The Health Pyramid-Sleep part 2

The Invisibly Empowered Health Pyramid

PART TWO: SLEEP

I Slept Eight Hours. Why Am I Still Exhausted?

After Part One, you might be looking at your sleep a little differently.

Maybe you're thinking about how many times your brain cycles through different stages while you're asleep. Maybe you're thinking about deep sleep, REM sleep, your circadian rhythm or the fact that your brain has its own overnight cleaning system.

Or maybe you're thinking:

Okay, Heather. That's great. But I DO sleep. And I'm still exhausted.

I hear you.

Actually, I really hear you.

I live with narcolepsy, so I know firsthand that the number of hours you spend sleeping doesn't always predict how rested you're going to feel when you wake up.

This is where the conversation around sleep needs to become more nuanced.

Because there is a difference between getting enough sleep and getting restorative sleep.

Eight Hours Is a Number, Not the Whole Story

We hear recommendations about how many hours of sleep we should get, and those recommendations absolutely matter.

But there's another part of the equation.

Sleep quality matters too.

Think about it this way.

Imagine going to bed at 10 p.m. and getting up at 6 a.m.

Technically, that's eight hours.

But what if during those eight hours you:

• woke up repeatedly

• struggled to breathe normally

• tossed and turned because you were uncomfortable

• spent long periods awake without realizing how long

• had your sleep repeatedly interrupted by noise, children, pets or bathroom trips

• experienced a sleep disorder that disrupted normal sleep architecture

You were in bed for eight hours.

That doesn't necessarily mean your brain and body experienced eight hours of healthy, restorative sleep.

This distinction is important because I think a lot of people blame themselves when they wake up tired.

They think:

What is wrong with me?

Why am I still tired?

I went to bed early.

I slept eight hours.

Why can't I just have more energy?

Sometimes the better question is:

What happened during those eight hours?

Your Sleep Can Be Fragmented Without You Realizing It

One of the things that surprises people is that you don't necessarily remember every interruption to your sleep.

We naturally experience brief awakenings during the night, but certain conditions can cause repeated disruptions that interfere with restorative sleep.

Sleep apnea is one important example.

With obstructive sleep apnea, the airway repeatedly becomes blocked or narrowed during sleep. Your brain has to respond enough to restore normal breathing, and this can happen over and over throughout the night.

Some people wake up gasping.

Some people snore loudly.

Some people have a partner who notices that they seem to stop breathing.

And some people don't know it's happening at all.

They just know they wake up exhausted.

Other clues can include morning headaches, dry mouth, difficulty concentrating, mood changes or significant daytime sleepiness.

This is exactly why "just go to bed earlier" isn't always helpful advice.

You cannot bedtime routine your way out of an untreated medical sleep disorder.

Tired and Sleepy Aren't Always the Same Thing

This is another distinction I wish more people knew.

When we say, "I'm tired," we can mean a lot of different things.

Sleepiness is the actual tendency to fall asleep.

You're fighting to keep your eyes open. You're nodding off during a movie. You could fall asleep as a passenger in the car. Maybe you're unintentionally dozing during the day.

Fatigue can feel different.

You may feel physically drained, weak or mentally depleted, but you wouldn't necessarily be able to fall asleep if someone put you in a quiet room.

And yes, you can experience both.

Understanding what you actually mean when you say "I'm exhausted" can provide useful information when you're trying to figure out what's going on.

For me, this distinction became incredibly important.

Narcolepsy isn't simply "being tired."

It is a neurological sleep disorder involving the brain's regulation of sleep and wakefulness.

That's very different from staying up too late watching Netflix.

Sometimes Your Body Clock and Your Life Don't Agree

Remember the circadian rhythm we talked about in Part One?

Your internal clock matters not only for how much you sleep, but also when you sleep.

There are people who naturally become sleepy earlier and wake earlier.

There are people whose biology leans later.

Teenagers are a perfect example of why this matters. During adolescence, sleep timing naturally tends to shift later. So the teenager who suddenly seems incapable of falling asleep early and would happily sleep until noon isn't necessarily just being difficult.

Their biology is changing.

Then we ask them to wake up incredibly early for school.

Anyone raising teenagers is probably nodding right now. 

Shift workers face another version of this problem.

Their job may require them to be awake when their internal clock is signaling sleep and asleep when their body is receiving signals that say daytime.

You can technically get hours of sleep and still be fighting your body's timing system.

Hormones Can Change Sleep Too

This is a big one, especially for women.

Sleep doesn't exist in its own little bubble separate from the rest of the body.

Hormonal changes can affect sleep quality.

Pregnancy can change sleep.

Perimenopause and menopause can change sleep.

Hot flashes and night sweats can cause repeated awakenings.

Changes in hormones can affect body temperature, mood and sleep patterns.

Sometimes a woman who slept beautifully for years suddenly finds herself awake at 2 or 3 in the morning wondering what happened to the person who used to be able to sleep.

This is another reason I don't love overly simplistic sleep advice.

Sometimes the person lying awake isn't doing anything "wrong."

Her body is changing.

Pain Doesn't Go to Sleep Just Because You Do

Anyone who lives with chronic pain knows this one.

You finally get comfortable.

Then you move.

Now your back hurts.

You reposition.

Now your neck hurts.

You finally fall asleep.

Then your body wakes you up again.

Pain can make it difficult to fall asleep and can disrupt sleep throughout the night.

And then poor sleep can make pain feel harder to manage the following day.

It can become a frustrating cycle.

