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Why Am I So Tired?
Why Am I So Tired?
17 May 2022

Why Am I So Tired?

Tiredness can negatively impact performance at work, family life, and social relationships. Fatigue has a reputation as a vague and difficult problem for doctors to investigate, and many people with fatigue do not report it to their doctor.

Doctors who are conscious of this, take the problem seriously and attempt to determine an underlying cause. There are many reasons people become tired, and, consequently, there are many ways to rectify the situation.

What is Fatigue?

Simply put, fatigue is the feeling of being tired.

It is generally different from the sleepy feeling of drowsiness, or the psychological feeling of apathy, although these might both accompany fatigue.

Other terms to describe fatigue include:

  • reduced or no energy
  • physical or mental exhaustion
  • lack of motivation

Causes of fatigue

Here are potential reasons why you’re always tired.

1. Not getting enough high quality sleep

Getting enough sleep is essential for overall health. Unfortunately, many of us don’t get enough, which may lead to fatigue.

During sleep, your body performs a number of critical processes, including releasing important growth hormones and repairing and regenerating cells. This is why most people wake up feeling refreshed, alert, and energized after a night of high quality sleep.

Importantly, sleep should be restful and uninterrupted to allow your brain to go through three stages of non-rapid eye movement (NREM) sleep and one stage of rapid eye movement (REM) sleep — the stage in which you dream.

Even though sleep time should be individualized, the American Academy of Sleep Medicine and Sleep Research Society recommends that adults get at least 7 hours of sleep per night for optimal health.

Even though you may know the importance of getting enough sleep, falling and staying asleep can be a struggle.

Insomnia is a term for any condition that causes difficulty falling or staying asleep. It can be caused by several factors, including menopause, medical conditions, psychological stress, poor sleeping environments, and excessive mental stimulation.

Insomnia is very common. In fact, one review noted that up to 40% of adults in the United States experience insomnia at some point in a given year.

Short-term insomnia, which lasts less than 3 months, is more common and affects 9.5% of the U.S. population. Yet, 1 in 5 cases of short-term insomnia turns into chronic insomnia, which occurs 3 or more times per week and lasts longer than 3 months.

If you’re experiencing insomnia, treatments like natural supplements, medications, and the management of underlying medical conditions may help. Visit your doctor to get the appropriate care and treatment.

2. Nutrient deficiencies

Nutrient deficiencies may lead you to feel exhausted on a daily basis, even if you’re getting more than 7 hours of sleep.

Deficiencies in the following nutrients have been linked to fatigue:

  • iron
  • riboflavin (vitamin B2)
  • niacin (vitamin B3)
  • pantothenic acid (vitamin B5)
  • pyridoxine (vitamin B6)
  • folate (vitamin B9)
  • vitamin B12
  • vitamin D
  • vitamin C
  • magnesium

Deficiencies in many of these nutrients are quite common.

Anaemia affects 25% of the world’s population. Iron deficiency anaemia is the most common type, responsible for 50% of all anaemia. Fatigue is one of the most common symptoms of this condition, but it typically improves once iron stores are restored.

Furthermore, studies suggest that up to 20% of people in the United States and United Kingdom ages 60 and over are deficient in vitamin B12. This deficiency is especially common in older adults because the body’s ability to absorb B12 declines with age.

B12 is critical for oxygen delivery and energy production, so low levels can cause extreme fatigue. Additionally, a vitamin D deficiency may cause fatigue. Over half of the world’s population has inadequate vitamin D levels. Because these deficiencies are quite common, it’s important to have your levels tested if you’re experiencing unexplained fatigue. Typically, fatigue related to a deficiency in one or more nutrients improves once your nutrient levels normalize.

3. Stress

Although some stress is normal, chronic stress is linked to fatigue. In fact, chronic stress may lead to stress-related exhaustion disorder (ED), a medical condition characterized by psychological and physical symptoms of exhaustion. Furthermore, chronic stress may cause structural and functional changes in your brain and lead to chronic inflammation, which may contribute to symptoms like fatigue.

While you may be unable to avoid stressful situations, especially those related to work or family obligations, managing your stress may help prevent complete exhaustion. For example, you can set aside time to decompress by taking a bath, meditating, or going for a walk.

