Medicine:Morning tiredness

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Morning tiredness

Morning tiredness (also known as morning fatigue) is a feeling of prolonged tiredness experienced in the morning. It could be caused by a simple reason such as inadequate sleep, however it could also be a sign of an underlying health problem. There have been numerous scientific studies conducted on morning tiredness such as it's relationship with caffeine in children[1] and its association with a person's particular characteristic such as their level of exercise.[2] Morning tiredness is not to be confused with sleep inertia which is the short term drowsiness experienced immediately after waking up.

Occurrence

Morning tiredness can occur in all individuals, although it may be more prevalent in certain individuals. An American study on morning and evening fatigue that was conducted on 586 outpatients with a range of cancers undergoing two treatments of chemotherapy found that there are several predictors to morning fatigue. According to the study, common predictors to both morning and evening fatigue included a person's ethnicity, functional status, depressive symptoms and level of sleep disturbance. The article suggested that patients with a lower functional status were at a higher risk of morning and evening fatigue, as well as a close correlation between depressive symptoms and morning fatigue which is supported by the fact that morning fatigue is one of the symptoms to diagnose depression. In addition, predictors to only morning fatigue included a person's age, body mass index, level of exercise and state anxiety. The study found that prior to cancer treatment, morning fatigue was more frequent in younger patients, individuals with a higher body mass index, and individuals with higher level of state anxiety.[2]

Exposure to sunshine calibrates the body clock.
Exposure to sunshine calibrates the body clock.

Another factor that influences the occurrence of morning tiredness, is the amount of sunlight a person receives. This is due to the need for the human body clock to synchronise with the time, a process called entrainment. Humans have a circadian rhythm which dictates the time for sleep or activeness, and being outdoors exposed to the sunlight calibrates the body clock according to sunrise and sunset. According to the article, to maintain a good rhythm, 1 – 2 hours of daylight is necessary.[3]

Furthermore, the subject of circadian typology has an influence on a person's tiredness in the morning. Circadian typology is a construct that categorises people into chronotypes which are according to their preference of time of day of when activity is performed. This categorisation is most commonly carried out through a Morningness-Eveningness Questionnaire (MEQ) which consists of 19 multiple choice questions which places people in one of five categories, however more commonly three categories are only used; morning types, intermediate types and evening types. Morning types have a preference to wake up early and are most alert in the early morning whereas evening types have a preference to wake up later in the morning and are most alert in the late afternoon and evening. Intermediate types, also called neither types are people that have no preference and represents approximately 60 – 70% of individuals.[4][5][6]

A Finnish study that was coordinated on 4904 men and women aged 25 – 74 who lived in Finland concluded that there was a relationship between morning tiredness and physical activity. People who experienced morning tiredness also had a low amount of time for leisure, only performed physical activity whilst travelling and spent most of their day sitting. Moreover, morning tiredness was a characteristic of people required to follow a specific external schedule.[4]

Causes

There are a vast array of causes to morning tiredness and it varies between individuals. It could be a single factor or multiple, however it is dependant on the person. Other than not receiving enough sleep, some possible causes may include physical and/or mental health problems and nutritional and/or lifestyle choices.

Physical/Mental Health Problems

Difficulty breathing during sleep is one cause for morning tiredness and may be a sign of an underlying medical condition such as cardiac problems.[7][8]Sleep apnea is a condition where a person may periodically stop breathing for a short time causing the person to awaken, which negatively affects the person's quality of sleep. A person could determine if they have sleep apnea by finding out whether they snore, as it is a signal of the condition.[7]

Gastroesophageal reflux during sleep can cause a person to wake up or prevent a person from falling asleep, lowering their quality of sleep and causing morning tiredness. Gastroesophageal reflux (or acid reflux) is when acid from the stomach travels backwards into the oesophagus and causes heart burn and can be caused by overeating, excess alcohol consumption and eating shortly before sleeping. However, food should not be completely avoided at night time as hunger can also negatively impact a person's sleep which consequently can cause morning tiredness.[7]

Adrenal fatigue, the exhaustion of the adrenal glands which are responsible for secreting over 50 hormones, can cause morning tiredness. Adrenal fatigue can occur when a person is under continuous constant stress over a long period of time causing the adrenal glands to become fatigued. This can lead to tiredness particularly in the morning and afternoon. However, the person may have a short period of high energy at approximately 6pm, followed by another state of sleepiness around 9pm, and then have another burst of energy around 11pm which can cause a person to have difficulty falling asleep, thereby further limiting a person's quantity of sleep and increasing the risk of morning tiredness.[9][10]

A person's mental health can also contribute to morning tiredness. Mental illnesses such as depression and anxiety can cause a person to find it harder to wake up in the morning.[8][11] A scientific study conducted on patients undergoing chemotherapy also concluded there was a positive correlation between depressive symptoms and morning tiredness.[2] Stress can also affect a person's quality of sleep which can cause a person to feel more tired in the morning.

