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Why Do I Feel so Tired All The Time?
Why Do I Feel so Tired All The Time?
17 May 2022

Why Do I Feel so Tired All The Time?

This is a question that bugs many people as they realise that feeling tired is having an impact on their family life and certainly on their performance at work as well as on their social relationships. They never feel at their best or able to give 100% but often because symptoms are so vague they hesitate to bother the doctor with them. However, doctors are very aware of the serious effect of continual tiredness on a patient’s health and will usually be very keen to uncover what is behind it. There are many reasons why somebody may feel tired all the time and there are also a lot of ways to find a solution.

What do we mean by fatigue?

To put it simply, fatigue is just another way of saying that we feel tired. This is a different feeling from the feeling of drowsiness or sleepiness or the feeling of apathy that is mostly psychological, although either one of these other symptoms may accompany a feeling of fatigue.  Several other terms are used to describe fatigue and they are:

  • Feeling of no or very little energy
  • Mental or physical exhaustion
  • No feeling of motivation

What are the most common causes of fatigue?

Here are some of the reasons that may be contributing to your feeling of tiredness all the time.

  • You are not sleeping well and missing out on high-sleep quality
  • You have an underlying health issue
  • You are worried about something at work or in your personal life that disturbs your sleep
  • You have sleep apnoea
  • Your sleeping environment is not ideal for sleep
  • Your mattress or pillow needs changing

There is no doubt that getting enough high-quality sleep is the key to maintaining our general health. However, life in the 21st century means that a lot of us never get the right amount of sleep and this can lead us to feel fatigued. It is while you are asleep that your body will go through many critical processes which include repairing and restoring cells as well as releasing important hormones, related to growth. If you have slept well you will know that when you wake up you feel alert refreshed and full of energy because you're high-quality night of sleep has regenerated you. 

To give you the maximum benefit, sleep needs to be uninterrupted and restful so that your brain can go through the three stages of NREM (non-rapid eye movement) sleep as well as one other stage of REM (rapid eye movement sleep). This is the stage of sleep where you have your dreams. 

Even though sleep patterns and not necessarily one-size-fits-all the Sleep Research Society and the American Academy of Sleep Medicine both recommend that we get a minimum of seven hours each night to keep ourselves in good health.

For most people, however, this is easier said than done and getting enough quality sleep even falling asleep or staying asleep can prove quite a challenge.

The term insomnia is used for anyone who has problems with falling asleep or remaining asleep through the night. Several different causes might lead to this situation, including some medical conditions, suffering from stress or going through menopause, a sub-optimal sleeping environment or too much stimulation directly before bed.

A lot of people suffer from insomnia and in the short term, lasting less than 12 weeks it could affect 10% of the population. This will normally resolve once the situation causing it has resolved, but in some cases, it will become chronic which is classified as the problem occurring more than three times a week and lasting over 12 weeks.

Some people find that taking a natural supplement to help them sleep helps them get over the problem. You should also address any underlying health problems you might have with your doctor.

1. Deficiency in Nutrients

If you are deficient in certain nutrients you are more likely to have feeling tired all the time even if you are getting adequate sleep. Some of the nutrients a lack of which may be responsible for causing fatigue are:

  • Folate (vitamin B9) vitamin
  • Magnesium
  • Pantothenic acid (vitamin B5)
  • Vitamin D vitamin C
  • Iron riboflavin (vitamin B2)
  • Niacin (vitamin B3)
  • Pyridoxin (vitamin B6)
  • B12

Sadly deficiency in these vital nutrients is all too common.

It is estimated that over 25% of the population of the world is affected by anaemia and anaemia iron deficiency which is the most common accounts for half of all cases of anaemia. It can be treated simply and will improve once iron stores have been replenished.

Other studies that have been done support the fact that some 20% of people living in the United Kingdom who are over 60 years of age have a deficiency in vitamin B12. This is more common with older people because their body loses its ability to absorb B12 as efficiently.

Vitamin B12 is essential for delivering oxygen and for producing energy so if someone is low in B12 they will certainly start feeling tired. As well as that, vitamin D deficiency will also cause people to feel fatigued. It is estimated that half of the population of the world are living with inadequate levels of vitamin D. To rule this out as a cause for your fatigue it is a very good idea to get tested to make sure that your levels are in the normal range. Usually, this is not a difficult problem to resolve and the fatigue will improve once the nutrient levels have been normalised.

