Fatigue Beyond Sleep: Why You’re Still Tired (Even When You Sleep)
July 14, 2026 | Episode 66
Producer’s Note: The following is an AI-generated transcript of The Wellness Conversation, an OhioHealth Podcast
SPEAKERS: Marcus Thorpe, Katie Lowe, Guest: Dr. Carolina Ortiz Villabona
Marcus Thorpe 0:00
All right, welcome to the Wellness Conversation, an OhioHealth podcast. Have you ever felt like you got a great night's sleep, a full eight hours and everything seems to be in line, and yet you wake up, you're still dragging, and you can't figure out why.
Katie Lowe 0:27
The worst feeling. It's the worst.
Marcus Thorpe 0:29
So you start to think to yourself, maybe I didn't sleep as well as I did. That fatigue starts to build in, but maybe there's something else going on. And here's the thing: you're definitely not alone.
Katie Lowe 0:40
Yeah, and today we're really digging into that a little bit more. We're looking into what causes fatigue when sleep doesn't seem to be the answer, and again, this is one certainly that I can relate to at times. I'm Katie Low, joined by co-host Marcus Thorpe, and we're excited to welcome Dr. Caro Ortiz Villabona to the conversation. Thank you so much for being here, Dr. Ortiz Villabona is a resident physician training at Riverside Methodist Hospital. I know you have a busy schedule, so again, we thank you for your time. And I'm told that you just finished your rotation on sleep, so this is a topic you're pretty familiar with.
Dr. Ortiz Villabona 1:17
Yeah, absolutely. So I'm a psychiatry resident, so we do work quite a bit with sleep, but I did actually just have quite a few weeks of more specific experience. So I'm excited to be talking today and dig in a little bit more about sleep and fatigue and all the related symptoms. Yeah,
Marcus Thorpe 1:32
I think it is. It's one of those things that is hard to figure out from person to person, right? There's a lot of different factors that could lead to this, but let's just talk about kind of fatigue, being tired. Sometimes those seem like they equate to each other. How do you view something like that? How do you look at just the big picture view of somebody who feels like they're just dragging on an everyday basis?
Dr. Ortiz Villabona 1:58
Yeah, I think that is where we would need to start the conversation to set the stage. So, tiredness is very normal. That is, you have a bad night of sleep, you're tired the next day. That's our body's way of reminding us we need to rest. Fatigue is a lot more bone deep exhaustion, that weariness, that just lack of energy, and fatigue itself is a symptom. It's not a diagnosis, but it's a symptom of an underlying cause, and so that's where we really want to explore a little bit more what we can do for it.
Marcus Thorpe 2:27
Yeah, I think that we just-I mean, we talked about it there, but that is the worst feeling, right? You go to bed on time, you feel like, okay, I looked at my sleep monitor or whatever. I know what I did. Why am I feeling like this still, right?
Dr. Ortiz Villabona 1 2:41
and for a lot of people, it's like, well, it's got to be sleep, right? You can't think of any other reason why you would be dragging. You have that fatigue. So, can we just dive a little bit deeper into that difference of sleepiness versus fatigue? What should people be looking out for? So, the somewhat obvious one is with tiredness, you sleep a few days and it gets better. Fatigue is really when it's like going on weeks, even months, where no matter what you do, like you said, you get to those eight hours. Your sleep app is giving all the thumbs up, and yet you're still tired. That's more fatigue. Other things I would look for are more physical symptoms. So if you're just tired, that's one thing. But if you're fatigued and then you're also experiencing like no appetite, weight loss, you know, muscle weakness, maybe things that used to be easy like going up a flight of stairs or suddenly getting a lot harder for you, those would be kind of warning signals for me that there might be something else going on. And then the other thing I also like to consider is the impact of the fatigue. So is this something where you know you had a long night out and then you had to sleep in on a Saturday morning? That's okay. But if the fatigue is so much that you're sleeping through alarm clocks, you're missing days of work, you're you know not wanting to hang out with friends or go do social things, that's other things I would really want to keep at the forefront of my mind to be kind of, again, that warning signal that there might be something else going on.
Marcus Thorpe 4:05
are there studies out there? Are we thinking that there's some hidden elements that really could be in play here with our bodies that has really little to do with sleep? There's other hidden factors that could be just lingering there that we're really struggling with.