Nutritional/Lifestyle Choices

An unstructured body clock is one reason for morning tiredness as human's have a natural instinct for rhythm and time. An unstructured body clock is most commonly caused by irregular sleeping habits; waking up and going to sleep at different times every day. When the body is able to follow a specific routine, it is able to perform more optimally which includes being prepared to wake up at a particular time. If the body has a certain routine, the hour prior to waking up, sleep will become lighter, body temperature will increase and hormones will be released to prepare itself to wake up. However, in the contrary, morning tiredness may be experienced as the body has not adjusted to awakening from deep sleep.[3]

Caffeine such as in coffee increases risk of tiredness in the morning
Consumption of stimulants such as caffeine shortly prior to sleep can cause morning tiredness.

Consuming alcohol and stimulants are contributing factors to morning tiredness. Alcohol, sedatives and illicit substances disrupt the sleep cycle, which may cause a feeling of tiredness upon awakening.[7] Stimulants on the other hand, such as caffeine, stimulate the central nervous system and causes the body to feel more alert and awake, thereby making it harder to fall asleep.[12] This can lead to insufficient sleep and a lack of quality of sleep, which can lead to morning tiredness.[7] Furthermore, scientific studies have shown a significant association between high caffeine intake and morning tiredness.[1][13] Extreme diets that cause nutritional imbalances negatively affect a person's health and can lead to medical disorders, overall impacting on their quality of life and sleep.[8]

Using electronics like smart phones before bed can cause morning tiredness
Using electronic devices before sleeping can lead to morning tiredness.

Using electronics immediately prior to going to sleep increases the electrical activity of the brain[14] and can negatively affect a person's quality of sleep hence lead to tiredness in the morning.[15] The light from the screens of the electronics disrupt the release of the hormone, melatonin, which is responsible for causing sleep.[14][16][17] In addition, the content on the devices can cause the release of the adrenaline and the stress hormone, cortisol, which wakens the body and makes it more difficult for the body to be in a relaxed state which is needed for sleep.[14] Hence, the timing of the body is also affected as sleep is delayed, thereby the natural body clock is interrupted and it will be harder to fall asleep at an earlier time, thus a person may receive less sleep and wake up feeling tired in the morning[17]

In 1991, a study was conducted in the Netherlands examining the relationship between night time road traffic noise, morning tiredness and the use of sleep medications. Data was collected from 18 973 participants aged 15 - 74 years through a postal questionnaire, with questions such as "Do you in general get up tired and not well rested in the morning" and "Do you often use sleep medication or tranquilisers" which were in a "yes/no" format. The study deduced that there was a significant association between night time road traffic noise and morning tiredness but no relationship between night time road traffic noise and the use of sleep medications. Furthermore, the frequency of morning tiredness was magnified in insomniacs during night time road traffic noise. Thereby, the article hypothesised that the symptoms of insomnia are amplified from exposure to traffic noise. [18]

Remedies

One of the most common remedies to ease morning tiredness is to not press the 'snooze' button on an alarm clock upon awakening to fall asleep again. In stark contrast, wake up immediately when awoken.[3][11] This is due to immediately prior to awakening according to its natural body clock, the body places itself in a lighter state of sleep, hence the body is prepared to resume activity. However, when the body re-enters a state of deep sleep after hitting the 'snooze' button and is woken up, it is then that the body is left feeling tired and in discomfort.[3] In addition to this, falling asleep and waking up at the same time each day will reduce morning tiredness by setting the body's internal clock to follow a particular routine.[3][19]

Another good practice to reduce morning tiredness is to create an environment that promotes sleep to encourage a better quality sleep and in turn, a better morning. Creating a favourable environment for sleep may include keeping the room quiet, dark and cool which allows the brain to associate the bedroom with sleep. A Dutch scientific study performed in 1991 supports the link between night time road traffic noise and morning tiredness. The article suggested that to reduce the feeling of tiredness upon waking and to enhance sleep quality, the location of the bedroom and the insulation of the room should be improved in order to decrease the effects of the environmental noise.[18] Additionally, removing electronic devices such as televisions and computers and keeping all work and study away from the bedroom to limit sleep to that particular room can also reinforce the brain's association between sleep and the bedroom.[19]

