If you wake up exhausted no matter how long you slept. If you’ve been told it’s anxiety, depression, perimenopause, or just stress and treated for all of those and you still feel like something isn’t right. If you’ve quietly wondered whether there’s something nobody has actually looked for yet.
There might be.
Sleep disorders are among the most under-evaluated contributors to everything we cover in this series: mood, weight, blood pressure, hormonal imbalance, insulin resistance. Two conditions in particular are being missed at a scale that should concern everyone: obstructive sleep apnea and chronic insomnia. They’re different problems with different biology. They frequently coexist. And both are doing considerably more damage than most people realize, not just to sleep quality, but to the cardiovascular system, metabolism, hormones, and mental health.
I want to tell you about a patient who changed the way I think about this.
Her cardiologist referred her for antidepressants.
Her primary care doctor had already tried two. She’d seen a therapist for six months working on sleep hygiene and anxiety. She was eating well, exercising, not drinking. She was doing everything right and still waking up every morning feeling like she hadn’t slept, exhausted, foggy, irritable, with a headache that started before she got out of bed.
She came to see me for what she described as “treatment-resistant depression.”
This is the opening of a longer article.
The full piece — the mechanisms, the labs to ask for, and what to do about it — is free to read on our newsletter.
Sources & Research
Every claim in this article is grounded in peer-reviewed research. DOI links open the original studies.
Seda G, Han TS. Effect of obstructive sleep apnea on neurocognitive performance, fatigue, and sex differences. Sleep Medicine Clinics. 2020;15(1):77–85. doi:10.1016/j.jsmc.2019.11.005; see also: Theorell-Haglöw J, Lindberg E. Sex differences in obstructive sleep apnea. Current Sleep Medicine Reports. 2016;2(2):71–78. doi:10.1007/s40675-016-0041-9
American Academy of Sleep Medicine. Evaluation and management of obstructive sleep apnea in adults hospitalized for medical care: an AASM systematic review, meta-analysis, and GRADE assessment. Journal of Clinical Sleep Medicine. 2025. doi:10.5664/jcsm.11866
Pedersen SD, Manjoo P, Dash S, Jain A, Pearce N, Poddar M, et al. Pharmacotherapy for obesity management in adults: 2025 clinical practice guideline update. CMAJ. 2025;197(27):E797–E809. doi:10.1503/cmaj.250502
Cheah KL, Norhayati MN, Husniati Yaacob L, Abdul Razak AR. Effect of ashwagandha (Withania somnifera) extract on sleep: a systematic review and meta-analysis. PLOS ONE. 2021;16(9):e0257843. doi:10.1371/journal.pone.0257843