A therapist may also help you develop strategies to reduce stress. Many health insurance plans cover mental health counseling, and virtual therapy is also an option.

4. Emotional shock

A bereavement, redundancy or a relationship break-up can make you feel tired and exhausted.

5. Depression

If you feel sad, low and lacking in energy, and you also wake up tired, you may have depression.

It robs your brain of the chemicals it needs to work at its best. One of those is serotonin, which helps regulate your internal body clock.

Depression can lower your energy levels and make you feel tired during the day. You may also find it hard to fall asleep at night, or you might wake up earlier than you want in the morning.

Talk to you doctor if you think you're depressed. Talk therapy and medicine can help.

6. Anxiety

If you have constant uncontrollable feelings of anxiety, you may have what doctors call generalised anxiety disorder (GAD) in adults.

As well as feeling worried and irritable, people with GAD often feel tired. See a GP, as medication and talking therapies can help.

If you think your tiredness may be a result of low mood or anxiety, try this short audio guide to dealing with your sleep problems.

7. Dietary imbalances

Your diet significantly affects the way you feel. To maintain energy and get the nutrients your body needs to perform critical processes, it’s important to consume a balanced diet high in nutrient-dense foods.

Undereating - or eating ultra-processed foods low in essential nutrients - may lead to calorie and nutrient deficiencies, which can cause exhaustion.

When you don’t obtain enough calories and nutrients like protein, your body starts breaking down fat and muscle to meet energy demands. This leads to a loss of body fat and muscle mass, which may trigger fatigue. Older adults are especially at risk of malnutrition and nutrient deficiencies due to factors like age-related changes in appetite and reductions in physical activity.

Additionally, diets high in ultra-processed foods impair energy levels. For example, a diet high in added sugar may harm sleep and lead to chronically high blood sugar and insulin levels, which can result in fatigue. In a 28-day study in 82 people, a diet high in refined sugars and highly processed grains resulted in 38% and 26% higher scores for depressive symptoms and fatigue, respectively, than a low glycemic load diet high in whole grains and legumes but low in added sugar.

What’s more, a review including over 53,000 postmenopausal women associated diets high in added sugars and refined grains with a greater risk of insomnia — and diets high in fruits, vegetables, and whole grains with a lower risk of insomnia.

Following a diet low in ultra-processed food and added sugar but rich in nutrient-dense foods like fruits, veggies, legumes, and protein sources like fish and eggs may help reduce fatigue and support healthy sleep while providing your body with optimal nutrition.

8. Consuming too much caffeine

Although caffeinated beverages like coffee and energy drinks give you a temporary boost of energy, over-reliance on them may make you more tired the next day. That’s because too much caffeine can harm sleep, which may cause fatigue.

Research shows that feeling tired in the morning leads people to consume large amounts of caffeine, which impairs your sleep cycle. In turn, you may overuse coffee or other caffeinated drinks for energy, which continues the cycle of poor sleep followed by too much caffeine.

Drinking too much caffeine is linked to increased nighttime worrying, sleeplessness, increased nighttime awakenings, decreased total sleep time, and daytime sleepiness.

A study in 462 women linked high calorie coffee and energy drink intake to poor sleep quality and sleep disturbance. Those who didn’t drink these beverages reported better sleep quality.

Still, caffeine tolerance varies, and some people are more sensitive to caffeine’s effects on sleep than others.

While coffee and caffeinated beverages like green tea may benefit health when consumed in moderation, energy drinks are extremely high in stimulants and added sugar. Thus, you should avoid them whenever possible.

If you’re currently experiencing sleep issues and frequently drink caffeinated beverages, try cutting back to see whether it helps improve your sleep and energy levels.

9. Inadequate hydration

Staying well hydrated is important for maintaining energy levels. The many biochemical reactions that take place in your body every day result in a loss of water that needs to be replaced.

Dehydration occurs when you don’t drink enough liquid to replace the water lost in your urine, stools, sweat, and breath. Several studies show that being dehydrated leads to lower energy levels and a decreased ability to concentrate.

In fact, dehydration affects your entire body, including your sleep cycles.

