For me it was sleep apnea. It was undiagnosed and I have lived most of my life basically exhausted.

Once I was diagnosed, thanks to a CPAP recall/shortage during the pandemic I couldn’t get a CPAP machine so used a custom fit oral appliance which took a few days to get used to, but once I did I woke up one day, having done nothing very different from any other day, feeling fresher than I can ever remember feeling.

It was fascinating to realize that I had basically lived my entire adult life of over 2 decades in a half asleep stupor.

It can be incredibly hard to get a diagnosis. Even when you are shown to have it, you can find out that insurance uses an entirely different metric and, therefore, will refuse to pay. I don't get any sleep as a result and there's not a thing I can do from what it seems.

I paid cash for mine, all in around $2500, but it was worth it to skip the insurance hassles, constant monitoring, and just get what was recommended by the Doctor directly.

If it's sleep apnea, go to eBay and buy a CPAP for $100. It'll be the best $100 you spent.

Make sure you know how to calibrate it though.

As the other commenters mentioned: there is something you can do.

Put your health before saving money.

Did you have any issues with the device when you first got it? I've been using a cpap machine for a while, but it took me literally years before I could sleep through an entire night with it on. I've been thinking of either having surgery or going the oral appliance route this year.

For me the trick was a full face mask (Dreamwear, where the hose comes out the top of your head) and a heated hose.

I was initially resistant to the full mask, thinking it would feel more restrictive than the nose-only, but distributing the pressure over a wider area ended up feeling a lot more comfortable.

Similarly with the heated hose, my initial thought was that it would feel like breathing hot air all night. The the actual effect is that it keeps the added humidity from condensing out out of the air and gurgling in the tube.

Not OP, but it took me a year of actively reading my machine data and changing settings to figure it out. Have you tried OSCAR?

I have! Or I think it was sleepyhead? It helped me a little bit, but I think I had a hard time figuring it out because I wasn't really wearing it for very long before I'd take the mask off, so it didn't feel like there was enough data each night.

I did also post to one of the apnea boards with data from it and they helped figure out better pressure settings for me which did help some.

I have been having serious issues getting used to it. What do you mean by surgery and oral appliance? Thanks.

My old dentist made and sold these, but the oral appliance is a custom-fit mouthpiece that forces you to keep your lower jaw forward while you sleep, preventing airway collapse.

achileas mentioned the oral appliance. It's apparently somewhat common, but I didn't know about it for the longest time either.

For surgery, it really depends on your body and what the cause of the apneas are. In my case, it is _probably_ due to tonsils + a long(?) palette. An ENT told me I could have surgery to remove the tonsils and also shave down the palette, but I didn't go through with it because it sounded like a terrible recovery time and didn't have any guarantee it would actually fix the issue.

If you haven't already, it might be worth talking to an ENT (Ear Nose Throat) specialist that also deals with sleep apnea. The oral appliance definitely sounds like the less painful option though.

Thanks for the info. I suffer from it as well. Can you please write in more about the "custom fit oral appliance" ? I'm interested in trying it myself.

Not OP, but old dentist made and sold these. It is a custom-fit mouthpiece that forces you to keep your lower jaw forward while you sleep, preventing airway collapse. It’s the same thing you’re taught to do for CPR to force the airway open.

Oh man, I had something like that as a kid, for my overbite. It was called a bionator and was like a retainer on steroids.

Can you say more about this custom appliance?

It positions your lower jaw so that your airway is more open.

Can we buy this custom appliance over the counter without a prescription to try it out?

I think my dentist offered it for $3600 without insurance? I haven't done it yet, but I want to. They did need proof of a sleep study, but I think that is more of an insurance thing.

This probably does something similar. https://www.sleepon.us/mrd-m2/

As we age slow-wave sleep degrades. This is the stage of glymphatic clearing the article describes.

This decrease in slow-wave sleep begins in our late 30s and is linked to Alzheimer's, Diabetes, weakened immune function and more.

We've been working on this for a few years through auditory stimulation during sleep. Published peer reviewed research using our stimulation protocol is at https://soundmind.co/research

When will this be released? What can we do in the interim?

Q1 '25

We're in the process of getting Ethics approval in Australia (which is a legal requirement to provide units for our trial).

Discussions with manufacturers has begun.

We're also collaborating with some universities and providing units for them to run their own trials.

I thought I always felt tired. Until I got a sleep mask, ear plugs, stopped eating 4 hours before bed, slept in a cold room, and went to bed at the same time every night. I found my body just adjusted itself back to its natural rhythm. Curious how many of the contestants surveyed did exactly this and still had trouble with their sleep.

Edit: diet and general lifestyle changes (such as going to the gym and being outside) also helped.

What led to you making so many changes to your normal routine all at once?

Not the parent, but in my case it was the attempt to optimize the process of falling asleep, in any way possible, after years of sleeping problems. There are a lot of articles, books or YT videos compiling tips and tricks. 4-7-8 breathing is another common advice.

After I had been diagnosed with sleep apnea, I received a prescription for an APAP machine (auto-adjusting pressure, in contrast to constant-pressure CPAP). Unfortunately, I still wake up every night after ~3 hours of sleep with a feeling of suffocating and panicking which makes me take off the breathing mask. Therefore I have yet to experience any positive effects from using the APAP machine to treat the apnea.

Any advice from somebody who has gone through the same thing?

I’m sure it has occurred to you to try CPAP; was it ruled out by your pulmonologist? If the pressure is incorrect enough to wake you up gasping, “it ain’t workin’”. As a CPAP user, being able to access the hidden control menu for my device was key: it allowed me to change the pressure, the ramp, and other runtime configuration that really improved my experience - which improved my compliance and thus my energy level (and that small thing of not being at risk of sleep-death!). You have to press a certain combo of buttons to access, maybe your APAP has something similar?