Dr. Ortiz Villabona 4:21
Oh, absolutely. So, Germany actually had a really good study they did in 2021. They compiled all of the primary care visits where they reported fatigue as a primary concern. They broke them all down and they looked at what was the actual cause that they found for the fatigue. The main one was sleep breathing disorder. So that's our sleep apnea. So if you're those people who snore loudly at night, who their partner is like, oh my gosh, I had to shake you awake because you stopped breathing. That's something you really do want to get checked out because CPAP machines. We have a lot of treatments that are very effective in just improving that sleep quality.
Marcus Thorpe 4:58
Guilty for sure. I. I'm on a CPAP because of that. I was one of those that my wife would be like, "Oh my gosh, will you please stop? So yes, that is an easy one. I think if you take it seriously, boom. And I've I sleep better than I ever have, and I feel better than I have after I get a good night's sleep.
Dr. Ortiz Villabona 5:15
And Marcus, there's no shame in that. Average time to diagnosis is 10 years for sleep apnea.
Marcus Thorpe 5:20
Oh, I was ahead of the curve. Wow!
Dr. Ortiz Villabona 5:22
you know, snoring is just a thing you do when you sleep, but it really can be indicative of something else going on. Yep,
Katie Lowe 5:27
absolutely. I've heard that as well. For so many other things too, being a risk factor for even something like a heart attack or things like that. It sounds like getting that workup done to figure out the underlying symptom or underlying cause, I should say, of fatigue is so important. Let's talk about hormones a little bit. How do those influence how energetic or fatigued you might feel?
Dr. Ortiz Villabona 5:52
Absolutely. So, I love hormones. I could talk all day about hormones, but I would say when it specifically comes to fatigue, I would think of the sections of thyroid hormones, sex hormones, and stress hormones. So when it comes to thyroid hormones, those are the most straightforward ones. Abnormalities in your thyroid can cause really significant fatigue. So whenever I have a patient come to me with fatigue, that's one of the first things I do is I order a thyroid panel, and we make sure that there's not something we can just replace a thyroid hormone and make them feel better. As far as sex hormones, now sex hormones are very interesting, particularly in women. So throughout our whole lives, women we get a whole slew of different hormones: estrogen, progesterone. Specifically, when we're menstruating, though, we have our regular cycles, and in our luteal phase, which starts at the beginning of that third week of your cycle, our body basal temperature increases. We have spikes in estrogen, spikes in progesterone. We have an increased use of energy, and that causes a sensation of fatigue, and that is normal. And there are ways to plan around that and work with that. But a lot of times, if we think what caused the fatigue or where did it start? It can be during that third week, and that's very cyclical.
Katie Lowe 7:05
Lucky for us, being a woman.
Dr. Ortiz Villabona 7:08
when you pass menopause, the number one symptom of menopause is fatigue, and so that is also something that I always tell my patients to just be aware of, give themselves some grace, take a heads up, and sometimes hormone replacement therapy can be helpful for that. But there's always a lot of strategies that can be used there.
Marcus Thorpe 7:28
How about like vitamin deficiencies, maybe issues with blood, you know, anemia, those kind of things? Is that something that you hear about or see in some of the research that you've looked into?
Dr. Ortiz Villabona 7:39
Yeah. So going back to that study I was mentioning earlier, the top one we said was the sleep disorders. The second two are actually depression and what they called excessive psychosocial stress, so stress or anxiety. So those are the top three, but you're absolutely right. The next ones that come in are anemia, a low red blood cell count, things like vitamin D deficiency, abnormalities in B12, thyroid hormone deficiencies. So there is a lot of causes. I will say the other thing is that only 0.6% of that was related to any form of cancer, and so that kind of oh no, that immediate thought of like is there something else going on? Don't listen to Google. Don't listen to WebMD. Fatigue can cause can be caused from a lot of things, but it usually is more benign things that can be treated relatively easily.
Marcus Thorpe 8:26
Yeah, we've been doing this podcast for a long time now, and it's funny. No matter what the topic is, whether it's you know mental load or issues I'm dealing with with sleep or something else, stress seems to be like the number one factor that is pushing a lot of the health issues that we're all dealing with. Could we dive even deeper into stress and kind of what we're all feeling and how that impacts fatigue or wellness and and kind of the space that you really are passionate about?