2. Suffering from stress

Although suffering from a certain amount of stress is normal, in everyday life, when chronic stress develops it can be linked to fatigue and may even lead to stress-related exhaustion disorder which is a medical condition that has both physical and psychological symptoms of exhaustion. Chronic stress might also lead to functional and structural changes in the brain that can lead to chronic inflammation which may also contribute to fatigue.

Of course, it's not possible to avoid all types of stressful situations especially where we encounter them at work or with family relationships. Learning to manage your stress will be a great help in preventing you from feeling completely exhausted.

One way in which you can do this just to take time for yourself to wind down perhaps by having a nice soak in the bath going for a walk or doing some meditating.

You might even want to consult a therapist to be able to help you develop some strategies that will help you reduce your stress levels. Virtual therapy is another thing that you may want to look at.

3. Suffering an emotional shock

There are life events such as a redundancy or bereavement or perhaps the breakup of a marriage that will naturally leave you feeling exhausted. It may be worth seeing your doctor for a temporary aid such as an antidepressant or a sleeping tablet to see you over such events.

4. Depression

There will be times when you feel low and sad with a complete lack of energy. If, as well as this, you wake up feeling tired it may be that you are suffering from depression.

When you are depressed the chemicals that your brain needs to work at its best are missing, one of which is serotonin, the chemical that is responsible for regulating your body clock. Depression will make you feel very low in energy and also make you feel quite tired every day.

Despite being tired you're likely to find it difficult to fall asleep when you go to bed at night and you may wake up in the early hours or much earlier in the morning than you want to. If you think that you may be suffering from depression it is always a good idea to speak to your doctor because some medication may be prescribed. Talking therapies can also help.

5. Suffering from anxiety

If you find that you're feeling very anxious in a way that you can hardly control, you may have what doctors call GAD (generalised anxiety disorder).

People suffering from GAD are more likely to feel irritable and constantly worried and be dogged all the time by a feeling of tiredness. Your General Practitioner will be able to help you with medication or by prescribing a talk therapy for you. 

6. Dietary imbalances

Unsurprisingly, your diet will directly affect the way that you are feeling. So that you can maintain your energy and get all the nutrients that you need in your body to perform the most critical process a nutrient dense and balanced diet must be followed.

If you eat ultra-processed food that lacks the essential nutrients you need, you may end up with a nutrient and calorie deficiency that will lead to you feeling exhausted.

When you are not getting enough nutrients like protein or the calories that you need, your body will start to break down muscle and fat to meet its energy demands. This will lead to a loss of body fat as well as muscle mass and this will, in turn, trigger a feeling of fatigue. This can be a problem, particularly in older adults, because of a natural reduction in appetite and in the physical activity that they do.

Eating a diet that is very high in processed food will always have an impact on energy levels. For instance, people who eat a diet that's very high in added sugar content may find their sleep affected and may also suffer from higher blood sugar and insulin levels, which amongst other things can lead to a feeling of extreme fatigue.

One study done over 28 days with a core study group of 82 people eating a diet that was high in processed grains and refined sugars, showed a significantly greater increase in the symptoms of depression and fatigue compared to those who were eating a diet with a low glycaemic load and high in legumes whole grains while keeping added sugar at a minimum. In a study of 53,000 post-menopausal women, those eating diets that were high in refined grains and added sugars reported more insomnia while those eating diets that were high in vegetables fruits and with high whole grain content reported significantly less insomnia.

It seems clear that eating a diet that is very low in processed food content and contains little added sugar and that concentrates on nutrient dense foods like legumes, vegetables, fruit and sources of protein like eggs and fish, could help reduce the symptoms of fatigue and insomnia.

7. How much caffeine is too much caffeine?

Although beverages that are caffeinated like energy drinks and coffee itself will give a temporary lift of energy, relying on them too much may have the opposite effect of making you feel very tired the day after you have consumed them in excess. Unfortunately, the results achieved may give a temporary fix but will have a very injurious effect on sleep. As well as that, drinking too much caffeine is also associated with waking up and worrying in the night, having nightmares, suffering sleeplessness and a much lower total sleep time. All this is accompanied by feeling tired during the day.

