7 reasons why you may be so tired
“If I’m so healthy, why am I tired all of the time?” asked my patient, a 47-year-old mother. I had examined her, reviewed her lab tests, and assured her that all was well. But her complaint is one I hear every day.
Surveys of primary care medical practices in the U.S. show that patients mention moderate to severe fatigue in about a third of all office visits. A study reported in the Archives of Internal Medicine screened 1,000 patients with complaints of severe fatigue. About two-thirds of the cases were associated with identifiable diseases (anemia, diabetes, heart disease, lung disease, or rheumatoid arthritis); a third of them, however, had no definable cause.
Take notes on tiredness
If you notice a similar problem, these questions might lead your doctor to an accurate diagnosis:
1. Was the onset of fatigue sudden? If it was, the cause is usually physical. A gradual onset may have an emotional component.
2. Do you feel better after a good night’s sleep? Sleep deprivation is rampant today. In a landmark 2006 report, the Institute of Medicine recommended 7 to 8 hours of sleep as optimal for adults. But in 2011, a survey in the journal Preventive Medicine found that more than one in three adults failed to get that amount (that number doubled for adolescents).
Even if one gets sufficient sleep, the quality might not be top-notch. REM sleep, characterized by rapid eye movement, is the most beneficial type, and its absence can contribute to fatigue. A clue to non-REM sleep is the lack of dreaming, but to be certain, a sleep study is necessary. Apnea, in which the sleeper’s breathing stops and starts repeatedly, is a common disorder that disrupts sleep. (It’s often accompanied by severe snoring.)
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3. Are you confusing muscle weakness with fatigue? Sometimes the loss of strength (trouble lifting a suitcase, for example) can be mistaken for tiredness. Early symptoms of neurological disorders such as Parkinson’s disease or multiple sclerosis may seem like fatigue.
4. Are you experiencing menstrual irregularities? Fatigue is common in early pregnancy, and the flushes and nocturnal sweating associated with menopause deprive many women of sleep.
5. Do you have other symptoms? They can indicate a specific condition, for example, weight loss (cancer, an overactive thyroid), decreased libido (hormone-deficiency disease), changes in bowel habits (celiac disease, colitis), and shortness of breath (anemia, heart failure, lung problems).
6. Do you have an infection that’s not apparent? Your doctor might suspect an underlying problem, such as toxoplasmosis if you touched cat litter, brucellosis if you’ve done farmwork, or a tick-borne illness such as Lyme disease if you spent time in the woods.
7. Do you take drugs that might cause fatigue? Almost all of them can, but some prime offenders are beta-blockers (atenolol, metoprolol), diuretics (furosemide, hydrochlorothiazide), painkillers (gabapentin, opioids), antihistamines (chlorpheniramine, diphenhydramine), antidepressants (citalopram, sertraline), and anti-anxiety drugs (diazepam, lorazepam). If you’re utterly exhausted, your doctor might lower your dosage or change the medication altogether.
As my patient pondered those questions, the cause of her fatigue became apparent. In addition to running a household and coping with two rebellious teenagers, she was hosting holiday parties and shopping for gifts. That stress was on top of holding down a part-time job as a paralegal. She had been making mistakes at work, and her relationships with her husband and children were in turmoil. After talking things over with her husband, she got household help and began seeing a therapist. A month later she was no longer tired and was actually able to enjoy the holiday season.
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This article also appeared in the December 2014 issue of Consumer Reports on Health.
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