You're Sleeping, So Why Are You Still Exhausted?

When you go to bed on time but you’re exhausted in the morning or wilt during the day, you’re either not sleeping well or you’re not sleeping enough. After a solid night’s rest, you should rise refreshed and maintain your energy until you’re ready to wind down again, said Roy Artal, MD, a Cedars-Sinai pulmonologist and sleep medicine doctor.

Everything you do during the day affects how you sleep, and tweaking your sleep hygiene can transform your sleep quality. It’s just as significant to eat a healthy diet, exercise, and limit or avoid substances as it is to keep your bedroom cool, dark and quiet and restrict your cellphone use before bed. If you’ve addressed the sleep hygiene basics and you’re still getting up groggy, here’s how to examine your habits and your health to suss out what’s stealing your slumber and solidify a sound sleep routine.

“Anyone can move the needle and make some forward progress,” said Artal. “No one will be able to check off all the boxes every night, but if you’re making positive changes, your sleep will improve.”

Rethink Your Sleep Duration

Adults should aim for seven to nine hours of sleep every night, according to the American Academy of Sleep Medicine. Some people need more than seven to feel rested, while others feel well with less, Artal said.

If you’re clocking seven hours in bed but still feel fatigued or sleepy during the day, try expanding your bedtime hours.  

“There are always going to be outliers, and if you’re waking up tired, you may not be sleeping enough,” Artal said.

Tucking yourself in with your cellphone doesn’t count as sleep. The most common sleep disorder is inadequate sleep syndrome—chronic sleep deprivation usually associated with a sacrifice of sleep hours for work, school or scrolling. Ban your phone from the bedroom to maximize your resting hours and avoid “sleep debt,” which can cause not only exhaustion but also trouble concentrating, headache and irritability.

Reset Your Circadian Alignment

Light governs your circadian rhythm—your body’s internal clock, which regulates when you get tired and when you’re alert. A misaligned circadian rhythm can contribute to poor sleep quality and leave you drained even after you’ve tried to get enough sleep.

Leverage the sun to train your body into better alignment with the natural light-dark cycle, which can help you sleep more soundly and avoid getting tired in the day. Try to be outside for the sunrise and sunset. Absorbing 15-30 minutes of morning or evening light in your eyes helps sync your body with the environment.

“The light on your retina instructs your brain that the sun is going down, which signals a shift to get ready to sleep,” Artal said. “Small interventions such as taking a walk in the sunset before your evening commute seem to have nothing to do with sleep yet can have a beneficial impact when you do go to bed.”

Try to be outside for the sunrise and sunset.

Get Screened for Sleep Apnea

Sleep apnea is a vastly underdiagnosed condition that causes pauses in a person’s breathing throughout the night, which results in daytime fatigue, even after enough sleep. Untreated sleep apnea puts you at a higher risk for stroke, high blood pressure and cardiovascular disease—but there are ways to address it.

Ask your bed partner or roommate if they ever notice you struggle to breathe or stop breathing in your sleep, or if you snore loudly. These are symptoms that you should address with a doctor, who may recommend a sleep apnea assessment. This is usually done with a simple monitor you wear at home overnight.

“Even if you sleep well and feel rested, if somebody tells you your breathing is stopping at night, you should really discuss that with a physician,” Artal said.

Sleep apnea can affect people at healthy weights, though it is also often associated with obesity. Some people with a high body mass index (BMI) can cure or eliminate their sleep apnea with weight loss, so Artal suggests patients lose weight and be retested. One study showed three times as many people who lost weight achieved sleep apnea remission than people who didn’t lose weight. GLP-1 therapy is FDA-approved for people with both sleep apnea and a BMI of 30 or more.

Exercise also helps, even when it doesn’t result in weight loss. Another study demonstrated that 150 minutes a week of moderate-intensity activity plus twice weekly resistance training improved patients’ sleep apnea severity and reduced daytime sleepiness.

Doctors treat sleep apnea by prescribing a continuous positive airway pressure (CPAP) mask to wear while you sleep.

“Until you actually try it, you just don’t know how you’re going to respond,” Artal said. “Many patients love the CPAP and wouldn’t sleep without it because they know how they feel when they use it versus when they don’t.”

For people who can’t or won’t wear a CPAP machine, doctors can also prescribe a mask-free implantable device that has been approved by the U.S. Food and Drug Administration for treating sleep apnea.

Commit to Positive Change

Fatigue and sleep problems should be evaluated by a medical professional. A sleep medicine doctor can help you set sleep goals, plan your bedtime routine, get help with counselors and take accountability for your habits.

A commitment to good sleep can make all the difference in your immediate and long-term health. Sleep repairs muscles, fortifies your immune system and helps your brain form memories and regulate emotions.

“We all know the experience of waking up in the morning after we’ve just gotten an incredible, magical night’s sleep. Our mood is great, our brain is firing on all cylinders—we just feel great and we’re ready to go,” Artal said.

Top Sleep Tips

Reduce Caffeine or Alcohol

Caffeine stays in your body for at least four to five hours. One study found that even when taken at 7 a.m., 400 milligrams of caffeine (about four to five cups of standard coffee) kept people up later and reduced their total sleep time.

Alcohol causes drowsiness and can help you fall asleep, but it can also disrupt and fragment the second half of your night’s rest. Try cutting out alcohol or caffeine for two to four weeks and notice if you feel a difference.

Try CBTi

A third of people will experience insomnia at some point. Cognitive behavioral therapy for insomnia (CBTi) aims to correct destructive sleep patterns and habits. The impact of CBTi is more permanent and at least as effective as sleep medications (without the side effects or long-term cognitive risks).

Factor in Menopause Symptoms

Up to 70% of perimenopausal and postmenopausal women have a diagnosable sleep disorder. These sleep concerns often go unmanaged and are attributed to aging, anxiety or depression. Hormone replacement therapy and CBTi can help.

Reconsider Your Wearable

If you wake up anxious to consult your wearable sleep device about your night, it’s probably not helping you, Artal said.

Instead, try the original way of tracking your sleep: “When you wake up in the morning, ask yourself how you feel. Your wearable can’t tell you that,” he said.