Dr Ula: When sleep isn’t enough: What fatigue really means

The truth is fatigue isn’t a simple ‘sleep’ problem. It’s your body’s way of waving a red flag.

You’re in bed by 9pm. You’ve ditched the late-night scrolling. You even swapped the after-dinner espresso for magnesium.

But despite ticking all the ‘sleep hygiene’ boxes, you wake up feeling shattered. Not just physically — but across your mood, your memory, your drive.

At some point, you start asking: Is this really just life? Or is something deeper going on?

The truth is, for most people I see, fatigue isn’t a simple ‘sleep’ problem. It’s your body’s way of waving a red flag.

It’s not just about hours in bed

Yes, sleep matters. But if you’re still wiped out despite enough rest, the issue isn’t just about how many hours you’re clocking — it’s about how your body is actually repairing overnight, and what’s draining you during the day.

Fatigue is an energy problem. And real energy isn’t just about sleep — it’s created in your cells, fine-tuned by your hormones, fuelled by your gut, and shaped by your brain.

Most people think they just need to push harder or get more sleep. But true fatigue is usually a systems issue. It’s about imbalance, not effort or willpower.

The overlooked drivers of deep fatigue

1. Your blood sugar might be crashing

One of the most overlooked — and most common — energy disruptors is blood sugar instability.

You don’t need to have diabetes for this to matter. If your glucose is spiking and crashing throughout the day, your energy will do the same.

Common signs:

• Afternoon crashes

• Brain fog an hour after meals

• Cravings for sugar or caffeine

• Irritability or shakiness between meals

At Autonomy, we often use continuous glucose monitoring (CGM) to see how your body responds to meals, stress, and sleep. Often, subtle dysfunction here is the missing piece behind persistent fatigue.

2. Your stress response has lost its rhythm

Cortisol isn’t the villain. It’s essential — it gets you out of bed, sharpens your mind, and keeps your blood sugar stable.

But when stress is constant, your HPA axis (that brain–adrenal communication line) stops working the way it should.

Instead of rising in the morning and gradually tapering off, cortisol gets out of sync. You wake up foggy, crash mid-afternoon, then feel wired and restless at night.

This isn’t a personal failing. It’s a disrupted biological rhythm — and it’s something we can actually measure and track.

3. Your labs say “Normal”—But you don’t feel it

Basic blood work often misses functional deficiencies. You can have ‘normal’ iron and still lack enough ferritin to fuel your energy. You can have B12 in range and still be deficient at a cellular level.

Some of the most common (and overlooked) nutrient imbalances behind fatigue:

• Low ferritin (especially under 70 μg/L)

• Suboptimal B12 and folate

• Magnesium deficiency

• Vitamin D insufficiency

• Poor methylation

You don’t have to be fully deficient to feel it. You can just be below optimal — and that’s where most people get stuck.

4. Your body clock is out of sync

You might be sleeping 8 hours… but if your circadian rhythm is off, your sleep isn’t truly restorative.

Light exposure, screen time, irregular meals — all disrupt the timing of key hormones like cortisol, melatonin, and insulin.

Think of it like this: your body is doing the right things, but at the wrong time. The result? You wake up tired and stay that way.

5. Your Mitochondria are underperforming

These tiny energy factories live inside almost every cell in your body. They’re responsible for converting food and oxygen into energy (ATP). When they slow down—due to inflammation, stress, or nutrient deficiency—so do you.

You don’t need a mitochondrial disease to have poor mitochondrial function. You just need modern life: irregular meals, late nights, chronic stress, processed food, and not enough real recovery.

Fatigue isn’t in your head. It’s in your system.

You don’t need to settle for survival mode.You don’t need to blame your willpower, your age, or your calendar.

Fatigue isn’t a sign that you’re weak — it’s a sign that your body is wise enough to signal that something’s out of balance.

Once you know where that signal is coming from, you can do something about it.

Your next move

Book a Discovery Consultation at Autonomy. We’ll test your biomarkers and build a plan to restore your energy, mood, and performance from the inside out.

Because real energy doesn’t come from hacks.

It comes from healing — and that starts with answers.

Dr. Ula Co-Founder and Lead Physician, Autonomy

 

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