Fatigue – What is the commonest medical cause?

Many people are tired because they are stressed by many aspects of their life. They work too hard, play too hard and cut back on sleep. But, there are many very serious medical causes that need to be addressed, the most common being that of sleep apnoea. In reality, all adult males and postmenopausal females suffer a degree of sleep apnoea and one question will determine whether this needs to be investigated further and managed.

The question is very straightforward and strangely is not related to the level and amount of snoring you may do. When you wake up in the morning after what you perceive to be a reasonable night sleep, do you feel refreshed or unrefreshed? If the answer is unrefreshed, it is likely you have significant sleep apnoea that needs management. The problem is that the treatment is often more difficult than the complaint.

There are two basic types of sleep apnoea – the most common being obstructive sleep apnoea where the upper airway closes down during deep sleep and you never achieve the proper restorative sleep needed to keep you energetic throughout the day. The less common form is central sleep apnoea, which is typically due to some disorder of the brain, leading to reduced oxygen sensing at night time and diminished breathing as a consequence.

Firstly, there are many lifestyle factors that contribute to sleep apnoea and need to be addressed. The modern epidemic of obesity is a major factor, as is excessive alcohol and cigarette smoking. Other contributing factors, such as thyroid issues and many modern medications, typically sedatives & analgesics, may also contribute to sleep apnoea.

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Photo by David Clode on Unsplash

After lifestyle factors have been addressed, the two effective treatments of sleep apnoea include some sort of mandibular advancement device (basically a very fancy mouthguard, typically organised by a dentist with an interest in this area) and the more definitive therapy- nasal CPAP with all of its modern adjustments. Basically, nasal CPAP delivers continuous positive pressure into the airway keeping the airway open and allowing the smooth delivery of oxygen through the body via the lungs.

It is estimated that around 1 billion people around the world have some degree of obstructive sleep apnoea. For those who are prescribed nasal CPAP, only half can fully tolerate the therapy whilst some cannot use it at all.

Untreated sleep apnoea has been associated with a variety of very significant medical conditions including refractory hypertension, all forms of cardiovascular disease including stroke and heart attack, along with the other significant risk factors of obesity and diabetes and all of their associated illnesses & complications.

There has been some welcome news from Flinders University in Adelaide suggesting a multi-level surgical technique may be very effective for those people who are refractory to nasal CPAP. The surgeons remove the tonsils, reposition the palate and perform local surgery on the tongue to open up the airway and reduce obstruction. A study demonstrating the success of this technique was published in the Journal of the American Medical Association on September 4th.

The important message here is not to suffer in silence, because you won’t anyhow as your snoring is typically very noisy. If you are waking unrefreshed, experiencing daytime sleepiness and falling asleep in inappropriate situations, it is vital you have a thorough assessment for sleep apnoea. Talk with your doctor and obtain a referral to a sleep specialist for further management. You will feel so much better & it may even save your life.

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Dr Walker is an expert in the field of preventative cardiology and has published seven books. He gives lectures nationally and internationally.

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