A study in over 26,000 Chinese and American adults associated inadequate hydration with shorter sleep times.

Being dehydrated may also make you feel more fatigued during exercise and negatively affect exercise endurance.

Although you may have heard that you should drink eight, 8-ounce (240-mL) glasses of water daily, hydration needs depend on several factors, including your weight, age, sex, and activity levels.

The key is drinking enough to maintain good hydration. Common symptoms of dehydration include thirst, fatigue, dizziness, and headaches.

10. Overweight or obesity

Maintaining a healthy body weight is essential to overall health.

Not only is obesity significantly linked to a greater risk of many chronic illnesses like type 2 diabetes, heart disease, and certain cancers, but it may also increase your risk of chronic fatigue.

Obesity greatly increases your risk of obstructive sleep apnea, which is a common cause of daytime fatigue. It’s also linked to increased daytime sleepiness regardless of sleep apnea, suggesting that obesity directly affects the sleep cycle.

11. Hypothyroidism

Hypothyroidism is a disease in which the thyroid gland does not produce enough thyroid hormone. Thyroid disease is very common, especially in women, and affects 27 to 60 million people in the United States alone.

Thyroid hormones control your metabolism so that when levels are low, you may have symptoms of tiredness, weight gain, and feeling cold.4 Making the condition even more confusing, hypothyroidism can also contribute to symptoms of depression.

Thankfully, a blood test can determine if your thyroid gland is functioning within acceptable guidelines. If not, a healthcare provider can prescribe medications to help treat your underactive thyroid

What’s more, people with obesity have a higher risk of conditions associated with fatigue, including depression and type 2 diabetes. Plus, poor sleep quality and sleep restriction may cause weight gain or obesity. Maintaining a healthy body weight may support good sleep and energy levels, while getting high quality sleep may help prevent weight gain and reduce fatigue.

12. Too much exercise during the day

It’s normal to feel tired after working out, but fatigue is something different. This escalated feeling of tiredness, that effects the mind and body, happens when you don’t fully recover from the exercise. It normally leads to people feeling drained and exhausted, especially during or immediately after exercise.

Doing too much exercise is a natural contributor to this feeling. Try to cut back on the hours spent in the gym or in the swimming pool, make sure you’re fully hydrating after working out and restoring essential electrolytes, and be sure to get a good night’s sleep after intense physical exercise.

Additionally, fatigue and exhaustion can occur when you don’t fuel up before exercise. Without carbohydrates to feed off of during exercise, your body has to use its reserves of protein, fat and carbohydrates for energy – which can lead to you feeling tired.

However, exercise is still important for your general wellbeing. “Fresh air and brisk walks are effective ways to boost your energy, as they get the heart pumping and increase your blood flow,” says GP Dr Roger Henderson. So instead, opt for work outs three to five times a week and be sure to schedule in proper rest days.

13. Shift work

work causes sleep disruption and may result in fatigue. Sleep experts estimate that 2–5% of all shift workers have a sleep disorder characterized by excessive sleepiness or disrupted sleep over a period of 1 or more months.

14. A sedentary lifestyle. 

Leading a sedentary lifestyle may lead to tiredness during the day. Studies show that exercising more may improve symptoms of fatigue in some people, including those with medical conditions like multiple sclerosis (MS).

15. Daytime naps

If you're tired, you may nap during the day, which can make it more difficult to get a good night's sleep.

16. Certain medications. 

If you’re experiencing unexplained, chronic fatigue, you should visit your doctor and discuss your symptoms.

They may recommend testing to rule out certain health conditions that cause fatigue, such as sleep apnea, hypothyroidism, cancer, chronic fatigue syndrome, multiple sclerosis, anxiety disorders, kidney disease, depression, diabetes, and fibromyalgia.

It’s important to know that it’s abnormal to feel exhausted all the time. If you experience frequent fatigue, there’s likely one or more causes.

Some drugs, including steroids, blood pressure medications, and antidepressants, are linked to side effects like insomnia and increased tiredness.

It may be difficult or impossible to identify the factor(s) behind your fatigue on your own, which is why it’s important to work with a doctor you trust. They can help you find the cause and suggest possible treatments.