It is true to say that people’s caffeine tolerance does vary and some could drink a cup of coffee before bed and sleep like a top while others dare not drink any after lunchtime if they want a good night's sleep. It is also true to say that coffee and other caffeinated drinks like green tea can benefit our health when they're taken in moderation. Energy drinks on the other hand are very high in added sugar and in stimulants and should be avoided, whenever possible. If you think that your sleep levels may be affected by the caffeine that you drink, try an experiment, cut down a bit and see if it affects your quality of sleep.

8. Sub-optimal hydration levels

Being well hydrated is vital to our bodies and to our ability to maintain our energy levels. The hundreds of chemical reactions that our bodies perform every day rely on water and use a lot of it, which needs to be replaced.

If we do not drink enough we will become dehydrated. We need to be constantly replacing the water we have lost through our urine and stools, our sweat and even our breathing. Many studies have been done that show a direct correlation between dehydration and a loss of energy and the ability to concentrate. Being dehydrated affects more than just fluid levels. It will affect our entire bodies and will certainly impact our sleep cycle.

If you are dehydrated you are also likely to feel more tired when you are exercising which in turn will affect how much exercise you can do.

We've all had the mantra that we should drink 8 glasses of water a day but it is a little bit more nuanced than that because hydration will depend on many factors including age, weight and activity levels

The amount of hydration that is right for you depends on how much it takes to give you optimal hydration levels. Some of the symptoms that may indicate that you are dehydrated are:

  • Feeling thirsty
  • Feeling dizzy
  • Having headaches
  • Feeling fatigued

9. Being classified as overweight or obese

Ensuring that your body weight is within normal range is very important to your health. Not only is being significantly overweight linked to a lot of chronic illness such as type 2 diabetes certain cancers and heart disease but it will also very likely increase the risk of feeling chronically fatigued. Being obese, in particular, will increase your risk of obstructive sleep apnoea, a very common cause of feeling fatigued during the day. Even without sleep apnoea being overweight can be linked to feeling sleepy during the day and there is a lot of evidence to suggest that obesity has a direct effect on the sleep cycle.

10. Suffering from Hypothyroidism

The condition hypothyroidism occurs when not enough thyroxine, the thyroid hormone, is produced by the thyroid. This condition is very common, particularly in female patients. The hormones produced in our thyroid are responsible for controlling our metabolism. When those metabolic levels fall you might begin to feel tired or cold and you may notice, over time, that you gain weight. Then add to the mix that hypothyroidism can also contribute to the symptoms of depression.

It is relatively easy to identify hypothyroidism, a simple blood test will show if your thyroid gland is functioning correctly. If it is not, your healthcare provider will be able to give you medicine that will help to treat the underactivity in your thyroid gland.

Obesity is also often accompanied by sleep restriction and sub optimal sleep quality which in itself can lead to more weight gain, producing a vicious cycle. Keeping your body weight within the normal range for your height, sex and age can help a lot to support your sleep and to promote your levels of energy. If you're getting a really good sleep you may also be able to avoid being so tired and also avoid gaining more weight. 

11. Exercising too much during the day

Of course, it is quite normal to feel tired after you've had a workout but feeling fatigued is something very different. This is a feeling of tiredness that is escalated and will affect your body and your mind. It will happen when you don't recover properly from taking exercise. You will often feel that you're completely exhausted and drained, especially during the time straight after your exercise session. If you recognise this in yourself then try to cut back a bit and make sure that you are always hydrating properly after you've had a workout so that essential electrolytes can be restored. It's also important to try and ensure that you have a good night’s restful sleep after you have done any period of extreme exercise.

You might run into trouble if you don't fuel your body properly before you undertake your exercise. Without adequate carbohydrate stores to use during the time that you are exercising your body will go to its stores of fat protein and carbohydrates to get energy and this will leave you feeling drained.

We must do the right exercise to maintain our health and well-being but taking a brisk walk in the fresh air is just as beneficial and a good way to boost your energy to get your blood pumping and to increase the blood flow in your body. A good solution may be to cut back on the workouts and take more walks, which could be more sociable as well.

12. Working shifts

Shift work is a challenge for sleep patterns and often results in a person feeling fatigued. Studies have shown that around 2 to 5% of everybody who works shifts will have some sort of sleep disorder that will make them feel habitually tired for a month or more. It makes sense because you are asleep while everybody else is living life around you, hardly the best situation to sleep in.

