How Tired Is Too Tired?

Do you feel like you're always tired? Are you having trouble staying awake during prime time sitcoms? Most of us know what it's like to be tired, especially when we have a cold, flu, or some other viral infection. But when you suffer from a constant lack of energy and ongoing fatigue, it may be time to check with your doctor.

Fatigue is a lingering tiredness that is constant and limiting. With fatigue, you have unexplained, persistent, and relapsing exhaustion. It's similar to how you feel when you have the flu or have missed a lot of sleep. If you have chronic fatigue,, or systemic exertion intolerance disease (SEID), you may wake in the morning feeling as though you've not slept. Or you may be unable to function at work or be productive at home. You may be too exhausted even to manage your daily affairs.

In most cases, there's a reason for the fatigue. It might be allergic rhinitis, anemia, depression, fibromyalgia, or some other health condition. If that's the case, then the long-term outlook is good. WebMD looks at some common causes of fatigue and how they are resolved.

Allergies, Hay Fever, and Fatigue

Symptoms: Fatigue, headache, itchiness, nasal congestion, and drainage

Allergic rhinitis is a common cause of chronic fatigue. But allergic rhinitis often can be easily treated and self-managed. To make a diagnosis, your doctor will assess your symptoms. The doctor will also determine through a detailed history or testing whether your allergies are triggered by pollens, insects (dust mites or cockroaches), animal dander, molds and mildew, weather changes, or something else.

One way to reduce symptoms of allergic rhinitis -- including fatigue -- is to take steps to avoid the offending allergen. In addition, proper medication can help with symptoms. Drugs that might help include:

  • topical nasal steroids (recommended)
  • non-drowsy, second generationa oral antihistamines
  • topical nasal antihistamines
  • leukotriene modifiers
  • mast cell stabilizers

 

Allergy shots -- immunotherapy -- may help in severe cases. This treatment involves weekly shots of increasingly higher solutions of the offending allergens. Allergy shots take time to be effective and are usually administered over a period of three to five years.

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Anemia and Fatigue

Symptoms: Fatigue, dizziness, feeling cold, irritability

Anemia is the most common blood condition in the U.S. It affects more than 3 million Americans. For women in their childbearing years, anemia is a common cause of fatigue. This is especially true for women who have heavy menstrual cycles, uterine fibroid tumors, or uterine polyps.

Anemia, a condition in which your don't have enough red blood cells. It can be due to blood loss or decreased production of red blood cells. It can also be the result of hemorrhoids or GI problems such as ulcers, or cancer. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin can also lead to GI problems and bleeding. Other causes of anemia include a deficiency of iron, folic acid, or vitamin B12. Chronic diseases such as diabetes or kidney disease can also cause anemia.

To confirm a diagnosis of anemia, your doctor will give you a blood test. If iron deficiency is the cause of your fatigue, treatment may include iron supplements. Iron-rich foods such as spinach, broccoli, and red meat can also be added to your diet to help relieve symptoms. Vitamin C with meals or with iron supplements can help the iron to be better absorbed and improve your symptoms.

Depression, Anxiety, and Fatigue

Symptoms: Sadness, feeling hopeless, worthless, and helpless, fatigue

Sometimes, depression or anxiety is at the root of chronic fatigue. Depression affects twice as many women as men and often runs in families. It commonly begins between the ages of 15 and 30.

Women can get postpartum depression after the birth of a baby. Some people get seasonal affective disorder in the winter, with feelings of fatigue and sadness. Major depression is also one part of bipolar disorder.

With depression, you might be in a depressed mood most of the day. You may have little interest in normal activities. Along with feelings of fatigue, you may eat too much or too little, over- or under-sleep, feel hopeless and worthless, and have other serious symptoms.

Anxiety symptoms may include:

  • agitation
  • difficulty sleeping
  • excessive worrying
  • feeling "on alert" most of the time
  • feeling of impending doom
  • nervousness

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If you are depressed or have regular symptoms of anxiety, talk to your doctor and get a physical exam. If there is no physical cause for the depression or anxiety, your doctor may prescribe medication. Or your doctor may refer you to a psychiatrist or psychologist for a psychological evaluation.

Although the specific causes of depression and/or anxiety are unclear, these are highly treatable medical problems. Medication, psychotherapy, or a combination of the two can help relieve symptoms.

Fibromyalgia and Fatigue

Symptoms: Chronic fatigue, deep muscle pain, painful tender points, sleep problems, anxiety, depression

Fibromyalgia is one of the more common causes of chronic fatigue and musculoskeletal pain, especially in women. Fibromyalgia and chronic fatigue syndrome are considered separate but related disorders. They share a common symptom -- severe fatigue that greatly interferes with people's lives.

With fibromyalgia, you may feel that no matter how long you sleep, it's never restful. And you may feel as if you are always fatigued during daytime hours. Your sleep may be interrupted by frequent waking. Yet, you may not remember any sleep disruptions the next day. Some people with fibromyalgia live in a constant 'fibro fog' -- a hazy, mental feeling that makes it difficult to concentrate.

Constant daytime fatigue with fibromyalgia often results in diminished exercise. That causes a decline in physical fitness. It can also cause mood-related problems. The best way to offset these effects is to try to exercise more. Exercise has a tremendous beneficial effect on sleep, mood, and fatigue.