Fatigue can be a side effect of several different medications. Some of the most common medications which may cause fatigue include:

  • Antibiotics (used to treat bacterial infections)
  • Antidepressants (used to treat depression)
  • Antihistamines (used to treat allergies)
  • Antipsychotics (used to treat schizophrenia, bipolar disorder, and other serious psychiatric conditions)
  • Benzodiazepines (used to treat anxiety, muscle spasms, seizures)
  • Blood pressure medications
  • Diuretics (used to treat high blood pressure, glaucoma, and edema)
  • Narcotic pain medications
  • Proton pump inhibitors (used to treat stomach conditions such as acid reflux)
  • Statins and fibrates (used to treat high cholesterol)

17. Anaemia

It's a disorder that makes it hard for your blood to move oxygen around your body. A common type is called "iron-deficiency" anaemia.

Iron acts like a train car that transports oxygen in your blood. "People with low iron don't have enough cars on their train," Friedman says. "They're tired, they get dizzy when they stand up, they get brain fog, they get heart palpitations."

Your doctor can check you for anaemia with a simple blood test.

18. Diabetes

Doctors don't know exactly why it makes people so tired. One likely reason is that your body uses lots of energy to deal with your frequent changes in blood sugar levels.

What doctors do know is that fatigue is one of the most common symptoms of diabetes. It has other signs, too. You may feel thirsty and need to go to the bathroom often.

19. Heart Disease

Extreme tiredness is a common symptom of congestive heart failure, which happens when it doesn't pump as well as it should. If you have it, your fatigue usually gets worse when you exercise. You might also have swelling in your arms or legs and shortness of breath.

20. Sleep Apnoea

This disorder keeps you from getting enough oxygen when you sleep, which means you won't get real rest during the night.

"The brain notices you're not getting rid of your CO2, and it wakes up really briefly in an alarmed state," says Lisa Shives, MD, director of the Sleep Medicine Center at the University of California, San Diego School of Medicine. You don't even realise, which makes it hard to figure out why you're so sleepy during the day.

"You don't get into REM -- the sleep that makes you feel best," Shives says.

A device called a continuous positive airway pressure (CPAP) machine can help keep your airways open for a solid night's sleep.

21. Menopause

If you're a woman who's going through menopause, you may find it hard to get good sleep. Your hormones change a lot at this time, which give you night sweats and hot flashes. That can keep you up at night and leave you dragging during the day.

22. Hepatitis

Hepatitis is an inflammation of the liver with several possible causes ranging from infections to obesity.

The liver serves many important functions in the body from breaking down toxins to manufacturing proteins that control blood clotting to metabolizing and storing carbohydrates and much more. When the liver is inflamed, these important processes can come to a halt.

In addition to being tired, some of the symptoms that you might experience with hepatitis include jaundice (a yellowish discoloration of the skin and whites of the eyes), abdominal pain, nausea, dark yellow urine, and light-colored stools.8

Liver function tests are easily done in most clinics, and if abnormal, can lead you and a healthcare provider to look for the possible causes.

23. Chronic Fatigue Syndrome

Chronic fatigue syndrome, also known as myalgic encephalomyelitis, is a disorder characterized by intense fatigue that does not improve with rest and which may be made worse by physical or mental exertion. It is unknown what causes this condition.

In addition to debilitating fatigue, some of the other symptoms which define chronic fatigue syndrome include impairment in short-term memory or concentration, muscle and joint pain, headaches, tender lymph nodes, and frequent sore throat.

24. Heavy periods

If you feel tired before your period starts, you could be suffering from a lack of iron or even anaemia.

The body uses iron to make haemoglobin, which is a protein in red blood cells that carries oxygen from the lungs to other parts of the body. It also helps to make myoglobin, another protein that helps to provide oxygen to the muscles.

A lack of iron means a lack of these two proteins and this makes it harder for oxygen to reach your tissues and muscles. Deprived of energy, the heart has to work harder to move the blood around your body which makes you feel tired.

You can also suffer from anaemia all month long, not just when you’re on your period. Try eating foods that have a lot of iron in them like liver, baked beans and curly kale or taking supplements. Talk to your doctor or health provider if you are concerned.