Concerned about any of the issues raised in this article? It's well worth undergoing a full body health screening to check for underlying issues, with 4 GP appointments included in all Advanced and Elite MOTS throughout 2023.

13. Being sedentary

If you are someone who leads a very sedentary lifestyle you may also experience a feeling of tiredness during the daytime. Even for people suffering from medical conditions like multiple sclerosis, exercise is recommended to help aid sleep and general condition.

14. Napping during the daytime

If you feel tired it's natural to think that you might catch 40 winks and have a quick nap during the day. A short nap is probably alright but any longer than that will impact your sleep quality at night.

15. Some prescribed medication

If you are suffering from chronic fatigue that is unexplained then a visit to your doctor might be a good idea to discuss the symptoms you are having. Your doctor will probably test you for certain conditions that might cause fatigue such as

  • Hyperthyroidism
  • Sleep apnoea
  • Multiple sclerosis
  • Chronic fatigue syndrome
  • Kidney disease
  • Diabetes
  • Anxiety disorders
  • Fibromyalgia
  • Depression
  • Cancer

It is important to understand that it is not normal to be feeling continually exhausted. If you are feeling like this then it is worth seeing your doctor because they will most likely be a cause for it.

Some medications that you can take including blood pressure medication and steroids as well as antidepressants can be linked to insomnia and also to feeling increasingly tired. It may not be easy for you to work out, on your own, what medication is causing your tiredness so you need to see your doctor to discuss your symptoms so that they can see if there is a link to your medication.

The following are some of the major medicine culprits for tiredness.

  • Antibiotic treatment
  • Pain medication that contains narcotics
  • Medication to control high blood pressure
  • Antihistamines for allergies
  • Benzodiazepines are used to treat spasms anxiety etc
  • Antipsychotic medicines that are used in teaching and treating disorders like bipolar and schizophrenia
  • Proton pump inhibitors which are used in the treatment of conditions like acid reflux
  • Fibrates and statins used in the treatment of hypercholesterolemia

16. Anaemia

Anaemia is a condition in which the blood finds it difficult to get oxygen efficiently around your body. A very common type of anaemia is ‘iron deficiency anaemia’ which will make people feel dizzy when they stand up and also cause heart palpitations and brain fog. If you suspect you may be suffering from anaemia then a simple blood test can be done by your doctor to find out if you are.

17. Being diabetic

It is not known exactly why diabetes should make people feel tired. One possible explanation is that the body may be using a lot of energy to deal with changing blood sugar levels. What medical science does know is that fatigue is a very common symptom reported by people who have diabetes and there are other signs as well such as feeling incredibly thirsty and needing to go to the toilet often.

18. Suffering from heart disease

Feeling extremely tired is a very common symptom for someone who is suffering from congestive heart failure. This occurs when the heart does not pump blood as well as it should. If you are suffering from congestive heart disease your tiredness will increase markedly if you do any exercise and you may also notice swelling in your legs or arms or suffer from shortness of breath when you exercise and when you are resting.

19. Sleep Apnoea

This disorder keeps you from getting enough oxygen when you sleep, which means you won't get real rest during the night. What happens is that your brain will pick up on the fact that you are not getting rid of CO2 as you should be doing and wakes you up in an alarmed way. Often this frequent waking will not be noticed by the sufferer so they are bewildered as to why they are feeling so tired in the daytime. REM sleep is the sleep that makes us feel best and sufferers of sleep apnoea never manage to reach that state, so are never truly refreshed. There is a device that can be prescribed – the CPAP (continuous positive airway pressure) machine that will help to keep the airways of a sleep apnoea sufferer open so that they can get a good night's sleep.

20. Going through the menopause

When women go through the menopause they often find it difficult to get good, uninterrupted sleep. There are a lot of changes in hormones at this time and there can also be symptoms of hot flashes and night sweats all of which can keep you awake at night and give rise to the effect of being continually tired.

21. Suffering from hepatitis

Hepatitis is inflammation of the liver and there are several possible causes for this which can be anything from obesity to various infections.

Our liver has a lot of work to do for us and various functions to perform that include manufacturing proteins, breaking down toxins, storing metabolising carbohydrates, controlling clotting of the blood and many other vital functions. If the liver gets inflamed, work on all these vital functions ceases.

