Chronic Fatigue: Tired of Feeling Tired?

Learn what may be causing your chronic fatigue ... and 10 solutions.

From the WebMD Archives

Sure, we all know what it feels like to be tired. But chronic fatigue refers to a lingering tiredness that is constant and limiting.

According Harris H. McIlwain, MD, Tampa-based rheumatologist and author of The Fibromyalgia Handbook, patients who complain of fatigue feel tired even when they've had plenty of sleep and should feel rested.

While some patients admit to feeling sleepy, with fatigue there's usually there's a feeling of exhaustion without feeling drowsy says McIlwain, an adjunct professor at the University of South Florida. "Some patients with fatigue compare it to having the flu or to the feeling after working very long hours and missing a lot of sleep."

These patients say they are fatigued on arising in the morning, fatigued after mild activity such as grocery shopping, too fatigued to function adequately at work or do household chores, and too fatigued to exercise or have sex, McIlwain says. "In most cases, there's a reason for the fatigue, whether poor time management, too much caffeine, anemia, fibromyalgia, depression, or even undiagnosed heart disease."

Before you blame your age or your "superwoman" lifestyle on your feelings of fatigue, learn what might be at the root of your unexplained tiredness and what some top experts recommend to resolve your chronic fatigue.

Chronic Fatigue Cause No. 1: Time-Stacking

For many women who suffer from fatigue, the diagnosis is "time-stacking" or multitasking to the max and not getting enough sleep.

"If you're juggling kids, careers, and a long list of commitments and only getting five or six hours a night, it will catch up with you, says McIlwain.

But what if you're a healthy woman, getting eight hours of sleep nightly, and still feel fatigue? McIlwain recommends a checkup to see if there are any health problems to blame for the fatigue.

If you feel fatigued for longer than a week or two and you're getting plenty of sleep and you don't have a cold or other viral infection, McIlwain says to call your doctor. "Most of the time fatigue has a fairly straightforward explanation, and sometimes medical treatment is necessary."

Fatigue can also be the sign of a serious illness, which is why your doctor may be able to quickly diagnose the problem.

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Chronic Fatigue Cause No. 2: Caffeine Overload

Many of us grab an espresso, latte, or cola for a quick burst of energy, but for some women, caffeine has the opposite effect.

In an article published in the journal US Pharmacist, W. Stephen Pray, PhD, RPh, reports that caffeine is a stimulant, but if you take too much, the tables can turn.

"In some patients, continued abuse results in fatigue," says Pray. And if you think this means you simply require more caffeine to get the kick, this isn't the case. "Any attempts to solve the problem by increasing caffeine intake causes the fatigue to worsen," he says.

The solution to caffeine overload? Eliminate as much caffeine from your diet as possible. This means not only cutting out coffee. Chocolate, tea, soda, and even some over-the-counter and prescription medications also contain caffeine and could be causing unexplained fatigue.

Chronic Fatigue Cause No. 3: Anemia

"If you are in your reproductive years, and particularly if you experience heavy menstrual cycles, have fibroid tumors or uterine polyps, or if you've recently given birth, the blood loss may have caused you to develop anemia -- a leading cause of fatigue in women," says Rebecca Amaru, MD, clinical instructor of obstetrics and gynecology at the Mount Sinai Medical Center in New York City.

Problems occur, she says, when the bleeding leads to a deficiency of hemoglobin, the iron-rich protein in red blood cells that carries oxygen from the lungs to other parts of your body. When your tissues and organs don't get enough oxygen, she says, the result is fatigue.

Other causes of anemia include internal bleeding and a deficiency of iron, folic acid, or vitamin B-12. Anemia may also be caused by chronic diseases like kidney disease. Symptoms can include dizziness, feeling cold, and irritability.

To confirm a diagnosis of anemia, your doctor will give you a blood test. Treatment, she says, usually consists of iron supplements if iron deficiency is the cause, and adding iron-rich foods -- such as spinach, broccoli, and red meat -- to your diet.

The good news: With effective treatment for anemia, your fatigue should begin to lift in 30 days or less.

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Chronic Fatigue Cause No. 4: Undiagnosed Urinary Tract Infection (UTI)

Although most women associate a urinary tract infection with symptoms such as burning or urgency, sometimes fatigue is the only clue.