25. Too much sleep

Too much sleep can make you feel tired when you wake up as you’re disrupting the body’s biological clock. Otherwise known as the circadian pacemaker, this group of cells in the brain controls hunger, thirst, sweat and internal rhythms, including tiredness.

The pacemaker is triggered by light signals from your eye, signalling that it’s daylight and the morning. It then sends out chemical messages to the rest of the body to suggest it’s time to wake up.

When you have too much sleep, the pacemaker is thrown off it’s regular schedule, which can make you feel fatigued as your body began to wake up hours ago.

To help combat this, sleep expert James Wilson (aka The Sleep Geek) recommends including natural light in your morning routine to help you feel more alert in the mornings. He says, “Having natural light earlier in the day helps your body to understand it is now daytime.

“It will reduce your lethargy and improve your alertness. This can be done by getting outside earlier in the day and using a sunshine alarm clock which has a light that rises like the sun and pulls your body out of sleep.”

26. Waking up a lot in the night

A lot of us wake up in the night so briefly that we can’t remember doing it. It makes us think we’ve slept right through but in the end, waking up more than five times a night can be the equivalent of losing an hour’s sleep. So while there might be plenty of reasons for waking up in the middle of the night, including the symptoms of menopause and insomnia, there are other more natural reasons like noises in the house or outside.

So if you fit into the latter category, check out this simple technique used by registered nutritionist and army veteran, Rob Hobson.

How to fall asleep in 2 minutes:

Rob Hobson shared the following trick with us that has reportedly used by the US military in the past to get to sleep in difficult circumstances.

“This technique is said to work for around 96 per cent of people after practising for around six weeks,” he said.

Relax the muscles in your face, such as tongue, jaw and around the eyes.

Drop shoulders as low as they will go, followed by your upper and lower arm, one side at a time.

Breathe out, relaxing your chest then legs, working downwards from the thighs to the feet.

Say ‘Don’t think, don’t think’ for 10 seconds to clear your mind.

By setting a proper routine for yourself, it’s also possible that your body will adapt better to times when it should be asleep and awake so you’ll feel less tired. To do this, it’s important to fix your sleep schedule and go to bed at the same time every night, then wake up at the same time every morning.

27. Too hot or too cold in bed

If you’re too hot or too cold to get to sleep, this is going to affect the quality of sleep you manage to get overnight.

It’s also going to leave you feeling less than refreshed come the morning. “Getting a comfortable night’s sleep can be more challenging during the hottest months” says Thom Hemelryk founder of the Drowsy sleep company.

“Increased temperatures make it harder for us to drift off and mean we toss and turn more than the usual. But then sleeping with the windows open also increases outside light and noises that can keep us up.”

Thom says the key to how to sleep in the heat is all about regulating your body temperature, “Your body temperature naturally peaks in the evening and then drops when you are asleep. Even slight changes to your normal patterns can be disruptive. So, it’s important to be aware of your temperature patterns and prepare accordingly.”

He suggests these 3 hacks for summer temperature control:

Invest in a good fan, it keeps the temperature down and blocks out external noise.

Sleep with a light cotton sheet instead of a quilt. If temperatures really soar, try rinsing it in water to keep you cool.

Don’t sleep naked as this could actually make you hotter.

Have your own bedding! In the winter it might be great to cuddle up to your partner to keep warm, but in the summer the heat from your two bodies can make you more uncomfortable. Regulate things by having separate bedding for both of you.

While keeping your bed cool or warm is vitally important for good sleep, it’s also a good idea to make sure that you keep your house cool to ensure proper temperature regulation.

28. You need a new pillow or mattress

A new mattress should be purchased every 7-10 years. If your one is starting to reach the end of its life cycle, it could be impacting your sleep.

Before buying a new one, it’s important to understand your own preference and the different options available when you shop.

Even if you go to bed early and think you’re sleeping through until morning, your pillow could be undoing all this good work. The right pillow will support your neck and spine and prevent back pain. An old or uncomfortable pillow means that you’ll toss and turn all night which stops your body getting the rest it needs, making you feel tired.