As well as feeling very tired some other symptoms you might notice when you have hepatitis include a yellowish colour to the skin and to the white part of the eye, which is called jaundice, some pain in the abdomen, urine that is dark yellow, stools that are very light coloured and nausea.

liver function test is a very simple blood test that can be done in most surgeries to check if your levels are normal or whether further investigation of your symptoms needs to be undertaken.

22. Suffering from chronic fatigue syndrome

Myalgic encephalomyelitis otherwise known as chronic fatigue syndrome comes with an intense feeling of fatigue that does not improve when you rest and which may be made a lot worse by mental or physical effort. The exact cause of this condition is not yet known.  What is known is that as well as completely debilitating feelings of fatigue there are other symptoms such as short term memory impairment, difficulty in concentrating, muscle and joint pain, swollen tender lymph nodes, headaches and frequent occurrences of sore throats. 

23. Suffering from heavy periods

If you often feel very tired before you have a period then you could be suffering from low iron levels or even from anaemia. Our bodies use iron to make haemoglobin. This is the protein within our red blood cells that will carry oxygen from our lungs around to other parts of our bodies. It will also help to make myoglobin which is another protein that assists in providing oxygen to our muscles. 

If iron levels are too low this means that it is more difficult for oxygen to be delivered into your muscles and tissues and without that energy the heart has to work even harder to make sure that the blood that you need circulates your body. The result of this is that you will feel very tired. 

A good idea can be to try and eat foods that are high in iron or take iron supplements. If you suspect you may be suffering from this problem speak to your doctor to get a diagnosis.

If you suffer from heavy periods you are not only liable to have this anaemia at the time of your period but also through the rest of the month.

Anaemia can suffer throughout the month not just when you get period. Have foods rich in lots of iron such as curly kale, baked beans and other necessary supplements. Doctor consultation will help if you have any concerns.

24. Sleeping too much

Getting excessive sleep will make you tired after waking up because you have disrupted your body’s biological clock. Popularly called as circadian pacemaker, there is a group of cells within the brain that controls thirst, hunger, sweat and our internal rhythms including how tired we feel.

The light signals will trigger the circadian pacemaker that comes from your eyes signalling that it is daytime and morning. It will respond through the transmission of chemical messages all over the body which will then wake up.

If you sleep too much the circadian pacemaker will be thrown out of its rhythm and this will make you feel tired because your body wanted to wake up hours before you did.

If you think this may be responsible for your tiredness try adding natural light to your routine in the morning so that you feel more alert. The earlier in the day you are exposed to natural light the more your body will respond naturally as night turns into day. You will feel less lethargic and you'll feel more alert.

One way to do this may be to wake up early or use sun rays as the alarm which includes a light within it but intensifies to wake up. You could also sleep with your curtains or blinds partially open so that the natural light reaches you as the dawn breaks. 

25. Stay wakeful during the night

Very many of us will wake up through the night not even realise in that we have done so. This gives us the impression that we've slept soundly all through the night but waking up more than four or five times in a night can be equal to losing an hour of sleep. There can be many different reasons behind your waking up at midnight including insomnia and menopause there may be other reasons such as external noises or old disturbances within your house that make you wakeful during the night.

There are very many sleep techniques online that you can try to see if they will help you fall asleep and stay asleep at night. Experiment until you find one that works for you.

26. Feeling too cold or too hot in bed

If you are a little bit too cold or too hot you will find it difficult to fall asleep and if you don't correct this your whole night will be disturbed. You will wake up in the morning feeling dull, not refreshed from your night's sleep. A comfortable sleep is sometimes difficult, especially in a very hot summer but you need to find ways of coping, such as changing your bedding or using a fan or air conditioner to ensure that the room temperature is cool enough to sleep. The temperature of our bodies will peak naturally in the evenings and then drop down when we're asleep. Even a very slight change to a normal pattern can disrupt your sleep so it's important to know what's comfortable for you and try your best to achieve it.

It is equally important that you are not too cold in bed. Even if you feel warm when you go to bed keep an extra blanket nearby in case things cool down later in the night.

27. Change your mattress or pillow when they need it

The general rule is that a mattress should be changed every 7 to 10 years. If the mattress you're sleeping on is getting towards the end of that time it may be not as comfortable as it was and that could affect your sleep quality. When you are selecting a new mattress make sure that you do your homework, and ideally go into a bed shop to try one and to discuss your particular requirements with a salesperson there.