Aerobic exercise such as running can reduce morning tiredness
Aerobic exercise can reduce morning tiredness

Another remedy is to drink one glass of water immediately after waking up. This is because during sleep the body has been deprived of water and is dehydrated, which causes tiredness, thereby consuming water relieves this feeling.[11]Along with drinking water, splashing cold water on the face can also cause a person to feel more energized immediately upon awakening. This is due to the cold water causing a mild shock to the face, thereby causing the body to release adrenaline.[20][11]

Performing yoga after waking up can help alleviate a tired body as it stretches and reactivates the muscles that have not been used for several hours during sleep.[11]Aerobic exercise can also benefit supported through extensive scientific research that shows increased physical activity and exercise reduces tiredness.[4][11][21]

Consuming breakfast also helps in relieving morning tiredness as it provides energy to the body, due to the fact that the body has fasted for several hours during sleep. Natural foods are more effective in providing the body with the essential nutrients that is needed particularly at the start of the day. This includes natural whole foods such as fruits, vegetables, nuts and seeds.[22][8] Not only natural foods, but also a breakfast high in protein can benefit rather than a meal that is high in carbohydrates with little protein which could cause blood sugar levels to peak but then suddenly drop later in the day.[20]

One Swedish study has suggested that morning tiredness can be reduced through improved nasal ventilation. The study was conducted for six months on 42 men who used a nostril dilator during sleep and it was conclusive that morning tiredness was experienced less when using the device.[23]

