Chronic Fatigue and Sleep Apnea: The Root Cause of Many Diseases

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Many patients often ask their doctors, "Why am I always so tired? Is it because my liver is not functioning well?" In reality, for men over 40 and women over 50, the throat reaches a physiological limit, marking the beginning of years of snoring and increasing fatigue with sleep. Many people unknowingly suffer from obstructive sleep apnea, accumulating sleep debt over time, leading to depression, dementia, heart disease, and even accidents.

Some exhibit signs such as mouth breathing during sleep, loud snoring abruptly stopping, dry coughing, chest tightness, palpitations, numbness in the hands, leg cramps, frequent urination, and night sweats. Upon waking, instead of feeling refreshed, they often experience a dry throat, hoarse voice, frequent colds, dizziness, headaches, anxiety, difficulty breathing, and acid reflux—indications that they may be suffering from sleep apnea, a condition common in older adults (affecting 10-50%) and sometimes even children.

Sleep apnea only became the focus of precise scientific research in Europe around the late 1980s. In 1995, studies revealed that patients' brainwave tests showed alternating periods of sleep and sudden awakening, explaining why patients felt constantly fatigued during the day.

Subsequent studies in Japan showed that individuals who repeatedly snored and stopped snoring during the night were unable to enter deep sleep, making them more prone to hypertension. By 2004, snoring had been firmly linked to heart disease and stroke. In 2010, it was confirmed that sleep apnea was a major cause of hypertension, diabetes, acid reflux, chronic dizziness, headaches, memory loss, and even glaucoma and retinal disorders.

Further research revealed that pregnant women with sleep apnea might be at risk of preeclampsia due to heightened sympathetic nerve activity and oxidative stress. Children with hyperactivity, behavioral issues, learning disabilities, and social adaptation challenges may also be suffering from poor or insufficient sleep.

A 20-year-long study conducted by the University of Wisconsin in 2013 confirmed that severe sleep apnea significantly increases the risk of cancer and cancer-related death. Moreover, poor sleep quality contributes to various neurological conditions. Mild cases lead to memory loss, sensitivity to cold and heat, numbness in the limbs, and unexplained dizziness or headaches. Over time, individuals become more prone to dementia and severe depression.

Why does sleep apnea have such a wide-ranging impact, covering many chronic diseases?

The physiological cause lies in malfunctions in the throat and central nervous system. The nasal passages or upper airways are unable to remain clear during sleep due to high resistance or repeated collapse. Patients must increase their respiratory drive to maintain normal airflow, resulting in frequent awakenings. The condition could be described as “unable to breathe peacefully during sleep” or “unable to sleep peacefully while breathing.” Throughout the night, patients are in a constant battle between life and death, leading to extreme fatigue.

Why is sleep apnea so difficult to detect early?

First, it occurs when individuals are least aware of danger—during sleep. Patients do not hear their own snoring, and family members often mistake it for deep sleep. Over time, the snoring becomes normalized, and by the time serious issues arise, it's often too late.

Second, repeated awakenings lead to autonomic nervous system dysfunction, particularly overactivation of the sympathetic nervous system, causing hypertension and multiple organ damage.

Third, the lack of oxygen causes tissues and organs to age and deteriorate, and in some cases, cells may even become cancerous. Abnormal airway resistance triggers an excessive respiratory drive, increasing the oxygen demand on the heart. Over time, endocrine disruptions can lead to various diseases, including menstrual irregularities, autoimmune diseases, and even preterm birth or infertility. Chronic fatigue and the need for daytime naps also reduce physical activity and exacerbate insomnia.

Poor sleep leads to daytime fatigue, drowsiness, reduced activity, and disruption of the body’s circadian rhythm, which in turn worsens sleep apnea. Those who work night shifts, smoke, drink alcohol, exercise infrequently, or are overweight are at greater risk of worsening sleep apnea. These patients, who are constantly fatigued, become desensitized to their surroundings, rarely exercise, and have lower sensitivity to daily cycles. Leg swelling can further exacerbate the condition.

Treatment for Sleep Apnea: Repaying the Sleep Debt

The treatment strategy for sleep apnea involves first repaying part of the "sleep debt," then considering adjustments to waking times, reevaluating improper medication types and schedules, strengthening the body's day-night mechanisms, and long-term monitoring of lifestyle and routine adjustments to ensure they are functioning properly.

As of now, sleep apnea caused by upper airway collapse has no definitive cure.

Children and adolescents with enlarged tonsils or adenoids should undergo surgical treatment.

For adults, throat surgeries can reduce snoring, but only 30% of cases see significant improvement in sleep apnea symptoms. Non-surgical treatments, such as wearing a dental appliance during sleep to slightly move the jaw and tongue forward, can increase the space in the upper airway. Young patients with mild to moderate sleep apnea, not caused by nasal issues or obesity, may benefit from using a dental device to improve sleep.

For severe cases, especially those with palpitations, angina, or even heart failure, continuous positive airway pressure (CPAP) therapy is required. This treatment uses continuous positive pressure to counteract the negative pressure during inhalation, maintaining upper airway patency, reducing energy consumption during sleep, decreasing heart muscle load, and calming the sympathetic nervous system. However, it requires a period of adjustment.

Without good sleep, it’s difficult to maintain physical and mental health, let alone a high quality of life. Modern sleep medicine has established standardized treatment protocols for sleep apnea with good results. It is recommended to visit the Taiwan Society of Sleep Medicine for appropriate medical resources.