Is Insomnia An Overlooked Cause of Fatigue

Did you know lack of sleep can make you tired? I didn’t! When I developed fatigue over eight years ago, I thought it was my heart or thyroid. When those checked out, I thought it was depression. I started to see mental health doctors: had a psychotherapist, psychologist, and psychiatrist. They thought it was PTSD, given my history. What they didn’t appreciate was all Black people have PTSD. How can we not living in a racist white world that tells us we don’t matter. You see, the diagnosis was not a brilliant, novel, or creative one.

Having experienced anxiety and depression before that, it was odd that I had no feelings of melancholy or anxiety. No weight loss changes, no tearfulness, or anhedonia. No loss of pleasure in activities. My only symptoms were fatigue and decreased exercise tolerance, and in retrospect, an increased pulse rate. My doctors did not appreciate the latter, and once thyroid was not the cause, it became a non-issue.

My resting pulse went from 55 to 100-110 in about a month and stayed there. I was in great shape, working with a trainer, spending 2 hours at the gym, 3-4 times a week. Then suddenly, I could barely walk on the treadmill for 5-10 minutes without feeling dizzy. My trainer tried everything, but eventually, I had to stop working out.

Hypnotic therapy was cool, and I learned how to meditate during this time. It bothered me that the mental health professionals were so focused on PTSD despite not having other symptoms associated with PTSD.

On charting my fatigue, I noted it cycled with sleep. I could go months on 2-4 hours of sleep a night, but eventually, I would crash and take Seroquel, which would knock me out for an entire weekend. The Monday after that Seroquel weekend, I was a different person: cool, calm, and collective.

I started to ask the mental health professionals about sleep. But as with any profession, all patients who see mental health professionals must have psychiatric issues. They could not see outside that box. Also, at that time, many doctors did not consider insomnia a primary diagnosis that could lead to mental and physical issues—fascinating that something so obvious today less than ten years ago was heretic medicine.

I recall mental doctors dismissing it. They wanted to keep pumping me with psychiatric medications, many with nasty side effects like seizures or sudden death. The side effects were so scary thinking about them kept me up.

So what does this have to do with today?
In the last couple of weeks, I had similar symptoms. My resting pulse on beta-blockers was high, and I stopped taking ‘pep’ pills because my blood pressure was high. My exercise tolerance crashed, where I could run 6 miles two weeks ago, I could barely eke out three miles without an HR of over 150, and feeling as if death was knocking on my door. Also, focusing was difficult and simple tasks seemed complicated. If I had not blogged about sleep earlier, I would not make the association.

I did a two day sleep vacation. And I feel amazing, and that is as good as I am going to get. Once again, I can gather my thoughts enough to put on paper. Yesterday I jogged, and my pulse averaged 120. Had I listened to my doctors when I reached out, I would be in an ED getting COVID. Fatigue with normal labs does not mean mental illness; it could be a lack of sleep caused by stress and other things.

Everyone is different. Where I had a cardiac, thyroid work-up, etc.,  I learned fatigue and a rise in my resting pulse are signs of sleep deprivation.   Finding ways to relax and get sleep is the best cure.


Author: Angela Grant

Angela Grant is a medical doctor. For 22 years, she practiced emergency medicine and internal medicine. She studied for one year at Harvard T. H Chan School Of Public Health. She writes about culture, race, and health.

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