Fatigue: Why am I so tired and what can I do about it?
Physical and mental fatigue are different, but they often occur together. Long-term physical exhaustion can also lead to mental fatigue.
Poor sleep can lead to fatigue if ongoing, and according to the Centers for Disease Control and Prevention (CDC), 1 in 3 Americans say they do not get enough sleep. The National Heart, Lung, and Blood Institute (NHLBI) recommend sleeping 7 to 8 hours a day for adults over 18 years of age.
Poor sleep is associated with a variety of medical problems and health conditions. These include:
Lack of sleep can prevent a person from fulfilling their usual tasks. It can make it hard to get out of bed in the morning. When it affects safety, for example, on the road, it becomes a public health concern. In severe cases, a person may show signs similar to that of an intoxicated state.
Here are some key points about fatigue. More detail is in the main article.
- Fatigue can be due to a variety of medical conditions and health problems..
- Some causes can include anemia, thyroid conditions, diabetes, lung and heart disease, and having recently given birth.
- If a health condition, such as diabetes, is diagnosed and properly managed, the fatigue may go away.
- A healthful diet and regular physical activity can help reduce fatigue for many people.
Fatigue can make it hard to stay awake or to get up in the morning.
There are different types of fatigue.
Physical fatigue: A person finds it physically hard to do the things they normally do or used to do, for example, climbing stairs. It includes muscle weakness. Diagnosis may involve a strength test.
Mental fatigue: A person finds it harder to concentrate on things and stay on task. The person may feel sleepy, or have difficulty staying awake while working.
Sleepiness or fatigue?
Sleepiness can happen when a person does not have enough good-quality sleep, or when there is a lack of stimulation. It can also be a sign of a medical condition that interferes with sleep, such as sleep apnea or restess leg syndrome.
Typical sleepiness is more likely to be short term. Sleepiness and drowsiness can often be solved by getting regular and consistent sleep.
Fatigue, especially chronic fatigue, is usually linked to a medical condition or health problem. It may also be its own chronic condition known as myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS).
Fatigue is associated with many health conditions.
1) Mental health issues
It can result from stress, bereavement and grief, eating disorders, alcohol abuse, drug abuse, anxiety, moving home, boredom, and divorce. It can occur with clinical depression, either due to the depression itself, or because of associated problems, such as insomnia.
2) Endocrine and metabolic reasons
3) Drugs and medications
Some antidepressants, antihypertensives, statins, steroids, antihistamines, medication withdrawal, sedatives, and anti-anxiety drugs can cause fatigue. Changes in doses or stopping medications can also be a cause.
4) Heart and lung conditions
Pneumonia, arrhythmias, asthma, chronic obstructive pulmonary disease (COPD), valvular heart disease, coronary heart disease, congestive heart failure, GERD, acid reflux, and inflammoatory bowel disease (IBD) can cause fatigue, among many other heart, lung and digestive diseases.
5) Sleep problems
6) Chemicals and substances
Vitamin deficiencies, mineral deficiencies, poisoning, and consuming too many caffeinated or alcoholic beverages may disrupt normal sleep, especially if these are consumed too close to bedtime.
7) Various diseases, conditions, states, and treatments
Cancer, chemotherapy, myalgic encephalomyelitis (ME), radiation therapy, chronic fatigue syndrome (CFS), fibromyalgia, systemic lupus, rheumatoid arthritis, obesity, massive blood loss, and weakened immune systems can all cause fatigue.
Fatigue can also be a sign of infection. Some infections that cause extreme tiredness include malaria, tuberculosis (TB), infectious mononucleosis, cytomegalovirus (CMV), HIV infection, flu, and hepatitis, among many others.
8) Chronic pain
Patients with chronic pain often wake up frequently through the night. They typically wake up tired and poorly rested, unable to get good quality sleep. The combination of pain and lack of sleep can cause persistent tiredness and fatigue.
Some diseases and conditions where pain is the main symptom, such as fibromyalgia, may also be linked to other conditions, such as sleep apnea. This further worsens syptoms of fatigue. In one study on fibromyalgia and sleep, half of the individuals with fbromyalgia also had sleep apnea.
9) Being overweight or underweight
Being overweight increases the risk of fatigue, for various reasons. These include having to carry more weight, being more likely to have joint and muscle pain, and being more likely to have a condition where fatigue is a common symptom, such as diabetes or sleep apnea.
Similarly, a person who is underweight may tire easily depending on the cause of their condition. Eating disorders, cancer, chronic disease, and an overactive thyroid, can all cause weight loss along with excessive tiredness and fatigue.
10) Too much or too little activity
A person who feels fatigued may not exercise, and lack of exercise can cause further fatigue. Lack of exercise may eventually cause deconditioning, making it harder and more tiring to perform a physical task.
Fatigue can also affect healthy individuals after prolonged, intense mental or physical activity. Working or staying awake for long hours without a break, especially when driving, increases the risk of errors and accidents. Statistics have shown that, among truck and bus drivers, longer hours of staying awake lead to more motor vehicle accidents.