This is where compassion matters.

If someone is dealing with chronic pain, telling them to "prioritize sleep" without acknowledging what is keeping them awake isn't particularly helpful.

Your Brain Can Be Exhausted and Still Refuse to Shut Up

Then there's stress.

You know this one.

You're exhausted all day.

You fantasize about your bed.

You finally climb into it.

And suddenly your brain decides this is the ideal time to revisit:

• the awkward thing you said in 2007

• tomorrow's schedule

• a conversation you need to have

• something you forgot at the grocery store

• your finances

• whether your child filled out that form

• every possible scenario that could happen during the next six months

Apparently 11:47 p.m. is when the brain likes to hold its staff meeting. 

Stress and anxiety can make it harder to fall asleep and harder to stay asleep.

This is one reason creating a wind down routine can be helpful. It gives your brain and body a transition between "doing everything" and "we're done for today."

We'll get into exactly what that looks like in Part Three.

Other Things Can Quietly Affect Your Sleep

Sometimes the answer is hiding in something we don't immediately associate with sleep.

Things that may affect sleep include:

• caffeine, especially later in the day

• alcohol

• nicotine

• certain medications

• late or irregular work schedules

• light exposure at night

• inconsistent sleep and wake times

• chronic stress

• pain

• hormonal changes

• breathing disorders during sleep

• movement disorders such as restless legs syndrome

• insomnia

• circadian rhythm disorders

• neurological sleep disorders such as narcolepsy

This doesn't mean every tired person has a sleep disorder.

It means persistent exhaustion deserves curiosity rather than judgment.

What About Your Sleep Tracker?

Now we have watches, rings, mattresses and apps telling us how we slept.

I actually think this technology can be useful.

It can help you notice patterns.

Maybe you discover that your sleep changes when you drink alcohol.

Maybe your bedtime varies dramatically throughout the week.

Maybe you're sleeping much less than you thought.

Maybe you start noticing patterns between your sleep and how you feel the following day.

That's useful information.

But consumer sleep trackers aren't the same thing as a medical sleep study.

Your watch may estimate your sleep stages based on things such as movement and heart rate, but it isn't measuring sleep the same way a clinical sleep study does.

So use the information as a tool.

Don't let your sleep score become another thing to obsess over.

If your ring says you slept beautifully but you can barely function, how you feel matters.

When Is Being Tired More Than Just Being Tired?

Everyone has bad nights.

Everyone occasionally stays up too late.

Everyone has seasons when sleep gets disrupted.

But there are times when persistent sleepiness or poor sleep deserves more attention.

Consider talking with a healthcare professional if you regularly:

• get what should be enough sleep but remain extremely sleepy during the day

• fall asleep unintentionally

• struggle to stay awake while driving or doing other important activities

• snore loudly or wake up choking or gasping

• have witnessed pauses in breathing during sleep

• wake repeatedly throughout the night

• experience uncomfortable sensations or an irresistible urge to move your legs at night

• regularly struggle to fall asleep or stay asleep

• wake with headaches or significant dry mouth

• have unusual behaviors during sleep

• experience sleep paralysis, vivid dreamlike experiences around sleep or sudden episodes of muscle weakness associated with strong emotions

The goal isn't to diagnose yourself from a blog.

The goal is to recognize when your body may be telling you something worth investigating.

Please Stop Blaming Yourself

This may be the most important thing I say in this entire article.

Being exhausted is not a character flaw.

It doesn't automatically mean you're lazy.

It doesn't mean you're unmotivated.

It doesn't mean you're weak.

And it doesn't always mean you need to become more disciplined.

Sometimes you need more sleep.

Sometimes you need better sleep habits.

Sometimes you're living through a demanding season.

Sometimes your hormones are changing.

Sometimes pain is disrupting your sleep.

Sometimes stress is keeping your nervous system on high alert.

And sometimes there is an actual medical reason you aren't getting restorative sleep.

Those are very different problems.

They shouldn't all receive the same solution.

The One Small Yes

For the next few mornings, before you immediately grab your phone, ask yourself:

How do I actually feel?

Not:

"How many hours did my watch say I slept?"

Instead, notice:

• Do I feel refreshed?

• Am I struggling to get out of bed?

• Am I sleepy again an hour later?

• Do I wake with a headache?

• Do I remember waking throughout the night?

• Am I relying on caffeine just to become functional?

• Do I have energy during the day?

You don't need to diagnose anything.

Just start paying attention.

Your body gives you information all day long.

Sometimes the first step is simply learning to listen to it.

From Surviving to Thriving

For a long time, I thought exhaustion was something I simply needed to push through.

So I pushed.

And pushed.

And pushed.

What I've learned is that there's a difference between occasionally being tired because life is busy and living in a body that is continually asking you to pay attention.

Sleep hygiene matters tremendously.

But it isn't the answer to every sleep problem.

Sometimes the most empowering thing you can do for your health is stop assuming you should be able to fix everything yourself.

Ask questions.

Pay attention to patterns.

Advocate for yourself when something doesn't feel right.

And remember that needing rest doesn't make you weak.

Your body isn't inconveniencing you by asking for sleep. It's communicating with you.

In Part Three, we're going to take everything we've learned and make it practical.

I'm inviting you into my bedroom.

Okay, that sounded wrong. 

I'm inviting you into my bedtime routine.

I'll show you how I created my own sleep sanctuary, the habits that actually stuck, the ones that didn't, and some incredibly simple ways you can start giving your own brain and body the signals that the day is finally over.