Do you often feel like your energy levels are sinking even in the first half of the day? If you often end up feeling fatigued and low on energy despite eating a healthy diet and resting enough, it could indicate underlying physiological or neurological disruptions affecting sleep quality. Here’s a clinical breakdown of potential causes:
Metabolic and endocrine dysfunctions
Conditions like hypothyroidism, insulin resistance, and adrenal insufficiency can contribute to persistent fatigue. Hypothyroidism (low T3/T4 levels) slows metabolic activity, while insulin resistance leads to fluctuating glucose levels that can make you feel fatigued. In adrenal insufficiency, a deficiency of cortisol and aldosterone causes chronic fatigue, despite other measures.
Cellular hypoxia and nutritional deficiencies
A lot of people do not consume the necessary vitamins and minerals that ensure optimal energy levels while also suffering from chronic fatigue, indicating that a person has to alter their diet in order to ensure they no longer feel drained irrespective of how long they sleep. Iron-deficiency Anemia leads to inadequate oxygen transport, causing cellular hypoxia that manifests as fatigue. Low vitamin D, B12, and magnesium levels can impair mitochondrial ATP production, reducing energy synthesis at the cellular level. A complete blood panel is essential for diagnosis.
Unregulated neurotransmitters and hormones
According to Dr. Jayalakshmi T K, Sr Consultant Pulmonology, Apollo Hospitals Navi Mumbai, “The hypothalamic-pituitary-adrenal (HPA) axis plays a key role in sleep regulation. Elevated cortisol from chronic stress or dysregulated melatonin secretion can disrupt circadian rhythms, leading to non-restorative sleep. Similarly, imbalances in dopamine and serotonin, often seen in mood disorders, affect REM sleep stability.”
Stress and anxiety
According to Dr. Sandeep Sonawane, Consultant, Internal Medicine, Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai, “Mental stress and increased anxiety can keep the brain in a state where it cannot fully relax, which can hinder a person’s sleep cycle by introducing restless nights, which consequently prevents a person from experiencing the deep level of slumber they require to feel energized.”
Caffeine and alcohol
Parts of the everyday elements that could interfere with sleep quality include caffeine and alcohol. Consuming these drinks even hours prior to sleep can disrupt healthy sleep patterns, particularly affecting restorative and deep sleep.
Sleep architecture disruptions
Sleep occurs in cycles of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep, essential for cognitive and physiological recovery. Disorders such as obstructive sleep apnea (OSA) lead to repeated nocturnal hypoxia and microarousals, impairing deep sleep (N3 stage). Periodic limb movement disorder (PLMD) and restless leg syndrome (RLS) cause involuntary movements that fragment sleep architecture. A polysomnography (PSG) study can identify these disturbances.
Chronic systemic inflammation
Persistent inflammation, seen in conditions like chronic fatigue syndrome (CFS), fibromyalgia, and autoimmune disorders, leads to elevated proinflammatory cytokines (IL-6, TNF-α, CRP), which interfere with sleep regulation. Patients often experience non-restorative sleep and morning stiffness, indicative of ongoing neuroinflammatory processes.
How to manage fatigue?
1. Diagnostic Testing: Sleep studies (PSG, multiple sleep latency test), hormone panels, inflammatory markers, and metabolic screenings can help pinpoint the cause.
2. Therapeutic Strategies: Sleep hygiene modifications, cognitive behavioral therapy for insomnia (CBT-I), melatonin regulation, or CPAP therapy for OSA may be needed.
3. Nutritional and Lifestyle Adjustments: Addressing deficiencies through diet or supplements, optimizing circadian rhythms, and reducing inflammatory triggers can enhance sleep quality.
Persistent fatigue despite adequate sleep warrants a comprehensive clinical assessment to rule out underlying systemic, neurological, or metabolic conditions.