It is important not to drive while sleepy. A survey carried out by the CDC found that around 1 in 25 drivers aged 18 years and above had fallen asleep while driving in the previous 30 days.
The main symptom of fatigue is exhaustion with physical or mental activity. The person does not feel refreshed after resting or sleeping. It may be hard to carry out daily activities including work, household chores, and caring for others.
The signs and symptoms of fatigue may be physical, mental, or emotional.
Common signs and symptoms associated with fatigue can include:
Body aches can be a sign of fatigue.
- aching or sore muscles
- apathy and lack of motivation
- daytime drowsiness
- difficulty in concentrating or learning new tasks
- gastrointestinal problems such as bloating, abdominal pain, constipation, and diarrhea
- irritability and moodiness
- slowed response time
- vision problems, such as blurriness
Symptoms tend to get worse after exertion. They may appear some hours after activity or exercise, or possibly the next day.
Diagnosis can be difficult, because the causes and symptoms are varied and non-specific.
The doctor may ask questions relating to:
- the quality of the fatigue
- patterns of the fatigue, for example, times of day when symptoms are worse or better, and whether a nap helps
- quality of sleep including emotional state, sleep patterns and stress levels
A person can help by keeping a record of the total hours slept each day, and how often they awaken during sleep.
The physician will carry out a physical examination to check for signs of illnesses and ask the patient which medications they are using. Other factors to consider include present or recent infections, and events that may trigger fatigue, such as giving birth, having undergone surgery, or recovering from a major injury or illness.
The doctor will also ask about lifestyle habits, including diet, caffeine use, drug use, alcohol consumption, work and sleep patterns.
These can help diagnose an underlying cause. Urine tests, imaging scans, mental health questionnaires, and blood tests may be necessary depending on other symptoms.
Tests can help rule out physical causes, such as an infection, hormonal problems, anemia, liver problems, or kidney problems. The physician may order a sleep study to rule out a sleeping disorder.
If an illness is diagnosed, that illness will be treated. Controlling diabetes, for example, may help solve the fatigue problem.
To treat fatigue successfully, it is necessary first to find the underlying cause. Some examples could be:
- sleep apnea
- poorly controlled blood sugar
- underactive or overactive thyroid
- an infection
- an abnormal heart rhythm
Appropriate treatment for the condition can help alleviate fatigue.
Yoga, CBT, and mindfulness for fatigue
In one study, participants reported that fatigue, anxiety and depression fell, while quality of life improved in those with multiple sclerosis (MS) who underwent 2 months of mindfulness meditation training.
A study on the benefits of yoga, found some improvement of symptoms of fatigue and sleep quality in cancer survivors. The 4-week program included postures, meditation, breathing, and some other techniques.
A 2017 study reviewed the benefits of cognitive behavioral therapy (CBT), mindfulness, and yoga on treating sleep disturbances in breast cancer patients. Researchers reported those who participated in CBT appeared to have the most improvement in sleep, with decreased fatigue, depression, and anxiety, along with improved quality of life.
Results from studies on mindfulness and yoga were not as clear, but seemed to show slight improvement or at least some benefit, overall.
Here are some tips for overcoming fatigue.
Quality sleep is an important part of managing fatigue. To practice good sleep hygiene:
- Aim to go to bed and wake up at the same time each day, even on days off.
- Set the bedroom temperature at a comfortable level. Cooler may be better. The National Sleep Foundation recommend a room temperature of 60 to 67°F.
- Make sure the room is dark and quiet.
- Avoid screen time an hour before sleeping, as the light and sounds from a TV or computer screen can stimulate brain activity, affecting sleep quality.
- Avoid eating within 90 minutes or 2 hours before going to bed.
- As bedtime approaches, physically and mentally slow down. Have a consistent routine. A warm bath or listening to some soothing music can help you clear your mind of stressful and worrying thoughts before going to sleep.
Keeping a sleep diary may also help.
Eating and drinking habits
Diet can affect how tired or energetic we feel.
Here are some tips:
- Eat small frequent meals throughout the day.
- Eat snacks that are low in sugar.
- Avoid junk food and follow a well-balanced diet.
- Consume plenty of fresh fruit and vegetables.
- Drink alcoholic and caffeinated beverages in moderation, or not at all. Avoid caffeine in the afternoon and evening.
A moderate and well-balanced diet can lead to better health and better sleep.
Regular physical activity can help reduce fatigue by improving sleep. However, those who have not been physically active for some time should introduce exercise gradually. A doctor or sports therapist can help. Exercise during the time of day that is most productive for you.
Take a break from driving
The CDC urge people to know the warning signs of drowsiness on the road.
If a driver notices they are doing any of the following, they should pull over and take a nap or change drivers.
- yawning and blinking
- not remembering the last few miles they have driven
- missing an exit
- drifting across the lane
- driving onto a rumble strip
- having trouble staying focused
If fatigue and sleepiness are affecting your daily life, and none of these tips work, you should see a doctor.