Pillow test: Place the middle of the pillow over your arm, if the sides hang down it’s time to buy a new one!

29. Smoking or drinking alcohol before bed

We often feel sleepy after drinking a lot of alcohol, so you’re fooled into thinking it aids sleep. But actually, our quality of sleep is affected after having a few drinks and you’ll feel tired the next day. Similarly, smoking last thing at night can mean your quality of sleep suffers – even though you think you’ve had enough sleep. This is because like alcohol, nicotine is a stimulant.

Tom Hemelryk explains, “Stimulants like alcohol, tobacco and heavy foods in the run up to bed will disrupt the chemical balance in your brain needed for restful sleep.”

If you do smoke, try to have your last cigarette at least four hours before bedtime. Nicotine patches or chewing gum can also affect your sleep. It’s also best to avoid drinking large amounts of alcohol close to bedtime if you are feeling tired or having sleep problems.

30. Watching too much TV before bed

Rebecca Small, assistant medical director at Bupa says, “Television, laptop and computer games can all stimulate the mind and therefore can prevent a good night’s sleep. Reading, meditation and exercise such as yoga can have a relaxing affect, helping prepare your body for sleep.”

Even having the light from street lamps come through your windows can disrupt your sleep, as the high-intensity LED light emits the same blue light as a screen, although it’s a smaller quantity. The American Medical Association have even issued a warning about street lights.

“The blue light emitted from phones, laptops and TVs can delay the release of sleep-inducing melatonin by up to three hours,” says Dr Vishal Shah, medical director at Thriva.

To avoid this blue light from screens, try limiting your TV watching and texting to an hour a night, and don’t let it be the last thing you do before you go to bed and don’t use your bed for anything other than sleeping. It’s not a good idea to watch TV in bed, or anything else like sorting out bills, make shopping lists or arguing. Let your body recognise that when you get into bed it’s time for sleep.

As for the street lights, make sure to use black-out curtains to ensure that no light creeps through!

31. Spending too much time indoors

If your day is made up of waking up, getting in the car, working in an office or staying at home all day and then going to bed, you probably don’t get enough fresh air or sunshine.

Fresh air gives you a burst of oxygen and sunshine gives you vitamin D. Both these elements boost your energy levels and wake you up. They also boost your immune system, so you’re less likely to get colds, bugs and other illnesses which make you feel run down.

Try getting out of the office at lunchtime or going for a walk in the evenings. When it’s warm enough, open windows and doors too to let the air and sunshine go through your house.

32. Work and money worries

It’s not new to us that worrying about our jobs and our finances makes us feel exhausted. But a study has confirmed that work and money worries can also cause sleep problems, saying that nearly 1 in 3 of us are having problems sleeping more than once a week. And those who took part in the study said work and money worries were the biggest problems when it comes to nodding off.

Try setting some time aside with your boss or manager to talk through your concerns if you’re stressed about work. If you’re feeling overworked or not supported, and they should be able to help you. Even a small step like this will make you feel like you are doing something about it and you’ll feel better.

33. Feeling unwell

The most common theory on why you feel tired when you’re unwell is that the body is forcing you to slow down. By slowing down and making you feel more tired, and so sleep more, the body has the chance to heal and fight off the infection.

34. An underlying health problem

Depression, Seasonal Affective Disorder (SAD) and going through menopause can all make you feel tired, fed up and sluggish as well as disrupt your sleeping pattern.

People who have SAD need a lot of sunshine to boost their mood and energy levels, so much so that many buy light boxes to simulate sunshine during the winter. And if you suffer from depression or are struggling with the symptoms of the menopause there are natural ways you can boost your energy levels which will make you feel happier, more awake and help you cope with all that the menopause might throw at you!

There are other health problems which can make you tired too. These include Restless Leg Syndrome, hypothyroidism, diabetes, high and low blood pressure and Irritable Bowel Syndrome. Talk to your doctor or health provider if you are concerned.

“If you’re feeling tired for longer than a couple of weeks, see your GP,” says Dr Shah.

“As soon as you notice any change in your appetite, you feel pain, notice blood in your stools or urine, or are worried about any other symptoms, go and see your doctor.”