Dr. Ortiz Villabona 8:58
Yeah. So cortisol is the main stress hormone, and it is a fascinating little hormone. Spoiler: either too little cortisol or too high of cortisol can cause fatigue. So, too little cortisol is not seen that often. It's more like an adrenal gland not producing enough hormones. But unfortunately, in our current day and age, too high of cortisol is becoming more and more common. So, to take a step back, cortisol it fluctuates normally throughout the day. Within about 30 to 45 minutes of awakening, we have this cortisol awakening response, which is this big spike of cortisol. It tells us, all right, let's get our day going, let's get going, and then it slowly starts to taper down throughout the day. It hits a low when we're going to sleep, and it'll slowly start to increase in the early morning to tell us to wake up. That is very normal. On days when we have something very specific going on, so say a job interview. Before that job interview, I'm sure we've all had it. You know those the nervous sweats, that full feeling of cortisol overload. That's normal. However, the morning of, they've actually found studies that show your cortisol awakening response, that spike, is way higher. So even if you're not in that stressful situation, just that anticipation of stress can cause increased hormone levels.
Katie Lowe 10:16
Yeah, that that makes sense. That tracks. I can think of a bunch of times where you know I'm really nervous for something, and I feel that adrenaline, and so I can imagine those those high levels for too long are just not good.
Marcus Thorpe 10:30
You can’t live in that space, right? That's the hard part.
Dr. Ortiz Villabona 10:33
Absolutely. So you know a spike here too is normal, but if you're someone who has high resting anxiety or high stressors in a daily setting, then your baseline adjusts, and now suddenly your normal level of cortisol is a lot higher than maybe it needs to be, and then that's going to have that impact where it's really inhibiting your body's ability to really slow down and sleep and get good quality sleep.
Marcus Thorpe 10:56
Interesting.
Katie Lowe 10:56
Yeah. So we know how cortisol levels can affect our energy, but let's talk about how our own routines can affect those cortisol levels. I'm thinking a lot of parents, you know, specifically mothers. They're balancing a lot. A lot of them have full-time jobs, but then they also have the family at home. They're making all these important decisions when it comes to the kids. Like they're just balancing a lot. So how does all of that affect the cortisol levels?
Dr. Ortiz Villabona 11:24
Yes. So, not surprisingly, that increases your cortisol levels. However, there are things we can do ourselves to bring those down as well. So, surprise to no one, the biggest and easy quote unquote easiest way to affect your cortisol level is through exercise. So, having some consistent thing that you're doing, I wish I could say this is the best exercise. This is what's going to help, but really it's just whatever you're going to be able to do realistically and stick to. For me, it's you know setting that treadmill to a really slow speed and a high incline, and I can just read my books and forget about exercising. But whatever it is that you can stick to and you find works for you, that is able to reduce your cortisol dramatically, or at least make a better cortisol regulation throughout the day.
Marcus Thorpe 12:06
Yeah, I find that interesting because there are people who are-I don't know. You, you're a runner, right? I'm not. Like it, I detest even the thought of running. So I can go out and run for two weeks, just like Katie can. But in two weeks I'm gonna be like, you know what, this stinks. I am not gonna do this anymore, and so it didn't really help me because those two weeks didn't do anything to help a habit. It's finding something that I like that I'm going to do. So if I go play pickleball, I'm still doing the running, but I'm not just running in a straight line. So if you want to get that benefit, you have to find something that works for you. That's the best thing you said out of that for me, is because I don't have to go be a marathoner because I hate it. I don't want to do it. I just got to find what works for me.
Dr. Ortiz Villabona 12:47
Absolutely, and actually, if you try to do, you know, if you put yourself this goal, if I'm going to run every day for two weeks, and at the end of the two weeks you realize you didn't do it, that can actually have more negative impact on your own mood, self-esteem, feelings of guiltiness, and that's that ends up putting you in a worse place than if you had started out looking for that pickleball or whatever it is that you enjoy. I
Marcus Thorpe 13:07
love your mindset of this and the way that you're presenting it is so cool because it's almost like I think of it like kind of putting a puzzle together and there's all these different pieces and one isn't the answer. It's putting them all together and you mentioned hormones. So if you think hormones are a piece of your puzzle and you're starting to put together, how do you suggest going about figuring out what those hormones are doing to you and how it maybe impacts the rest of your life?
Dr. Ortiz Villabona 13:34
So I would say a lot of our hormone levels we can actually just study. We can get labs on them. The other thing is that we can also somewhat assume at this point that most of us have high cortisol levels, and so you know sometimes we get so stuck on these workups, like I need this number to tell me that something's wrong. However, in reality, there are things we can do that have a low risk profile. So I say mindfulness therapy is one of the best studied therapy modalities to help with reducing that hormone, that stress level. So, one easy mindfulness kind of strategy I talk with my patients. It's called progressive muscle relaxation. So we start in our faces, we squeeze our faces tight. You hold as much tension in your face as you can, and then you release it. Then you go down to your shoulders, hold it tight. Few seconds release, and that process from head to toe of kind of tuning in with each body part, releasing tension. A lot of times, don't even realize how much tension we're holding until we're intentionally checking in with ourselves. Doing an exercise like mindful mindfulness-like exercises, 10 to 20 minutes a day, have actually shown to dramatically reduce cortisol levels.
