This is a complaint voiced by millions of people every day. In fact, it is estimated that at least 20 percent of people develop fatigue intense enough to interfere with their usual routines.
Fatigue – also referred to as weariness, tiredness, exhaustion, lethargy or lack of energy – is one of those conditions that challenges doctors. It’s actually hard to define fatigue because it can feel different for each individual. It can also accompany many physical ailments and can be related to depression, anxiety, not enough sleep, too much sleep, lack of exercise, too much exercise, or stress. Physical, psychological, social, cultural and behavioral factors can all contribute to fatigue.
Figuring out what’s at the root of your fatigue is no easy task. It involves a detailed review of your symptoms, medical history, lifestyle issues and possibly, testing for some common medical conditions that cause fatigue. Your doctor will proceed like a detective, asking questions, following leads and exploring possibilities. It’s often a process of trial and error. Here’s how your doctor may try to uncover the cause of your fatigue, determine which approaches are best for you, and work out a plan to help you regain your energy.
• Describing your fatigue. How long have you had it? (Fatigue due to viral infection may last a month or so and then go away. Fatigue that lasts longer needs further evaluation.) Did it start suddenly or develop gradually? (Sudden onset may be linked to a viral infection, medications, or stress. Gradual onset may be linked to anemia, depression or metabolic causes such as diabetes or an underactive thyroid.) Do you start the day already fatigued and with the level of fatigue remaining constant throughout the day? (That could indicate depression.)
• Medical history. Your doctor may ask you about medications you’re taking, eating habits, sleeping patterns, activity level, stress, how busy your days are and other symptoms you may be experiencing.
• Tests your doctor may order. These may include blood tests such as complete blood count (for anemia, infection or other problems with blood), thyroid stimulating hormone (for thyroid function), sedimentation rate (for inflammatory conditions), glucose (for diabetes), blood urea nitrogen and creatinine (for kidney function) and liver function tests. Your doctor may also do an electrocardiogram, chest x-ray or other tests specific to your situation.
• Thyroid problems. When your thyroid produces too little thyroid hormone (hypothyroidism), you may experience sluggishness, feeling cold, dry skin or constipation. If it produces too much thyroid hormone (hyperthyroidism), you may experience fatigue, tremors, muscle weakness, increased heart rate, weight loss or irritability.
• Anemia. When your red blood cell count is low and your red blood cells lose their ability to transport oxygen, this can lead to fatigue, pale skin color, sensitivity to cold, shortness of breath, lightheadedness and rapid heartbeat.
• Infections. You may be slow to recover from influenza or pneumonia, leaving you feeling fatigued. Or you may have a more serious infection, such as hepatitis.
• Sleep problems. Sleep apnea and restless leg syndrome (RLS) may interfere with sound sleep, leaving you fatigued during the day. Signs and symptoms of apnea include loud snoring, pauses between breaths and frequently gasping for air. Symptoms of RLS include creeping or tingling sensations in your legs, often relieved by moving your legs.
• Depression. Symptoms include sadness, loss of appetite, loss of pleasure in usual activities, problems concentrating and, of course, being tired.
• Diabetes. Fatigue is an early common symptom of diabetes. Other signs and symptoms include excessive thirst, frequent urination, blurred vision and recurring infections.
• Chronic Fatigue Syndrome (CFS). Fatigue accompanied by several other symptoms may mean you have CFS. These include loss of concentration, sore throat, painful and mildly enlarged lymph nodes in your neck and armpits, unexplained muscle soreness, pain that moves from one joint to another, headache, sleep disturbance and extreme exhaustion after normal exercise or exertion.
• Other health problems. Fatigue may also be associated with obesity, fibromyalgia, cardiovascular disease, lung disease, cancer, neurologic diseases and connective tissue disorders such as lupus and rheumatoid arthritis.
• Exercise gradually but steadily. Yes, it may be hard at first, but exercise builds strength and stamina and can actually make you feel less tired. Start slowly, because exercise may increase your fatigue initially. Even if you can only accomplish 10 minutes a day at first, keep working at it. Try to build up to at least 20 to 30 minutes of moderate physical activity five days a week.
• Reduce stress. Learn stress-reduction techniques such as deep breathing, progressive muscle relaxation and meditation to help manage stressful times. Allow time each day to relax. Learn how to say no, so you don’t become overextended. Pick activities that give you the most pleasure.
• Set a manageable and even pace. Pushing to do more on days you feel better may lead to days when you feel worse. To better manage your time and energy, make a list of what you have to do, set priorities so that you do only the most important items.
• Practice good sleep habits. Establish and follow a ritual for going to bed. Limit daytime naps. Don’t take work materials to bed. Take a warm bath one to two hours before bedtime. Keep your sleeping environment dark, quiet and comfortably cool. Eliminate foods and beverages containing caffeine, such as coffee, tea, cola and chocolate. And maintain a firm time for going to bed and getting up.
• Make dietary changes. Your body needs fuel for energy. That means a healthy diet and drinking plenty of water. Start your day with a low-fat, high-fiber breakfast. Throughout the day, eat small amounts more frequently – every three or four hours — versus eating three large meals a day. Include fresh fruits, vegetables, whole grains, lean meats and low-fat dairy products in your diet. Don’t fill up on high-fat or sugary foods. They tend to leave you feeling sluggish.
Yes, you don’t have to be tired of getting tired. You can fight fatigue!