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The Terrible Two: Fatigue & Insomnia

The Terrible Two: Fatigue & Insomnia

In the parenting world, the “terrible twos” refers to the period of time that toddlers start seeking their independence and get into mischief. In this article, I refer to a very different kind of terrible two; the fatigue and insomnia that so many individuals face as a part of their chronic migraine experience.

A vicious cycle

My rheumatologist seemed to be the first doctor that actually cared about my insomnia and was willing to try her hand at treating it. All of the neurologist and headache specialists gave me the same line, insomnia was not something they treated. On the other hand, my rheumatologist was willing to acknowledge that there was a cycle between no sleep and high pain levels. The general lack of sleep or quality of sleep can affect us both mentally and physically. Not only does it drain us, leaving us very fatigued, it increases our pain and our irritability. In order to get the best handle on pain levels, it is important to get enough sleep.

Insomnia during the night

There are few things more frustrating than feeling completely exhausted all day long, and yet be unable to fall asleep. When you are so tired your eyes actually hurt, yet your brain still cannot turn itself off so that you are able to rest. Besides being frustrating, irregular sleep and extreme lack of sleep can both be a migraine trigger. When we experience high pain levels, the pain can also interfere with our ability to fall or stay asleep. This adds to our issues requiring a high quality of sleep in order to feel well rested and restored. Some individuals with chronic pain find it harder to both fall asleep and to stay asleep at night. Due to being in pain, they do not get to deep sleep cycles and can easily be awoken from their sleep. I personally have both of these issues. Without the assistance of medication, I have a hard time falling asleep and the slightest thing causes me to wake up.

Fatigue during the day

Our bodies can be faced with an increased level of fatigue from multiple angles. These angles mainly include the lack of sleep we get due to insomnia along with exhaustion from high pain levels. When your body is fighting a chronic condition, you need more rest than if you were perfectly healthy. So when we find ourselves unable to even acquire the normal amount of sleep, we become exhausted even faster than the average individual. I have learned to not attempt to keep up with the healthy individuals in my life. By this I simply mean, I have learned my own limitations and know when I need to let them continue on without me. It is by no means always easy to do, but it is most definitely necessary to properly care for my body. We can be faced with both physical and mental fatigue. The physical fatigue is presented in ways such as muscle weakness. For example, when you are trying to open a jar and cannot succeed or when you struggle to carry something you should be able to carry with ease. On the other hand, mental fatigue is more a matter of not being able to concentrate and feeling sleepy. Our pain levels also add to the general feeling of fatigue because it both drains our bodies and can interfere with our ability to concentrate.

Burning both ends of the candle

I have definitely learned that I have to listen to my body more. Those of us who have a war going on inside our bodies, cannot burn the candle at both ends. It always catches up with us and we will regret it when it does happen. As hard as it can be to do sometimes, we have to learn to tell others and even ourselves no occasionally, and allow our bodies the time needed to properly rest. Personally, this is one of the hardest things for me to this day. My husband has to remind me sometimes that the chores will still be there later and I need to stop and rest or let him do it instead.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • LuvsPugs
    6 months ago

    This is a great article! I sent it to my psychiatrist because although he is very understanding, this article provides some back-up to my strange (to me) combination of symptoms.

  • rossbow13
    3 years ago

    I agree with all of these comments. Personally I find before getting a migraine, during and in recovery mode I seem to go into bursts of physical activity which leave me even more exhausted, added to the side effects of Imigran and Paramax to control attacks. Personally I think this frenetic activity is something to do with the changes in the brain during attacks. I originally thought because I knew I would be incapacitated during a full blown attack then I was trying to do as much as possible before I was laid low, to make up for prostration. Now, after fifty years of weekly attacks, I think differently. I should tune in to what my body needs and be more attentive to the need of taking time off. I find melatonin helps enormously, both to send me to sleep and the quality of such. I usually take a quarter or a half of a 3 mg pill an hour before going to bed. If I take more I feel sleepy for the first part of the next day. The side effects of melatonin, however, are not so severe as taking sleeping pills as it is nature’s natural way to promote sleep.

  • Pete
    3 years ago

    I burned it at both ends until I crashed and burned. Ultimately ended up with diabetes (I am not heavy); mess always have drawbacks. The only way I get to sleep most nights is through self-hypnosis. Find the right practitioner- it is critical that you are a good fit.
    Unfortunately, I still wake up from pain every 90-150 minutes. Stopped all pain mess 15 months ago. Hope this helps someone.

  • mammapeaches (Susan McManus)
    3 years ago

    My insomnia increased due to what I thought was peri-menopause. My PA suggested a sleep study to see what was causing the insomnia which was triggering more migraines. It ends up that I have sleep apnea! Insomnia is a side effect of sleep apnea. It’s sort of your body’s way of saying “don’t fall asleep because when you do, you don’t breath!” Sleep apnea ended up being a huge piece of my migraine puzzle. I take Ambien every night now and switched from a CPAP machine to a sleep apnea mouth guard. Maybe when I’m through menopause, I can stop the Ambien

  • aks868
    3 years ago

    I couldn’t have said it better. I am constantly battling between fatigue and insomnia. The insomnia got so much worse after hospitalizations for migraines because of the large doses of sedatives they gave me, which are so hard to wean down from.

    Does anyone know what the recommended use of Medical Marijuana is, because I just got my license and I don’t want to fall back into rebound headaches? But, like, Candy, it really does help with sleep.

  • Candy Meacham
    3 years ago

    I have had chronic migraine for years, and my sleep problems have increased with age, which is also a factor. Cannabis has been a huge help for me. I use an indica strain with a vaporizer pen. Just 2 puffs at bedtime. I live in a state that has legalized marijuana so buying it is not a problem.

  • beckyalison
    3 years ago

    I was just talking with my husband about this very same problem that I have. I could have written this? I’m taking Ativan (.5-1mg), but I know that’s a very difficult med to come off of, which worries me. I’ve tried one other sleep med and it was horrible – and also was not supposed to be used long term, only for a couple of weeks. What medicine has helped you?

  • Amanda Workman moderator author
    3 years ago

    I am glad you can relate and I promise, you’re definitely not alone in this at all. I have fibro as well as CM, I personally use a muscle relaxer and Trazadone. Trazadone is in some ways classified similar to Ativan but, according to my doctors, also helps with depression. There are many different types of medications for insomnia and as with most medications, different people have different results. Unfortunately I believe most sleep medications have the risk of possibly becoming dependent on them. If your current medication is not helping, speak to your doctor about other possible alternatives to try out. Some people have had success with melatonin, hot baths prior to bed, mediation, and ‘sleep hygiene’ techniques. I hope you can find some help with your insomnia.

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