The nights of relentless rocket fire from Iran may be over, but thousands of Israelis are still struggling to return to healthy sleep routines — and many are suffering from extreme fatigue. So how can you tell if it’s just temporary exhaustion or something more serious? How much sleep do we really need at different ages? When should you consider medical testing? And what do sleep hygiene experts recommend? 

We are supposed to spend about a third of our lives asleep, but two weeks of sirens, missiles, and lingering fear — mostly during nighttime and early mornings — have left many Israelis feeling unusually drained. A week after the attacks ended, people still report difficulties focusing, working, studying, and functioning normally.

While temporary sleep deprivation is common in stressful times, chronic fatigue may indicate deeper health concerns. Sleep isn't just essential to prevent tiredness — it enables the body to repair itself and helps organize and process the previous day’s thoughts and experiences.

How much sleep do we need?

Under normal circumstances, most adults need seven to nine hours of sleep at night. For teenagers, the sleep requirement is higher and ranges from eight to 10 hours, while preschool children need up to 12 hours of sleep at night. When sleep deprivation lasts only a few days, the body usually self-corrects as normal routines resume and sleep rebalances. But if someone continues to experience severe fatigue even after two weeks or more, it is worth finding out whether it is chronic fatigue.

Signs of chronic fatigue

Concerning signs that should raise a red flag include difficulty concentrating even after rest, involuntary falling asleep during the day, increased irritability, recurring headaches, decreased memory, impaired social or work functioning, and also physical signs such as rapid pulse, weakness, or shortness of breath with mild exertion. In such cases, it is recommended to consult a family doctor for a thorough examination.
People take shelter in an underground parking lot in Tel Aviv, during ongoing missile attacks from Iran (credit: Chaim Goldberg/Flash90)
People take shelter in an underground parking lot in Tel Aviv, during ongoing missile attacks from Iran (credit: Chaim Goldberg/Flash90)
A possible underlying cause of chronic fatigue is depression. Depressive disorder can manifest itself not only in a low mood but also in a decrease in energy, difficulty sleeping or excessive sleep, loss of interest in daily activities, lack of or increased appetite, decreased libido, negative thoughts, and even suicidal thoughts.

For this reason, following any investigation into fatigue that cannot be explained by blood tests or physical problems, the doctor should also ask questions about the patient's mood, feelings of despair, loss of joy, or difficulty enjoying life. Treatment for depression usually involves speaking with a professional such as a psychiatrist or psychologist, medication if necessary, and cognitive behavioral therapy, which has been proven to be particularly effective in reducing depressive symptoms and improving sleep quality.

The diagnostic process

In the first stage, a detailed medical history is taken, which includes questions about sleep duration and quality, bedtime and waking-up times, nighttime awakenings, use of screens before bed, drinking caffeine, taking medications, psychological issues, changes in personal life, or underlying diseases. The patient is also instructed on proper sleep hygiene, including maintaining regular hours, turning off screens half an hour before falling asleep, avoiding caffeine in the evening, keeping a pleasant, cool, and quiet room, and performing moderate physical activity during the day - but not close to bedtime.

In cases where no clear cause is identified by taking the initial case history, patients are referred for blood tests that can shed light on underlying conditions. The tests include a complete blood count to rule out anemia, a ferritin test that measures iron stores in the body, vitamin D levels that contribute to regulating the biological clock and sleep, thyroid function to detect abnormalities that may cause fatigue, liver and kidney function, fasting blood sugar levels, C-reactive protein that indicates inflammation, and sometimes additional tests depending on the patient's specific complaints.

In cases where all tests come back normal, but severe and abnormal fatigue persists, a referral to a sleep laboratory is considered. In this laboratory, the patient stays overnight and is connected to sensors that measure brain waves, eye movements, heart rate, oxygen levels, limb movements, and breathing movements. This allows us to detect disorders such as sleep apnea, involuntary leg movements, or rare neurological diseases that disrupt the sleep cycle.

Medications: last resort but effective

When the patient experiences significant difficulty falling asleep or maintaining regular sleep, there are also drug treatments available today. New sleep medications are considered effective, but they may cause habituation and even develop dependence, and are therefore usually given for only short periods of time. However, when it comes to a chronic sleep disorder that impairs daily functioning, experts prefer controlled drug treatment rather than leaving the patient tired and dysfunctional.

Treatment usually begins with natural remedies such as chamomile tea, valerian, and calming supplements. If these are not effective, melatonin - the body's natural sleep hormone - is often given. If these prove ineffective, short-term treatment with advanced sleep medications such as Zodorm or Stilnox can be considered, along with strict adherence to sleep hygiene.

Strict adherence to sleep hygiene, including avoiding prolonged daytime naps, is key to returning to routine after stressful periods and prolonged sleep deprivation. Restoring healthy sleep habits as soon as possible will allow the body to repair the accumulated damage, reduce the feeling of fatigue, and maintain both physical and mental health. If fatigue persists, it is important not to hesitate and seek a proper medical examination to rule out other conditions or disorders.