I implemented these changes over the course of a few months. I was so sick of being sleep deprived I eventually optimized my sleep.

How cold?

For me it was diet, after I gave up gluten, dairy, sugar, and virtually all carbs, and just stick to 80% meat, 20% vegetables, water and tea, I am full of energy, pain free, and hunger is very different, I only eat 1 meal a day and I’m not hungry (although it is a big meal usually - ~1500 calories)

My sleep improved once I started measuring using a whoop strap.

Within a few days of wearing the strap, it was clear to me that my 8 hours were ineffective 8 hours. I was accumulating significant debt every day and when I paid it off over the weekend, I felt energized again.

I recognized that every day is different and needed to change my environment, and consistency accordingly. Sleep is now a non-negotiable thing in my life.

Apple Watch is teaching me this lesson right now. Any success stories in terms of improving your ratio of sleep to in-bed time?

Besides the obvious less screen time in bed, the major ones for me were

1. Reducing alcohol consumption down to zero during week nights makes my percentage of rem sleep go up and percentage of light sleep go down

2. My deepest sleep is after 4 am. So dark blocking curtains help my sleep tremendously.

3. Certain workouts, such as light cardio, make my sleep and recovery better as opposed to others, such as playing a sport.

4. My ideal sleep temperature is between 68 and 70F.

These are all I know so far.

Appreciated, thanks!

I am feeling tired all the time. My hand / legs go numb when I am in same position for more than 10 mins or so. I feel lot of weird stuff when I am asleep. Thyroid, Vitamin D, b12, diabetes, iron levels, brain MRI all came up normal. So my neuro suggested seeing a psychiatrist (I was depressed during Covid) which also didn't show any improvement. I have GERD though. Anyone in the similar boat? I feel like I might a possible explanation from this thread. My doctors couldn't find anything. I am 25, work in IT. All this issues started during Covid (when I was sitting all day in front of my computer) and got worse after that.

Same boat, I'm a 32 software developer and gamer, always spent most of the day on a computer, but since last year I'm very tired every day, I'm a father and doctors dismissed me as having some sort of midlife crisis or changes in my life even though from my perspective, I've never been happier, the only thing bringing me down is being tired. I sometimes feel dizzy when standing up, way more often and stronger than the natural dizzy you sometimes get when staying sitting too long.

The list of possible reasons is long and not all can be tested: long Covid, ME/CFS, diabetes, sleep apnea, depression, vitamin deficiencies.

I've tried to practice more sports, stopped all coffee and alcohol for a month, slept for longer, nothing changed, but I should continue some of this anyway.

There's also this documentary on long covid or me/cfs where some people have it so much worse, can't get out of bed like the Youtuber PhysicsGirl... Devastating.

Early studies seem to indicate permanent brain damage because of viruses like Covid, so there might be no chance of recovery, just learning to live with it.

Anecdotal here but last year I changed my diet radically and completely swept away my daily tiredness and cyclical cluster headaches. First year in 7 years without one.

Largely I eat leafs and meats while keeping carbs down, keeping dairy low etc. It's not easy to make this adjustment but for me, where I was at physically I would try anything. Going to bed before the kids is for the birds.

My primary doc gave me the same rigamoure that you got so I finally kicked them to the curb and started a search for a new one. Found a doc who suggested the diet change and its worked well, I'll be working on adding some foods back in this year.

I'm eating mostly carbs and dairy and it's not the first time I hear this kind of thing, so I'll work on this now, thanks!

I had tried to do it at first but it was not easy to go from 100% carbs and dairy to 0% so I went back, but I'll have to commit to it.

It's very difficult tbh, don't give up, it'll get easier after 30 days. Tips for me since I tend to integrate a intermittent fast in the morning is just make sure to drink enough water, it does a pretty good job of kicking your hunger and then you'll get into ketosis which is good. The docs will tell you as part of this you should expect to go back down to your high school graduating weight which I said no way at the time, but sure enough, to a T I'm back down to it and have stopped losing weight now and when /if I do splurge on junk I will feel it, so it makes my lifestyle easy to maintain now.

I'm sure you've looked into this, but getting dizzy while standing up is a symptom of anemia. Best of luck to you!

Yes, blood tests confirmed I missed a little bit of iron, took supplements and levels are now normal but the fatigue and dizziness didn't go away.

Thanks, it seems a lot of people have similar symptoms, hope some of the causes get better treatments, but also more recognition, feels awful going to work every day like this, and doctors not prescribing time off work because symptoms are to broad/vague and no life threatening illness is found. If I didn't have a family to provide for, I'd just stop working right now.

I'm around the same age and I've been struggling with constant fatigue for years. It's very hard to be taken seriously. I am absolutely not an expert, but perhaps you have some kind of circulation issue? I hope you can find answers.

The article is more about sleep quality but I personally often realize that I am lethargic rather than tired when life/work is a bit boring and magically find energy when it gets exciting. Most of us have relatively dull and repetitive lives so we don't get the adrenaline flowing enough to fend off a baseline tiredness/lethargy on most days

I recently was diagnosed with sleep apnea (am in my late 30s), and once I got used to wearing a mask (nasal pillows with Ayr gel to improve the seal work best for me) the quality of life improvement was enormous.

For a few people I know, it was thyroid related.

I was diagnosed with thyroid problems (hashimoto) when I was around 18. Now, 12 years later, I can safely say: It did help with some of the tiredness, a specific kind of tiredness.

I am still tired in a different way. I feel like I either need a lot of sleep in general (usually 9-10 hours) or something else is up.