Morning Fatigue: The Impact of Sleep Oxygen Levels and Anemia

Waking up feeling fatigued?

Doctor, I visited an otolaryngologist and the result showed that my sleep oxygen level is 85.
Later, I was diagnosed with a deviated septum, which could lead to frequent nasal congestion.
Could this be a reason for waking up feeling very tired? In January, I had a blood test that revealed thalassemia with a hemoglobin level of 11.9, hematocrit of 38, mean corpuscular volume of 65.1, and mean corpuscular hemoglobin of 20.4.
Could anemia contribute to low blood oxygen levels or fatigue caused by nasal congestion? I have a follow-up appointment on Thursday; what additional tests should I consider? Thank you.

ken, 30~39 year old female. Ask Date: 2010/08/30

Dr. Chen Bozhang reply Family Medicine

Hello,
In response to your inquiry, you mentioned feeling very fatigued upon waking, and tests revealed that your blood oxygen saturation during sleep was 85%.
This indicates a moderate level of hypoxia during sleep, primarily caused by periodic upper airway obstruction.
If you consistently feel fatigued every morning and experience difficulty concentrating during the day, I recommend seeking assistance from a sleep specialist as soon as possible.
Prolonged nighttime hypoxia can increase the risk of hypertension and cardiovascular diseases, beyond just the fatigue and symptoms of sleep apnea that you may be experiencing.
Regarding thalassemia, it is a hereditary genetic disorder.
Most adults who grow up without complications exhibit mild, asymptomatic Mediterranean anemia.
For instance, your hemoglobin level of 11.9 g/dL is not significantly different from the normal range for adult males, which is 13-17 g/dL.
Therefore, the symptoms related to anemia may not be pronounced.
However, I advise you to consult your family physician to confirm whether there are any accompanying causes of anemia, such as iron deficiency anemia or blood loss, that can be corrected.
Anemia and hypoxia are two different conditions, but their symptoms can potentially exacerbate each other.
In your case, the symptoms and consequences of nighttime hypoxia should be prioritized.
I suggest discussing this matter in detail with an otolaryngologist and undergoing comprehensive polysomnography to identify the underlying cause for targeted treatment.
Sincerely,
Dr.
Chen Po-Chang
Department of Family Medicine
Keelung Hospital, Ministry of Health and Welfare

Reply Date: 2010/08/30

More Info

Morning fatigue can be a complex issue influenced by various factors, including sleep quality, oxygen levels during sleep, and underlying health conditions such as anemia. Based on your situation, there are several key points to consider regarding your sleep quality and overall health.

Firstly, your reported sleep oxygen saturation level of 85% is concerning. Normal oxygen saturation levels during sleep should typically be above 90%, and levels below this can indicate hypoxemia, which can lead to various health issues. In your case, the low oxygen levels during sleep may be attributed to nasal obstruction due to a deviated septum, which can cause difficulty in breathing while sleeping. This can lead to obstructive sleep apnea (OSA), a condition characterized by repeated interruptions in breathing during sleep, resulting in fragmented sleep and daytime fatigue.

The relationship between your anemia and morning fatigue is also significant. You mentioned having thalassemia (海洋性貧血), which can lead to lower hemoglobin levels. Your hemoglobin level of 11.9 g/dL is below the normal range for adult males (typically 13-17 g/dL). Anemia can cause fatigue because it reduces the oxygen-carrying capacity of your blood, leading to decreased oxygen delivery to your tissues and organs. When combined with low oxygen saturation during sleep, the effects can be compounded, resulting in increased fatigue upon waking.

In summary, both the low oxygen levels during sleep and the anemia can contribute to your feelings of fatigue. The nasal obstruction from the deviated septum may exacerbate the situation by further reducing oxygen intake during sleep. Therefore, it is plausible that these factors are interacting, leading to a more pronounced feeling of tiredness in the morning.

As for your upcoming appointment, it would be beneficial to discuss the following with your healthcare provider:
1. Sleep Study: Given your low oxygen saturation and potential for sleep apnea, a polysomnography (sleep study) may be warranted. This can help assess the severity of any sleep-disordered breathing and guide treatment options.

2. Nasal Examination: A thorough evaluation of your nasal passages by an ENT specialist can determine the extent of the deviated septum and whether surgical intervention (such as septoplasty) might be necessary to improve airflow and reduce nasal obstruction.

3. Anemia Evaluation: It would be prudent to further investigate your anemia. This includes checking for iron deficiency or other causes of anemia that may be treatable. A complete blood count (CBC) and iron studies can provide more insight into your condition.

4. Lifestyle Modifications: Discuss potential lifestyle changes that could improve your sleep quality, such as sleep hygiene practices, weight management (if applicable), and avoiding substances that may exacerbate sleep issues (like caffeine or alcohol).

5. Follow-up on Symptoms: Keep track of your symptoms, including any changes in fatigue levels, sleep quality, and any new symptoms that may arise. This information can be valuable for your healthcare provider in determining the best course of action.

In conclusion, addressing both your sleep quality and anemia is crucial in managing your morning fatigue. By taking a comprehensive approach that includes medical evaluation and potential interventions, you can work towards improving your overall health and well-being.

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