Katie Lowe 14:42
I think that's something a lot of people hear, like a mindfulness exercise, and they think like really like woo woo, whatever. Yeah, but they can be so helpful. I remember I used to get so worked up before track meets and things like that, and my mom would have me do literally exactly that. And the the night before, I would feel so much better. And now, you know, now that I've gotten into my 30 s, I've done some meditation apps, which is same thing. I feel like there's a connotation with meditation, like that it's just you know kind of out there. It's not for everyone, but you can start out with like these five or 10 minute exercises, and they really can be so easy.
Dr. Ortiz Villabona 15:23
Absolutely, and at the end of the day, that's going to be a lot cheaper and might be a lot more efficient than trying to kind of search down this pathway for you know hormone imbalance. Again,
Marcus Thorpe 15:34
finding what works for you, right? If the facial scrunching and the rest of your body gets that out, boom, you found your thing. I think that's really great.
Katie Lowe 15:41
Yeah. What about? I know there there are so many underlying causes of fatigue. Let's talk about inflammation. How is that part of the puzzle?
Dr. Ortiz Villabona 15:49
So inflammation. I like to think of it as energy. So when it comes to fatigue specifically, inflammation impacts energy. So inflammation is normal. You know we need it when, say, we cut ourselves. That inflammatory response is normal and necessary to help heal. But if we're having sustained inflammation due to certain things like stress, like anxiety, like untreated depression, those are all aspects we know cause or lead to inflammation. That inflammation starts to kind of sabotage us in two ways. First, it reduces the effectiveness of our energy production, so it actually shifts the type of energy. If you remember back to middle school, that ATP, we're making less of that energy, and it also uses up more energy, and so it's really leading us to this kind of double-edged sword where our energy is just going to tank, and some inflammation. Finding ways to fight back against that inflammation can be really helpful.
Marcus Thorpe 16:46
I'm guessing food must come into play here, right? When it comes to inflammation, and again, if you've listened to this podcast with any regularity, you know that I don't always make the best choices with my food. So I'm guessing we're going to talk a lot about Mediterranean diet. Absolutely. Yep.
Dr. Ortiz Villabona
Absolutely. So that plant-based, you know, fish trying to reduce processed foods. That we have so many studies. They've actually said like you don't need to keep on studying it. We know Mediterranean diet is the best. And what I tell patients is they've actually found that that diet program or your kind of whole week-long diet is more valuable than any specific like superfood or any specific thing that you focus. So I always tell my patients, if you want to do a green juice smoothie cleanse on Saturday, great. But are you also eating vegetables the rest of the week? Because that is what's going to be more impactful overall in inflammation levels versus trying to do these kind of one-off things that make you feel good about yourself. But at the end of the day, it's really what you build into your routine that's going to be more helpful,
Katie Lowe 17:57
Yeah, it's like what we were just talking about with exercise. Like it's great if you want to push yourself way out of your comfort zone for a week, but it's got to be something that you can sustain. So instead of killing yourself with some just pure green juice diet for a week, you know you you should really start with something that you can maintain, like just adding in those those veggies for a long time. It sounds like there's so many different things coming into play when it comes to how this all affects your fatigue. So for someone who's just really feeling like okay, this is more than just sleep. Like there's something else going on here. What is that first step that they can take to try and tackle this problem?
Dr. Ortiz Villabona 18:42
So I would say the first step is before you go running for more lab works is to take a step back and think, look into yourself. So ask yourself, where did this fatigue start? And a lot of times people get all this lab work, it's all negative. Then they come to psychiatry, and then they're like, I don't know what's going on. I'm like, okay, so let's talk backwards. What happened, and then we found, you know, this actually this grief started around the time where you know I a close relative passed away, or I had a breakup, and then it's like okay, so maybe this is more related to grief or loss, and that's normal. Like let's find ways to treat the grief, or maybe it's related to you know having lost a job and financial insecurities, and now it's okay. That's anxiety and stress. Where do we need to target that? Or, like we said earlier, it's that cyclical week three of your cycle. Do we need to schedule less meetings during that time, less social events? How can we target that? Once we've done that, then I would say that the next thing is to reach out to a provider to see if there's other support you can get to help narrow down some of those things we've talked about when it comes to the more common causes of fatigue-that's sleep apnea, depression, and excessive stressors.