Next pay attention to the pillow that you're using. If you are an early bed person and feel as though you have been sleeping through the night without issue, but if your pillow is not right all this will go to vain. The correct pillow needs to support your spine and your neck so that you don't get any back pain. An uncomfortable old pillow will mean that you may toss and turn through the night and that will stop you from getting the rest you need and a tired next day.

28. Drinking alcohol or smoking before you go to bed

It is normal to feel quite tired and sleepy after we've had a lot of alcohol, and this makes people think that if they have a nightcap, it will help their sleep. The truth is that the quality of sleep we have will be affected by having some drinks and the result will be that we wake up from an unrestful night and feel tired the next day. The same is true of smoking at night which can also lead to poor sleep quality even though you might feel as though you've had a good sleep. Both alcohol and nicotine are stimulants.

If you are a smoker then make sure that your last smoke is at least 4 hours before you go to bed for the day. You should also be aware that nicotine chewing gum or patches might also have a detrimental effect on your sleep. For the same reason do not drink a lot just before you go to bed if you suffer from sleep problems or feelings of tiredness.

29. Too much mental stimulation before bed

We're all guilty of spending too much time looking at our phones, and laptops on television. But in the hours before we're hoping to have a restful night's sleep, doing this is stimulating the brain. Instead of watching screens of any sort try reading meditating or doing a session of yoga which can relax you and help you to get a good night's sleep.

Where stimulation is concerned, even a light from a streetlamp that shines through your window can have an impact on your sleep. This is because it emits high intensity blue light, the same as we get from our screens, even though in a lesser quantity.

It is a very good idea to avoid blue light from screens by limiting the time you watch TV or text on your phone and leaving a couple of hours between your last activity and bedtime to allow the effect of blue light to wear off. It is never a good idea to watch your TV in bed or do anything else that stimulates the mind and stops you from relaxing into sleep. If external factors like streetlamps are impacting your sleep get a blackout blind so that your sleep won't be affected.

30. Being indoors too much of the time

For many of us, we get up climb into the car walk into an office for the day or stay at home all day and then go to bed. Although this activity can be tiring it does not offer enough sunshine or fresh air to ensure that we end up relaxed and ready for sleep at the end of the day. 

Being outside in the fresh air will give you a boost of oxygen and you can get vitamin D from sunshine. Both of these factors will wake you up and boost your energy levels each morning and they will also boost the immune system so that you are less prone to get bugs and colds and other things that may make you feel that you are run down. 

If you do have an office job try to go out at lunchtime or go out for a walk in the evening when you get home. If the weather is good enough you can open a window and door so that air and sunshine can come into your home.

31. Where is about work and money

No one who has ever worried about their finances or their job will be surprised to say that this type of worry makes us feel very tired. But it can also cause us to have sleep problems as we toss and turn and go through things in our heads. This is a tricky one because we will all come across these problems from time to time. Try not to let things get out of hand and speak to your manager or boss about the problems at work that are keeping you awake at night. Whatever the worry or concern, try to take one small step towards finding a solution so that you start to feel that there is a light at the end of the tunnel. Your sleep will improve as well.

32. Not feeling very well

If you're not feeling very well you know that it often comes with a feeling of severe tiredness. The reason for this is that your body is trying to slow you down while it heals you or fights off any infection that you might have.

33. Suffering from an underlying health issue

Things like SAD (seasonal affective disorder), going through menopause or being depressed will make you feel very sluggish, fed up and tired and will very likely disrupt your sleep patterns as well. People who suffer from seasonal affective disorder will need a lot of light from sunshine so that their moods can be boosted and their energy levels will rise. Many will buy a light box which will simulate natural sunshine when it is in short supply in the winter. Likewise, for menopause or depression symptoms, there are some natural remedies that you can use to enhance your energy levels. These will make you wake up feeling a lot happier and help you cope with whatever the menopause might want to throw at you!

Some of the other health problems that can make you feel exhausted include:

  • Hyperthyroidism
  • Restless leg syndrome
  • Low blood pressure and high blood pressure
  • irritable bowel syndrome
  • Diabetes

See your doctor if you feel that you may be suffering sleeplessness because of one of these conditions. As a rule of thumb, if your symptoms of tiredness continue for more than a fortnight you should see your doctor.

