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Why am I so tired?

-by Dr. Alan Laird, Chief Medical Officer

Fatigue (tiredness) is a fairly common problem.  It may indicate a significant medical problem and is a problem if it keeps us from doing things we need to or want to do.  When fatigue reaches a level that it affects your work, relationships, mental or physical health, it is time to ask for help.

So what things can we each look at before we visit our healthcare provider to discuss this issue?  There are several helpful things to think about.  First, is this something new, or has it been going on for a long time?  As you might suspect, if it is serve, sudden and new the underlying cause is very different from something that has been mild, slowly worsening and long term.  Does it seem to relate to anything else that has changed in your life – a new work schedule, a loss of someone close to you, a new illness?  Major changes like these can upset your system and decrease one’s endurance.

Another important self-inventory to perform is regarding habits.  Am I getting enough sleep?  Is my sleep time regular or is it always changing?  Am I consuming significant amounts of alcohol or caffeine, smoking, not exercising or eating a diet of junk food.  While bad habits are not always the sole cause of tiredness, they often contribute to and make the fatigue worse.

Also helpful is to ask the question, “What is it I feeling tired about?”.  Do I find that I am physically exhausted? I used to be able to walk uptown without stopping, but now I have to stop and rest after two blocks (endurance).  I could lift my groceries into the car, but now I can’t (weakness).  I have a hard time finding joy in things (emotional). Or, I used balance my checkbook easily, but now I run out of energy (mental).  It may be a combination of all of these.  Try to be specific about what is affected. This can go a long way to identifying the source of the problem.

What will your healthcare provider do when you talk to them?  As you can imagine that depends on what you tell them.  Of course they will want to hear your story of things (take a history) and do at least some amount of physical examination (listen to your heart and lungs, etc.).  Typically, blood work or x-rays may be beneficial to help identify problems.  There may be needed input from other healthcare specialists.  And of course it may take a few visits to decide what the underlying problem may be and decide on a course of action.

The number of physical or mental problems can result in fatigue is very large.  That is why it may take time to figure it out.   In fact, for people who have struggled with fatigue longer than 6 months, an underlying problem can only be identified two-thirds of the time.  This can be very frustrating for both the patient and the healthcare provider.

So maybe your tiredness is not severe enough to visit a medical professional. What things can you do?  Beyond looking at the questions above about timing, duration and relationship to life events; there are several simple things you can do that will likely help no matter what the cause is.  Remember, I said simply…, I did not say easy.

Regular bedtime with the goal of eight hours of sleep.  Perhaps this is not possible for you.  But if you are up late because of a favorite TV program, that needs to change.  Regular exercise, even if it is just a walk can be helpful.  Remember to avoid exercising right before bed as that could cause more difficulty in getting to sleep.  A healthy diet (well balanced) and dispersed throughout the day.  Eating one large meal in the evening can cause your body to decrease your metabolism during the day (fatigue) and push the meal calories into fat while you rest at night.  Perhaps there is a habit you need to work on (alcohol decrease or elimination, stop smoking, decrease caffeine use).  That is not to say this change will fix everything, but you may feel better.

And of course during this recent time of unusual stress, social distancing and worry, consider your emotional health.   Please seek help if you believe life is becoming overwhelming.

If you are sick and tired of feeling sick and tired, give yourself a quick check up and then discuss things with your health care provider.  The answers are not always easy to find, but you do have a partner read to help you attempt to be the best you can be.