Marcus Thorpe 19:51
It's been a really fun episode because I do think that it-it's almost like you said you're a backpacker before we started. And it's kind of like the path; it's following your path that you need to be on as you're kind of moving and navigating through your daily life, and finding out what's the best path for you can be tough. But once you find it, and you know what's working for you, it really, it really works. And so I want to leave folks with a thought of kind of encouragement for people that might be tuning in for their daily lives as we kind of close this episode down. How do you look at it? What should that be as they start to kind of think to themselves, "What's my path? What's my perfect path here?
Dr. Ortiz Villabona 20:34
That's a good one. I would say targeting your path with an open mindset, so everyone is going to tell you there's this way to do this, there's that way to do things, but really, just finding what works the best. Like we've been saying this whole time, I think talking about inflammation, stress, anxiety, depression. One of the things that I do like to leave my patients with a little practice. I call it three good things. It's super self-explanatory. Basically, you end your day by saying three things that went well that day. So whether you write it down, whether you just say it out loud, the practice is trying to get yourself to first review your day and do that mindfulness approach of stepping back. Also, focusing not just on those anxious thoughts. Everything I said wrong. Everything that could have gone better. That meeting, that. But actually, taking a moment to spend as much energy as we do on the negative, try to spend a little bit of that on the positive. So what did go well today? And then also, it sets us up for a better quality of sleep. We're not going to sleep with all those anxious running around thoughts, but it's going to sleep with that more positive mindset. I'll also say for parents out there, this is a great exercise to do with your kids. So before bed, you know, once they're old enough to kind of engage, say, "Hey, what what went well today? And I will tell you, you'll hear the most hilarious answers when you ask them this. But it's a good way for them to start at a young age, really flexing that gratitude muscle.
Katie Lowe 21:58
I love that so much. Excuse me. I think I bet it's going to be a lot easier for me to incorporate this because you know I have two. Once once she turns three, I think that we could incorporate that. I think it's a lot harder for like you know young teens. They might just be like, okay, Dad. I have two teenage boys, and I I think I'm going to do this because honestly, they say so few words sometimes that I might be getting them to open up a little bit and not be so well. I played video games and I played hockey. You know, like getting something out of them would be really fun. And it really is, though. Like all jokes aside, it's it's you're giving them so much more, and it's it can be such a simple thing, but it's something that right, like you were saying, it's you're ending the day with these positive thoughts that can help them sleep better. Like there's so much good to that, and it could be a routine that sticks with them for years and years.
Marcus Thorpe 22:53
Selfishly, for myself, like it, yeah, it gives me some juice, some energy when I hear what they're up to. Yeah, that maybe it gets us all off our phones, and we start thinking about things that are really important in our lives. So I think that's great. I think it's really smart.
Katie Lowe 23:06
Yeah, Dr. Ortiz Villabona, thank you so much for being here. I think you have so much expertise, and I think it's going to give our listeners and our viewers a lot of hope who may be feeling that fatigue and not knowing where to turn, and just really giving them kind of a path forward to start tackling this and taking their health into their own hands.
Dr. Ortiz Villabona 23:27
Absolutely, it has been a pleasure, and I love to be back. I think I'd love to have you. Oh, for sure. I love talking to my patients. My last little thing here is whatever your stressor you're facing right now. I have patients who come and have these huge long appointments with me. Talk about these stressors. Follow up in three months. I ask them about the stressor. They're like, "Huh? So you wouldn't you wouldn't realize how much we feel stuck in this moment, whatever it is-excessive fatigue, you know, feeling down, feeling anxious, whatever it is in that moment. A lot of the times, give it a couple of months, and you realize that things are not maybe quite as stressful or as impactful as you're giving them credit in that time.
Marcus Thorpe 24:06
Yeah, prisoner of the moment, and then you can be on to something else. It just takes one good thing to maybe turn you back into where you want to be, and and make sure that those sleep hours are really coming through the way that you want them to. So this has been great. We're going to have you back on because this was an awesome episode. Thank you so much for joining us.
Dr. Ortiz Villabona 24:21
Absolutely, thank you.
Marcus Thorpe 24:22
And of course, for all of our listeners and viewers, we thank you for joining us for the Wellness Conversation and Ohio Health Podcast. If you'd like to learn more, we'll have an episode transcript on OhioHealth.com, and of course, you can always find any kind of things when it comes to your own wellness right there at OhioHealth.com as well. For Katie Low, I'm Marcus Thorpe. Thanks for joining us. We'll see you next time.