Why Am I Feeling Tired? Understanding PCOS and Energy Levels
Most of us know what we can be like when we don’t get a good night’s sleep. Poor sleep can make you feel tired, cranky, and unable to concentrate or make decisions. But what if you’re one of the many people who fail to sleep well on a regular basis?
Problems with sleep and low energy are indeed all too common. Tiredness is a widespread complaint. According to the Royal College of Psychiatrists, one in 10 people has prolonged fatigue, often because of having poor sleep.i
Common causes of tiredness
There are many reasons why you may feel tired and are unable to get the right amount of sleep every now and again. Your lifestyle may be to blame: too many late nights before early mornings, eating a diet with lots of sugar and fat, having caffeine or alcohol too close to bedtime, and even exercising late at night can make falling asleep a challenge.
Stress can affect your ability to sleep well too, which is why situations such as having a heavy workload, getting married, bereavement or moving house can contribute to sleeplessness and tiredness. Even being overweight can make sleeping more difficult, as your body has to work harder just to do everyday things.ii But if you feel persistently tired and low in energy it could be a sign of an underlying health problem, such as one of the following:
As the name suggests, the main symptom of chronic fatigue syndrome (CFS) is extreme tiredness. According to the ME Association, it’s currently estimated that 250,0000 people in the UK have CFS, across age groups. Other symptoms can include sleep problems such as insomnia, joint and muscle pain, poor memory and concentration and digestive problems such as bloating, constipation, diarrhoea, and nausea. Need more information? Take a look at our top tips for fighting fatigue.
If your thyroid gland doesn’t produce enough thyroid hormones the condition is known as hypothyroidism or an underactive thyroid. According to the NHS, it affects 15 in every 1,000 women and one in 1,000 men, with the main symptoms including tiredness, weight gain, being sensitive to the cold, depression, dry skin, dry hair, and muscle aches.iii
A lack of iron can cause iron-deficiency anaemia, with one of the main symptoms being tiredness and lack of energy. If your diet includes little iron you could go on to develop anaemia. It can also be caused by blood loss (through having heavy periods, for example) or pregnancy. Other symptoms can include palpitations, shortness of breath and pale skin. If your diet is to blame, you can boost your iron levels by eating more iron-rich foods. This includes dark green leafy vegetables, fortified foods, meat, beans, peas, and lentils. If you still feel you won’t be able to improve your iron intake through diet, it might be wise to choose an iron supplement. Cutting down on dairy foods and tea, coffee and milk may also help your body absorb iron more efficiently.
Conditions that cause persistent pain can also make it hard for you to sleep well, such as arthritis and other joint or muscle problems such as back pain.
Restless legs syndrome
Thought to affect up to 10 percent of people in the UK, restless legs syndrome is twice as common in women as men, including about one in five women who are pregnant.iv If you have RLS you typically have an irresistible urge to keep moving your legs, especially at night, which can disrupt your sleep significantly. Nobody knows what causes it, but it can run in families and is also linked with certain other medical conditions such as iron-deficiency anaemia, diabetes, and an underactive thyroid are just a few examples.
Studies suggest sleep disturbances are more common in women with polycystic ovary syndrome than others. PCOS may cause iron-deficiency anaemia, since some women with the condition are affected by heavy periods. Scientists have also noticed a relationship between PCOS and thyroid disorders.v Some of the reasons for this link include features that are found in both PCOS and hypothyroidism, including:
Polycystic ovaries – where many small cysts are found on the ovaries.
Insulin resistance – where your body doesn’t respond normally to the hormone insulin.
PCOS and insomnia
Insomnia is when you regularly find it difficult to fall and stay asleep when you wake up several times during the night and/or when you wake up early and can’t get back to sleep. Any of these can make you feel tired and irritable during the day, even when you first wake up, and you may also find it hard to nap during the day, despite feeling exhausted.
Studies admit that insomnia in women with PCOS has received very little attention to date. However, some do suggest since metabolic problems such as insulin resistance are a feature of PCOS, and as the endocrine system – which produces the hormones that regulate metabolism – has an important role in governing the sleep-wake cycle, it’s likely that PCOS interferes with both arousal and sleep.vi
What can you do?
Whether you have PCOS or not, there are some lifestyle changes you could make that could help you sleep more soundly. Firstly, avoid foods and drinks that contain caffeine before bedtime or after midday.
Having a set routine of when you go to sleep and wake every day may help your mind and body automatically become ready for sleep at those times. Make sure your bedroom is a calm and peaceful environment with as little noise and light as possible at bedtime. A bedroom that’s too hot can also make it difficult for you to sleep.
Taking regular exercise can also be helpful, with one study suggesting those who get at least 150 minutes of exercise a week are able to sleep better than those who exercise for less.vii Just remember not to be too active too late at night, as exercising before bedtime can make it harder for your body and brain to switch off.
Also try having your main meal earlier in the evening, as eating too close to bedtime can make it difficult for you to fall asleep. On the other hand, having a healthy light snack before bed could help you sleep better than going to bed hungry.