If you do try swimming (or any moderate exercise) to ease fatigue, start slowly. As you become accustomed to the added physical activity, you can increase your time in the pool or gym. Set up a regular time for exercise, but watch overdoing it to avoid added fatigue.

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Food Allergies, Food Intolerance, and Fatigue

Symptoms: Fatigue, sleepy, continually exhausted

Although food is supposed to give you energy, new medical research suggests that hidden food intolerances -- or allergies -- can do the opposite. In fact, fatigue may be an early warning sign of food intolerance or food allergy.

Ask your doctor about the elimination diet. This is a diet in which you cut out certain foods that cause a variety of symptoms, including sleepiness within 10 to 30 minutes of eating them. You can also talk to your doctor about a food allergy test -- or invest in a home test such as ALCAT -- which may help you identify the offending foods.

 

Heart Disease and Fatigue

Symptoms: Fatigue with an activity that should be easy

If you find yourself becoming exhausted after an activity that used to be easy -- for example, walking up the steps -- it may be time to talk to your doctor about the possibility of heart disease. Heart disease is the leading cause of death in women. If your fatigue is related to your heart, medication or treatment procedures can usually help correct the problem, reduce the fatigue, and restore your energy.

Rheumatoid Arthritis and Fatigue

Symptoms: Fatigue, morning stiffness, joint pain, inflamed joints

Rheumatoid arthritis (RA), a type of inflammatory arthritis, is another cause of excessive fatigue. Because joint damage can result in disability, early and aggressive treatment is the best approach for rheumatoid arthritis.

Medications that may be used early in mild RA include:

  • nonsteroidal anti-inflammatory drugs (NSAIDs)
  • disease-modifying antirheumatic drugs (DMARDs)

Other drugs used in more serious forms of RA include the anti-cytokine therapies (anti-tumor necrosis factor alpha agents), as well as injections and other forms of treatment.

Sleep Apnea and Fatigue

Symptoms: Chronic fatigue, feeling exhausted upon awakening, snoring

According to the National Sleep Foundation, more than one-third of adults in the U.S. snore at least a few nights a week. If snoring is associated with periods when breathing stops, a condition called sleep apnea, a person may have daytime sleepiness and excessive fatigue.

Obstructive sleep apnea results in low oxygen levels in the blood. That's because blockages prevent air from getting to the lungs. The low oxygen levels also affect your heart and brain function. Sometimes, the only clue that you might have sleep apnea is chronic fatigue.

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Talk with your doctor about a sleep study (polysomnogram) to determine if you have sleep apnea. Lose weight if you are overweight, and if you smoke, stop. Both obesity and smoking are risk factors for sleep apnea. Sleeping on your side instead of your back may help eliminate mild sleep apnea.

Your doctor may prescribe a medical device called CPAP that helps keep your airways open while you sleep. In severe cases of sleep apnea, surgery may help. The surgeon will remove tissues that are blocking the airways. If left untreated, sleep apnea can increase your risk of stroke or heart attack.

Type 2 Diabetes and Fatigue

Symptoms: Extreme fatigue, increased thirst and hunger, increased urination, unusual weight loss

The incidence of type 2 diabetes is escalating in children and adults in the U.S. If you have symptoms of type 2 diabetes, call your doctor and ask to be tested. While finding out you have diabetes may be frightening, type 2 diabetes can be self-managed with guidance from your doctor.

Treatment for type 2 diabetes may include:

  • losing excess weight
  • increasing physical activity
  • maintaining strict blood glucose control
  • taking diabetes medications (insulin or other drugs)
  • eating a low glycemic index carbohydrate diet, or, though controversial, a low-carbohydrate diet

Other lifestyle measures are important in staying well with type 2 diabetes. They include smoking cessation, blood pressure control, and reduction in cholesterol.

Underactive Thyroid (Hypothyroidism) and Fatigue

Symptoms: Extreme fatigue, sluggishness, feeling run down, depression, cold intolerance, weight gain

The problem may be a slow or underactive thyroid. This is known as hypothyroidism. The thyroid is a small, butterfly-shaped gland that sits at the base of your neck. It helps set the rate of metabolism, which is the rate at which the body uses energy.

According to the American Thyroid Foundation, approximately 17% of all women will have a thyroid disorder by age 60. And most won't know it. The most common cause is an autoimmune disorder known as Hashimoto's thyroiditis. Hashimoto's stops the gland from making enough thyroid hormones for the body to work the way it should. The result is hypothyroidism, or a slow metabolism.

Blood tests known as T3 and T4 will detect thyroid hormones. If these hormones are low, synthetic hormones (medication) can bring you up to speed and you should begin to feel better fairly rapidly.

WebMD Medical Reference Reviewed by Minesh Khatri, MD on 0/, 017

Sources

SOURCES:

American College of Rheumatology: "Rheumatoid Arthritis."

American Diabetes Association: "Type 2 Diabetes."

American Heart Association: "Women, Heart Disease, and Stroke."

National Fibromyalgia Association: "What is Fibromyalgia?"

National Institutes of Health: "Depression."

National Sleep Foundation: "Snoring...No Laughing Matter."

WomensHealth.Gov: "Hashimoto's Thyroiditis."

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