I’m always feeling drowsy and sometimes fall asleep in the middle of the day, what’s wrong with me? Dr. Altman’s answer on Quora.com
- Too few hours devoted to sleep (obvious but true, since our lives tend to be very busy and we often sacrifice sleep for the sake of accomplishing more in our work, our family life, etc.) Adequate sleep is crucial to normal brain function. Lack of sleep can also contribute to the development of chronic illnesses like diabetes and hypertension, both of which impact brain function.
- Alcohol consumption too close to bedtime results in uneven, interrupted sleep patterns.
- Stress and sleep work both ways. Stress results in release of hormones that contribute to sleeplessness and to less deep sleep. And lack of sleep contributes to more stress.
- Sleep apnea, a disorder of interrupted breathing when muscles are relaxed. Interruptions of breathing may last 10 seconds to a minute. When the brain oxygen levels drop, the brain wakes the person up to start breathing again. There may be hudreds of such cycles every night. Sleep apnea can contribute to fatigue, drowsiness, personality changes, depression, physical health changes and other medical issues. Sleep apnea is frequently associated with snoring. A sleep study done in a sleep lab can help determine if sleep apnea is present.
- The relationship between depression and sleep goes both ways. Depression may cause sleep problems, and sleep problems may cause depressive symptoms.
There are other medical causes of fatigue. Fatigue, especially if it is of acute onset, needs a workup. Some medical issues that can contribute to fatigue are:
- Thyroid problems. The thyroid gland, considered one of the master glands, regulates energy metabolism in the body, in addtion to many other functions. If thyroid function is low, fatigue is a frequent symptom.
- Diabetes is another metabolic problem that can present with fatigue.
- Iron deficiency, more common in women due to cyclical blood loss, but found in both genders if there is insufficient intake of iron or chronic iron loss, as in bleeding intestinal ulcers and others.
- Certain infections, like infectious mononucleosis, Lyme disease, pneumonia, the flue, etc. can result in fatigue.
- Autoimmune diseases, like lupus, rheumatoid arthritis or multiple sclerosis.
- Heart disease
- Certain medications
- Other medical conditions such as malignancies can present with fagiue
A work-up of fatigue should include a thorough medical history and physical examination, an electrocardiogram, a chest xray, and bloodwork that includes a complete blood count (CBC), a comprehensive metabolic panel, sedimentation rate, iron studies, thyroid function studies, ANA (antinuclear antibodies) and fasting blood sugar.
The lists I provided are not exhaustive, just a starting point for investigation of fatigue. If there is sudden onset fatigue, an evaluation by your primary care physician should be done as soon as possible.
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