Seeing a healthcare professional is also essential, especially if you’ve been having regular bouts of insomnia for no obvious reason. Your GP may explore whether or not you have an underlying health problem that’s causing your sleeplessness and can prescribe sleep medication – through these types of medicines are only suitable for use in the short term.
PCOS and sleep apnoea
Obstructive sleep apnoea is when your breathing stops while you’re asleep or when your breathing becomes abnormally slow and shallow because of an airflow problem. Either way, the problem can wake you up to make you start breathing normally again. You may not remember waking up, but these frequent interruptions to your sleep can make you feel tired during the day.
Many cases of sleep apnoea are diagnosed when a partner notices someone is snoring really loudly or that their breathing stops, becomes forced or noisy, or interrupted by gasping or snorting. Some people with sleep apnoea are aware of waking up during the night and gasping for breath. Other symptoms you may notice are night sweats, waking up to urinate several times during the night, waking up with a headache or feeling low or depressed during the day.
According to the Sleep Apnoea Trust Association, up to 13 percent of adult men and six percent of adult women in the UK are affected by sleep apnoea, with many also being overweight. However, while women are less likely to be affected than men, studies suggest sleep apnoea affects anything between 17 - 75 percent more women with PCOS compared with others of a similar age and body mass index (BMI).viiiExcess weight is, however, believed to be one of the strongest links between PCOS and sleep apnoea, with one study showing women with PCOS and a high BMI have a higher risk of sleep apnoea and daytime sleepiness.ix
What can you do?
Losing weight could be the single most important thing you can do to relieve the symptoms of sleep apnoea. However, many women with PCOS find losing weight a challenge, despite their best efforts. Here are some of our tips for staying motivated whilst losing weight with PCOS.
Other suggestions for better sleep include giving up smoking if you’re a smoker. Avoiding alcohol during the evening may also be useful as it makes the muscles around the upper throat relax more than usual, which can cause snoring and affect your breathing while you sleep. Not taking sleeping pills, sedatives and tranquilisers before bed can also help, as these all have a similar effect on your throat muscles as alcohol.
Some experts also recommend singing exercises to tone the muscles in your throat and help reduce snoring and mild to moderate sleep apnea.xMeanwhile if you suspect you have sleep apnoea, it’s important to have the condition diagnosed by a healthcare professional. That’s because if left untreated it can lead to several other conditions including high blood pressure, heart attack, stroke, congestive cardiac failure and type 2 diabetes, as well as depression and other mental health problems. Why not browse our hub for more information on managing your PCOS.
Sleep and tiredness: key facts. Royal College of Psychiatrists. Available online: http://www.rcpsych.ac.uk/healthadvice/problemsanddisorders/sleepandtirednesskeyfacts.aspx
Fernandez, R.C., et al. (2018). Sleep disturbances in women with polycystic ovary syndrome: prevalence, pathophysiology, impact and management strategies. Nat Sci Sleep. 10: 45–64. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5799701/
NHS UK. (2015). Underactive thyroid (hypothyroidism). (Date accessed 03/04/2018). Available online: https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/
Restless Leg Syndrome UK. (2018). WHAT IS RLS? (Date accessed 03/04/2018). Available online: https://www.rls-uk.org/what-is-rls/
Singla, R., et al. (2015 Jan-Feb). Thyroid disorders and polycystic ovary syndrome: An emerging relationship. Indian J Endocrinol Metab. 19(1): 25–29. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4287775/
Franik, G., et al. (2016 Dec). Sleep disturbances in women with polycystic ovary syndrome. Gynecol Endocrinol. 32(12):1014-1017. Available online: https://www.ncbi.nlm.nih.gov/pubmed/27348625
Loprinzi, P.D., Cardinal, B.J. (2005-2006). Association between objectively-measured physical activity and sleep, NHANES 2005-2006. Mental Health and Physical Activity. Volume 4, issue 2, 65-69. Available online: https://www.sciencedirect.com/science/article/abs/pii/S1755296611000317
Vgontazas, A.N., et al. (2001 Feb). Polycystic ovary syndrome is associated with obstructive sleep apnea and daytime sleepiness: role of insulin resistance. J Clin Endocrinol Metab. 86(2):517-20. Available online: https://www.ncbi.nlm.nih.gov/pubmed/11158002/
Tasali, E., Van Cauer, E., Erhmann, D.A. (2006 Jan). Relationships between sleep disordered breathing and glucose metabolism in polycystic ovary syndrome. J Clin Endocrinol Metab. 91(1):36-42. Available online: https://www.ncbi.nlm.nih.gov/pubmed/16219719
Hilton, M.P., et al. (May 2013). Singing Exercises Improve Sleepiness and Frequency of Snoring among Snorers – A Randomised Controlled Trial. IJOHNS. Vol. 2. No. 3, May 2013. Available online: http://www.creativenz.govt.nz/assets/ckeditor/attachments/1086/singing_reduces_snoring_by_o_jay_and_ernst.pdf?1413517377
Ojay, A., Ernst, E., et al. (Sep 2000). Can singing exercises reduce snoring? A pilot study. CompTherinMed. Vol. 8. Iss. 3, Sep 2000. 151-156. Available online: https://www.ncbi.nlm.nih.gov/pubmed/11068344