One of the most common reasons come to sleep clinic or to their PCP too for that matter is that they feel tired. Some use that word, tired while others say that they are exhausted, unrefreshed, fatigued or sleepy. When it comes to dealing with insomnia it is very important to make a distinction between fatigue and sleepiness. So which is which?
I lump fatigued and exhausted in one basket, unrefreshed in one and sleepy in another.
1. Exhausted/fatigued – a feeling of now having low energy. No difficulties staying awake.
2. Unrefreshed – feeling that sleeping is not helping one feeling less fatigued or sleepy
3. Sleepy – feeling that it is difficult to stay awake, urging to sleep.
This is important to know because the typical patient with primary insomnia (insomnia that is not due to an ongoing trigger that is the “real problem” for example taking care of a newborn) is not sleepy. Rather they are hyperalert. They feel high strung and easily aroused not only at bedtime but during the day as well. Most people with primary insomnia have a hard time sleeping day as well as night.
If someone has a hard time sleeping during the night but then feel sleepy and fall asleep during the day then they you have to ask yourself if there is some ongoing trigger for the insomnia like obstructive sleep apnea or pain.
If you have a hard time falling and/or staying asleep at night and do not fall asleep unintentionally or take naps during the day then you most likely will do well using CBTi as treatment for your insomnia.
If you have a hard time sleeping at night and keep falling asleep during the day then you may want to ask yourself if there is something like an external factor or health problem that is the “real problem” and your insomnia is caused by this underlying trigger.
How about feeling unrefreshed? Feeling unrefreshed is unspecific, it is not as helpful in telling one type of insomnia from another. People feel unrefreshed upon awakening if the have a hard time sleeping for any reason. It is off course an important symptom to recognize but it does not help us too much in finding out what is causing difficulties sleeping.