References

  1. ↑ 1.0 1.1 Watson, Emily J.; Banks, Siobhan; Coates, Alison M.; Kohler, Mark J. (2017-04-15). "The Relationship Between Caffeine, Sleep, and Behavior in Children". Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine 13 (4): 533–543. doi:10.5664/jcsm.6536. ISSN 1550-9389. PMID 28162144. PMC 5359329. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359329/. 
  2. ↑ 2.0 2.1 2.2 Wright, Fay; D'Eramo Melkus, Gail; Hammer, Marilyn; Schmidt, Brian L.; Knobf, M. Tish; Paul, Steven M.; Cartwright, Frances; Mastick, Judy et al. (2015-08). "Predictors and Trajectories of Morning Fatigue Are Distinct From Evening Fatigue". Journal of Pain and Symptom Management 50 (2): 176–189. doi:10.1016/j.jpainsymman.2015.02.016. ISSN 0885-3924. PMID 25828559. PMC 4526314. https://linkinghub.elsevier.com/retrieve/pii/S0885392415001529. 
  3. ↑ 3.0 3.1 3.2 3.3 3.4 "Hands off the snooze button! Wake up tired – and need an hour to feel human? Here's how to bounce out of bed". Mail Online. https://www.dailymail.co.uk/health/article-2031502/Hands-snooze-button-Wake-tired-Heres-bounce-bed.html. 
  4. ↑ 4.0 4.1 4.2 Wennman, Heini; Kronholm, Erkki; Partonen, Timo; Peltonen, Markku; Vasankari, Tommi; Borodulin, Katja (2015-08-28). "Evening typology and morning tiredness associates with low leisure time physical activity and high sitting". Chronobiology International 32 (8): 1090–1100. doi:10.3109/07420528.2015.1063061. ISSN 0742-0528. https://www-tandfonline-com.ezproxy1.library.usyd.edu.au/doi/full/10.3109/07420528.2015.1063061?scroll=top&needAccess=true. 
  5. ↑ Adan, Ana; Archer, Simon N.; Hidalgo, Maria Paz; Di Milia, Lee; Natale, Vincenzo; Randler, Christoph (2012-09-24). "Circadian Typology: A Comprehensive Review" (in en). Chronobiology International 29 (9): 1153–1175. doi:10.3109/07420528.2012.719971. ISSN 0742-0528. https://www.tandfonline.com/doi/full/10.3109/07420528.2012.719971. 
  6. ↑ Palesh, Oxana; Packer, M. Melissa; George, Holly; Koopman, Cheryl; Innominato, Pasquale F. (2016-01-20). "Associations between morning–evening chronotype, fatigue, and QOL in breast cancer survivors." (in en). Journal of Clinical Oncology 34 (3_suppl): 246–246. doi:10.1200/jco.2016.34.3_suppl.246. ISSN 0732-183X. https://ascopubs.org/action/captchaChallenge?redirectUri=%2Fdoi%2F10.1200%2Fjco.2016.34.3_suppl.246. 
  7. ↑ 7.0 7.1 7.2 7.3 7.4 "Morning Fatigue (Tired After Sleeping) Common Reasons | Healthhype.com" (in en-US). https://www.healthhype.com/5-common-reasons-for-morning-fatigue-tired-after-sleeping.html. 
  8. ↑ 8.0 8.1 8.2 8.3 "Morning Fatigue: Causes and Remedies – Step To Health" (in en-US). Step To Health. 2015-03-02. https://steptohealth.com/morning-fatigue-causes-remedies/. 
  9. ↑ "Reasons for Feeling Very Tired in the Morning" (in en). https://healthyliving.azcentral.com/reasons-for-feeling-very-tired-in-the-morning-12405667.html. 
  10. ↑ "Most Common Cause of Fatigue that is Missed or Misdiagnosed by Doctors" (in en-us). Mercola.com. https://articles.mercola.com/sites/articles/archive/2009/09/05/most-common-cause-of-fatigue-that-is-missed-or-misdiagnosed-by-doctors.aspx. 
  11. ↑ 11.0 11.1 11.2 11.3 11.4 11.5 "13 Quick Ways to Banish Morning Fatigue" (in en). Healthline. https://www.healthline.com/health/morning-fatigue-remedies#2. 
  12. ↑ "The Effects of Caffeine on Your Body" (in en). Healthline. https://www.healthline.com/health/caffeine-effects-on-body#1. 
  13. ↑ Orbeta, Rebecca L.; Overpeck, Mary D.; Ramcharran, Darmendra; Kogan, Michael D.; Ledsky, Rebecca (2006-04). "High caffeine intake in adolescents: associations with difficulty sleeping and feeling tired in the morning". Journal of Adolescent Health 38 (4): 451–453. doi:10.1016/j.jadohealth.2005.05.014. ISSN 1054-139X. PMID 16549311. 
  14. ↑ 14.0 14.1 14.2 "Power Down for Better Sleep" (in en-US). WebMD. https://www.webmd.com/sleep-disorders/features/power-down-better-sleep#1. 
  15. ↑ Johnson, Cathy (2016-10-21). "How technology messes with your sleep" (in en-AU). ABC News. http://www.abc.net.au/news/health/2016-10-21/how-technology-use-messes-with-your-sleep/7950336. 
  16. ↑ Wolff, Carina. "Why You're Waking Up Tired Every Morning" (in en). Bustle. https://www.bustle.com/articles/170127-11-reasons-youre-waking-up-tired-in-the-morning-how-you-can-fix-it. 
  17. ↑ 17.0 17.1 "How screen time affects rest" (in en). KidsMatter. https://www.kidsmatter.edu.au/families/enewsletter/screen-time-and-sleep. 
  18. ↑ 18.0 18.1 de Kluizenaar, Yvonne; Janssen, Sabine A.; van Lenthe, Frank J.; Miedema, Henk M. E.; Mackenbach, Johan P. (2009-08). "Long-term road traffic noise exposure is associated with an increase in morning tiredness". The Journal of the Acoustical Society of America 126 (2): 626–633. doi:10.1121/1.3158834. ISSN 0001-4966. https://doi-org.ezproxy1.library.usyd.edu.au/10.1121/1.3158834. 
  19. ↑ 19.0 19.1 "Twelve Simple Tips to Improve Sleep". 2007-12-18. http://healthysleep.med.harvard.edu/healthy/getting/overcoming/tips. 
  20. ↑ 20.0 20.1 Wolff, Carina. "9 Hacks To Fight Fatigue First Thing In The Morning" (in en). Bustle. https://www.bustle.com/p/9-hacks-to-fight-fatigue-first-thing-in-the-morning-9817147. 
  21. ↑ "Breast Cancer; Cancer: Exercise reduces tiredness". Women's Health Weekly; Atlanta. 2012-11-29. http://ezproxy.library.usyd.edu.au/login?url=https://search-proquest-com.ezproxy1.library.usyd.edu.au/docview/1179002431?accountid=14757. 
  22. ↑ "From Sleepy to Supercharged: 10 Foods for Morning Fatigue" (in en). Healthline. https://www.healthline.com/health/food-nutrition/morning-fatigue#1. 
  23. ↑ Loth, S.; Petruson, B. (1996-12-01). "Improved Nasal Breathing Reduces Snoring and Morning Tiredness: A 6-Month Follow-up Study" (in en). Archives of Otolaryngology – Head and Neck Surgery 122 (12): 1337–1340. doi:10.1001/archotol.1996.01890240045010. ISSN 0886-4470. https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/623825. 




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