Diagnosis

Doctors will ask a series of questions when diagnosing fatigue to determine the cause.

Fatigue is a difficult issue for doctors. It may be a physical problem rather than a psychological one.

The following conclusion from a research paper Trusted Source on psychological fatigue highlights the need for a partnership to be developed between doctor and patient for proper diagnosis.

“Patients consulting for tiredness are likely to report symptoms of psychological distress and attend more frequently than other patients.

They tend to view the problem as physical while their doctors view the problem as psychological. Having established that there is no physical problem, doctors may need to focus more on sharing ideas and explanations when patients complain of being ‘tired all the time.'”

When patients present with fatigue, doctors will try to develop a more precise description of symptoms, typically by asking the following types of questions:

Have you felt drowsy, or has the fatigue been more a feeling of weakness? – the answer can give clues to the diagnosis because drowsiness may be a symptom of a sleep disorder, while weakness may be a sign of a neuromuscular cause.

During the past month have you often been bothered by feeling down, depressed, or hopeless? – positive answers may indicate depression.

Has your fatigue developed gradually or suddenly?

Does your tiredness come in cycles? – for example, depression is indicated if the fatigue is worst in the morning but persists all day, whereas fatigue associated with exercise suggests a neuromuscular issue.

What are your concerns about the fatigue? What do you think may be the cause? – the doctor may be looking for a connection with any distressing life events, for example.

More general questions are designed to elicit information regarding psychological or lifestyle issues. There may be questions about relationships and any recent bereavements or upheavals related to employment or housing. The doctor may also ask about a patient’s diet and exercise.

Sleep history

The doctor might take a ‘sleep history’ to work out whether a sleep disorder is leading to the fatigue:

  • How much sleep do you get each night?
  • Do you have trouble getting to sleep or do you wake up during the night?
  • Has anyone told you that you snore?
  • Has anyone noticed that you stop breathing for short periods of time during sleep?
  • These sleep history questions are designed to determine the sleep quality, quantity, patterns, and sleep routine.

Physical examination

The doctor may also examine a patient physically or check their mental state to find physical and mental causes. If no specific cause is indicated, there is a set of standard tests used to help narrow down the diagnosis. Based on the patient’s complaints, these may include:

  • full blood count
  • erythrocyte sedimentation rate or C-reactive protein
  • liver function tests
  • urea and electrolytes
  • thyroid stimulating hormone and thyroid function tests
  • creatine kinase
  • urine and blood tests for glucose
  • urine test for protein

Treatment

There is no single treatment for fatigue – because the management approach depends on the cause of the tiredness.

If the diagnostic process unveils no underlying medical explanation for the fatigue, the following lifestyle and dietary modifications may help resolve it:

  • Improving sleep habits and ensuring adequate sleep.
  • Exercising regularly and balancing rest and activity.
  • Cutting out caffeine and drinking plenty of water.
  • Eating healthy to avoid becoming overweight or underweight.
  • Setting realistic expectations for workload and schedule.
  • Taking time to relax, perhaps trying meditation or yoga.
  • Identifying and dealing with stressors by, for example, taking time off work or resolving relationship problems.
  • Avoiding the use of alcohol, nicotine, and illegal drugs.

For some people with fatigue, doctors may consider offering a referral for counselling or a talking therapy known as cognitive behavioral therapy (CBT).

Some doctors specialize in chronic fatigue syndrome (or myalgic encephalopathy) services, and these may be a suitable referral even for people who do not meet the criteria for this diagnosis. They will offer a consultant opinion for occupational reasons for fatigue, or may provide a structured, multidisciplinary approach to management, including supervised graded exercise therapy.

The bottom line

Even though everyone has days when they feel exhausted, constantly feeling run down and tired isn’t normal.

Many possible factors cause chronic fatigue, such as underlying medical conditions, nutrient deficiencies, sleep disturbances, caffeine intake, and chronic stress.

If you’re experiencing unexplained fatigue, it’s important to talk with your doctor to find the cause.

In many cases, your fatigue should improve once you identify the underlying cause(s) and make appropriate lifestyle and dietary adjustments — or get the right treatment for medical conditions.