A lot of people walk around tired every single day. If you’re one of those people, you probably do the things you need to do—work, care for your family, socialize—all while wondering if you’ll ever feel rested again.
Don’t despair. Better sleep is possible, says UNC Health family medicine doctor Victoria Boggiano, MD.
“We all deserve restful sleep, but lots of things can get in the way of that,” Dr. Boggiano says. “If you’re not feeling like yourself, you don’t have to suffer. There are lots of small changes people can reasonably make that will make a huge difference.”
Dr. Boggiano explains why you might be feeling tired, and some of the tweaks you can try.
Why You’re Tired: You’re Not Getting Enough Sleep
This might seem like a no-brainer, but if you’re always tired, the first step is looking at the quantity of your sleep. A typical adult between the ages of 26 and 64 requires somewhere between seven and nine hours per night, but the exact number is different for everyone and changes over time.
You may have felt just fine on six hours per night in your 20s, but in your 40s, you might really need eight.
“Making time to get enough sleep is really important,” Dr. Boggiano says. “It starts with looking at what time you’re going to bed and what time you wake up, and then trying to extend that if you’re always tired. There may be some things you can’t change—a new baby, your work schedule, a loved one with overnight needs—but you may be able to make little changes to get an extra half-hour.”
You may need to be more intentional about your bedtime and wind-down routine. Think about your sleep environment—your bedroom should be dark, quiet and cool—and the activities you’re doing in the evening.
Stop using screens an hour before bed, as they “keep the brain going when it should be winding down,” Dr. Boggiano says. Implement a routine that helps your body know it’s time to sleep, such as reading a book (a hard copy, not on a screen), writing in a journal or meditating. Those practices can also help alleviate stress, a known sleep stealer.
Another thing to stop: caffeine in the afternoon.
“The effects can last for eight hours,” Dr. Boggiano says. “Look at when you’re having your last coffee, tea or even piece of chocolate.”
Smoking or using a nicotine replacement (these are stimulants), eating a large meal or napping too late in the afternoon can all impair your ability to fall asleep.
Exercise is a tricky one: Regular cardiovascular exercise helps with sleep, but you don’t want to do it within three hours of bedtime, because then it might keep you awake.
Why You’re Tired: Your Sleep Isn’t Good Quality
If you’re asleep for eight hours most nights and you’re still worn out, it’s time to think about the quality of that sleep. There are several factors that can affect how restful your sleep is.
“It’s important to avoid alcohol before bed,” Dr. Boggiano says. “A nightcap is a social ritual, and we think it’s helping us relax, but alcohol in the hours before bed is going to affect your ability to get into deep sleep. You might still get eight hours, but it’s not as restful as it should be.”
Your medications can also disrupt your sleep; cold and allergy medications and some heart and blood pressure medications are known for being particularly disruptive.
“Talk to your doctor about when you should take a regular medication,” Dr. Boggiano says. “If it seems like it’s affecting your sleep, they might recommend that you take it at a different time.”
If you frequently wake in the middle of the night to go to the bathroom, it may help to stop drinking fluids in the evening.
Sleep apnea, a disorder in which breathing stops and starts during sleep, could be the culprit.
“If someone has daytime sleepiness when they’re getting seven to nine hours of sleep, sleep apnea is a really important thing to consider,” Dr. Boggiano says. “Signs include intense snoring or a partner hearing pauses in your breathing. Most people see dramatic change in quality if they use a CPAP machine,” which provides constant air while you sleep.
Why You’re Tired: You Have a Medical Issue
Ongoing fatigue can be the sign of a health problem, but Dr. Boggiano says it’s rarely the only symptom.
“First, we want to look at low-hanging fruit,” she says. “Is the person getting seven to nine hours of sleep consistently? Are they drinking a large cup of coffee in the afternoon or running five miles right before bed? Have we considered sleep apnea? If we’ve addressed those, or if there are other symptoms or concerns in their history, there might be other issues to consider.”
Mood disorders, including depression and anxiety, can cause fatigue and affect sleep. Untangling sleep from how you’re feeling can be tough, but your primary care provider can help.
“Sleep can be more complicated when someone has depression or anxiety, but if you’re not getting good sleep, it is likely to make depression or anxiety symptoms worse,” Dr. Boggiano says. “It’s not something you have to handle alone—your provider can help you consider if you’d benefit from therapy or an antidepressant or something else.”
Your provider may order blood work to check for a nutritional deficiency or an electrolyte imbalance that might be affecting your sleep. Deficiencies in B or D vitamins, or a deficiency in magnesium or calcium can contribute to sleep difficulties.
Regular blood work can reveal how well your thyroid is working; an overactive or underactive thyroid can affect the quantity and quality of your sleep.
During perimenopause and after menopause, some women experience difficulties with sleep due to hot flashes or night sweats, symptoms caused by hormonal shifts. Your provider may consider menopause hormone therapy or nonhormonal options to help with these symptoms.
Other issues that can affect sleep include chronic pain, respiratory conditions such as chronic obstructive pulmonary disease (COPD) or asthma, and autoimmune conditions, including multiple sclerosis and lupus.
An estimated 1.3 percent of adults in the United States have myalgic encephalomyelitis/chronic fatigue syndrome, which your provider may consider if they can’t find other reasons why you never feel rested.
“If you have any concerns about whether your sleep could be caused by another condition, talk to your doctor,” Dr. Boggiano says. “There will still be a lot of lifestyle fixes you can try that will help with quantity and quality that can really impact your life.”
If you’re having trouble sleeping, talk to your doctor. If you need a doctor, find one near you.