Diagnosing the problem

When you go to your doctor complaining of symptoms of acute tiredness the diagnostic process will begin with a series of questions you will be asked to try and guide the doctor to a diagnosis. It should be said that diagnosing extreme fatigue is very difficult because there are so many things that could give rise to this symptom. It could also be either physical or mental.

The conclusion below came from a research paper where psychological fatigue had been studied. It emphasises that there must be a good partnership between the doctor and the patient to reach a definitive diagnosis. 

The paper reported that when a patient came to see their doctor because they were tired they were more likely to emphasise the symptoms that they were having that were due to psychological distress and they were also more likely to come back to see the doctor more often.

However many patients will tend to see that problem as a physical one while the doctor may view it as more of a psychological issue. Once it has been established that no physical problems are present then a doctor can share explanations and ideas with the patient when they complain that they are exhausted most of the time. When the patient says that they're exhausted in general terms doctors will often try to us specific questions to get to the bottom of what is going on. One example of a question may be:

“Have you been feeling drowsy or has your tiredness given you more of a feeling of weakness?’

What the patient answers to this may give the doctor a clue, because being drowsy might be the result of a sleeping disorder, while feeling weak may point more towards a neuromuscular cause.

Another question that a doctor may ask could be:

“Have you been feeling down over the past month, or perhaps hopeless or depressed?”

If the patient says that they have had any of these symptoms then depression may be the diagnosis.

Another question:

Has the extreme fatigue that you've been feeling happened gradually or suddenly?”

“Does the tiredness seem to come in waves?”

If a patient reports that their tiredness is worse in the morning and carries on all day then depression may be the diagnosis. If not and the tiredness is directly related to exercise then neuromuscular causes will be looked into.

What worries you about the fatigue that you are feeling?”

With this line of questioning the doctor may be trying to get out any life events that may have affected the patient negatively. 

The doctor may probe further with general questions that are designed to get at any lifestyle or psychological issues that might be present. He or she may ask the patient about their relationships whether there's been a recent bereavement or any other upheaval related to housing or employment etc. The doctor may also ask about patience exercise and diet habits.

Sleep history

Very likely a doctor will take a look at a patient’s sleep history so that they can determine whether a sleep disorder is to blame. Typical questions may be:

“How much sleep do you think that you are getting every night?”

“Do you have any trouble getting off to sleep?”

“Do you wake up at any time during the night?”

“Have you ever been told that you are a snorer?”

“Has anybody that you share a bed with noticed that sometimes you seem to stop breathing for a brief time while you are asleep?”


A full physical examination

A doctor will often want to examine the patients and also assess their psychological status as they search for the cause of the chronic tiredness. Some tests are used as standard and that will narrow down the likely diagnosis. Some or all of these tests may be ordered by the doctor:

  • FBC (full blood count)
  • C-reactive protein liver or erythrocyte sedimentation rate urea
  • Urea and electrolytes as well as thyroid stimulating hormone and thyroid function tests creatine kinase
  • blood and urine tests for glucose
  • Urine test for protein

The Right Treatment

There is no one right treatment for extreme fatigue because the approach and the management will depend on what is causing the patient to be so tired.

Once the underlying medical condition has been excluded as a cause for the fatigue the most likely course of action for a doctor will be to advise on the following lifestyle choices:

The patient will be advised to:

  • Improve their habits for sleeping so that they get the right amount of sleep
  • To exercise regularly and have a proper balance between activity and rest
  • To cut out caffeine where they can and take in plenty of water
  • Eat healthily so that they are neither overweight nor underweight
  • Set expectations that are realistic for their work and their overall schedule
  • Take up activities designed to aid relaxation such as yoga or meditation
  • Promptly resolving any problems that are leading to sleepless nights
  • Completely avoiding the use of nicotine and alcohol or any illegal drugs

Doctors may also consider a referral to a counselling service full talking therapy which is also known as CBT (cognitive behavioural therapy).

Some doctors’ surgeries will offer myalgic encephalopathy services For chronic fatigue syndrome.

And finally

Even though it is quite normal for all of us to have the odd day when we feel exhausted and run down, more than a day or so of feeling this way needs attention from your doctor, especially at our Clinic on Harley Street. This allows them to get to the bottom of what is causing your extreme fatigue. Very often, fatigue will improve once you understand what is causing it and make lifestyle changes accordingly or receive medical treatment for an underlying medical issue.

Are you experiencing any of the symptoms outlined in this article?

Contact the clinic today for a same-day GP appointment.