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I don't understand why my husband is so tired

My husband (he's 55) is exhausted all the time. He falls asleep in front of the TV and seems to get tired when he's driving also. He tries to stay awake by drinking lots of caffeine during the day, but it doesn't really help. I'm worried he might be in an accident as he has to drive for work.

I don't understand how this is possible as he sleeps all night; in fact his snoring is keeping me awake. He is a bit overweight and his diet isn't great. Should he see a doctor or is his lifestyle the problem?

Feeling tired all the time is something we see very often in general practice. It is a common problem in men and women of all ages. It is always worth going along to your doctor for a check-up if you have tiredness going on more than two weeks with no obvious cause.

He or she will normally perform a general examination and arrange for some basic blood tests. One of the most common causes of fatigue is dehydration. It's really important to ensure you are drinking at least 1.5 litres of fluid daily to counteract this. If your husband is drinking lots of caffeine this may make him more prone to dehydration as it works to remove fluid from the body. Other causes of tiredness include anaemia, low iron or vitamins, and underactive thyroid. In people over the age of 50 especially, doctors will also ask about chest pain, breathing problems or cough and any bowel problems as issues here can also cause tiredness.

You mention that your husband snores and you also mention he is overweight. This, combined with chronic tiredness, can suggest a condition called obstructive sleep apnoea (OSA). Most partners are aware of this as a gap in the snoring followed by maybe snorting or a vague gagging sound.

When we sleep, the muscles in our throat become more floppy. In most people this is not a problem, however, in those with OSA the muscles are so floppy that they cause the airway to narrow or collapse completely. This blocks off the air passages causing breathing to stop or episodes of very shallow breathing.

The air doesn't flow as freely into the lungs leading to a fall in oxygen levels in the blood. The brain responds by increasing the effort to breathe usually causing the gasping, grunting or waking that I mentioned. The person then settles back to sleep and the cycle starts again. If these episodes are occurring more than five times an hour then OSA is a likely cause.

Many people who suffer from OSA are unaware that they are not sleeping well. Those with severe OSA may fall asleep during daily activities such as driving or operating machinery; the risk of car crash is increased by 7pc to 12pc, so you are right to be concerned.

The recurrent episodes of low oxygen cause an increased release of stress hormones. This can put a strain on the heart leading to an increased risk of high blood pressure, stroke, and heart attack.

Risks that increase the chance of OSA include obesity, smoking, drinking alcohol in the evening, taking sedative medication, sleeping on your back and having enlarged tonsils or a receding jaw.

Your husband should see a doctor, and it is likely he will be referred for a sleep study.

Once a diagnosis is made, the most common treatment is CPAP (Continuous Positive Airway Pressure). This involves wearing a special mask at night that is connected to a machine emitting air. The results can be life-transforming.

Lifestyle modification also plays a very important role. It is essential to lose weight, avoid alcohol for four to six hours before bed, avoid sedatives, sleep on your side and stop smoking.

If your husband drives for work it is really important he gets this checked out. So, in answer to your question a combination of lifestyle change and medical help will hopefully improve his energy and also reduce his risk of further complications down the road.

Irish Independent