants), and, in some cases, may be genetically determined.
Treatment and Support of Parasomnias
Therapy
Benzodiazepines (common: Ativan, Xanax)
Tricyclic antidepressants (common: amitriptyline), SSRIs
Nightmares: Prazosin
Sleep-eating (common: topiramate, pramipexole/Mirapex, ropinirole/Requip)
Narcolepsy
Narcolepsy is characterized by the need to sleep several times during the day. It is often impossible to stay awake no matter how hard a person tries. A person with narcolepsy typically exhibits the following symptoms:
Extreme daytime sleepiness
The feeling that you are dreaming while you are awake
Nighttime interruptions
Inability to move when initially awakened from daytime "naps"
Cataplexy sometimes occurs, which is demonstrated by sudden muscle weakness in response to something startling or laughter.
Narcolepsy results in a great deal of fatigue for the person who is afflicted by it.
Treatment and Support of Narcolepsy
Over-the-Counter
Considered Herbal Remedies
Valerian (short-term)
Prescriptive Treatment
Stimulants (common: Provigil, Nuvigil, Sunosi, amphetamines - controlled substances) which help with daytime sleepiness and fatigue.