In most instances, a UTI is caused by bacteria in the urinary tract, often the result of improper bathroom hygiene (wiping back to front, for example). Sexual intercourse can increase the risk because it can push bacteria from the vagina into the urethra.

If your doctor suspects that you have a UTI, your urine will be tested. Treatment is quick and easy, and usually involves an oral antibiotic medication. You can expect the fatigue to lift within a week or less if the antibiotic works effectively.

If your symptoms return, get tested again. Some women have chronic UTIs, which are very difficult to resolve. If this is your case, ask your doctor about preventive care, which may include low dose antibiotics.

Chronic Fatigue Cause No. 5: Fibromyalgia

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.

Fibromyalgia is one of the most common causes of relentless fatigue and muscle pain, especially in women, Mcllwain says.

"Many of my fibromyalgia patients complain that no matter how long they sleep, it's never restful, and they're always fatigued during daytime hours. Their sleep may be interrupted by frequent awakening, yet they may not remember these sleep disruptions the next day and 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, causing worsened physical fitness and mood-related problems. The answer? Try to exercise more. Exercise has a tremendous effect on sleep, mood, and fatigue.

Mcllwain encourages fibromyalgia patients to try swimming to ease fatigue. "A heated pool helps relieve the deep muscle pain and discomfort, so you can be more active in the water. Swimming helps ease anxiety and stress, and increases the chances of more restful sleep, which may help resolve the 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. Set up a regular time for exercise yet watch overdoing it to avoid added fatigue.

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Chronic Fatigue Cause No. 6: Underactive Thyroid (Hypothyroidism)

If you are generally sluggish, run down, and even a little depressed, the problem may be a slow thyroid, also known as hypothyroidism. The thyroid is a small, butterfly-shaped gland that sits at the base of your neck and helps set the rate of metabolism, the rate at which the body uses energy.

According to the American Thyroid Foundation, by age 60 about 17% of all women will have a thyroid disorder and most won't know it. The most common cause, they say, 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.

Chronic Fatigue Cause No. 7: Food Allergies

While food is supposed to give us energy, some doctors believe hidden food intolerances -- or allergies -- can do the opposite. According to Rudy Rivera, MD, author of Your Hidden Food Allergies Are Making You Fat, even mild food intolerance can leave you feeling sleepy. Eat the offending food long enough and you could find yourself feeling continually exhausted.

"Evidence indicates food intolerance as a cause of fatigue, and even suggests that fatigue may be an early warning sign of food intolerance," Rivera says.

If you suspect that food may be behind all that yawning, Rivera says to start with an elimination diet, cutting out foods that cause you to feel sleepy within 10 to 30 minutes of eating them. You can also talk to your doctor about a food allergy test.

Chronic Fatigue Cause No. 8: Sleep Apnea

If you're not getting enough sleep, it stands to reason you'll feel fatigued. But what if you don't realize that your sleep is insufficient? This happens to millions of people with a condition called sleep apnea, a sleep disorder that causes you to momentarily stop breathing, often many times during the night. Each time you stop breathing, you awaken just long enough to disrupt your sleep cycle, usually without being aware of it.

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More than one-third of adults in the U.S. report that they snore at least a few nights a week, according to the National Sleep Foundation. Snoring is caused by the vibration of the soft parts of the throat while breathing in and out during sleep. Sometimes snoring can account for daytime symptoms such as excessive fatigue.

But with sleep apnea, a condition related to snoring, there are repeated periods when breathing stops during sleep.

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

What can you do? First, talk with your doctor about a sleep study to determine if you have sleep apnea. Both obesity and smoking are risk factors for sleep apnea, so losing weight and quitting smoking are recommended. Sleeping on your side instead of your back may help eliminate mild sleep apnea.

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

Chronic Fatigue Cause No. 9: Depression

Sometimes depression is at the root of fatigue. Depression affects twice as many women as men and often runs in families, starting between the ages of 15 and 30. Women can also get postpartum depression after the birth of a baby. Some people get seasonal affective disorder in the winter with feelings of fatigue and sadness. Depression is also one part of bipolar disorder.

According to Ronald Fieve, MD, psychopharmacologist and professor of clinical psychiatry at Columbia Presbyterian Medical Center in New York, mood is a dominant aspect of life. In his book, Bipolar II, Fieve explains that mood disorders are a large group of psychiatric conditions. Abnormal moods and physical disturbances -- like changes in eating habits, sleep patterns and body motion, either speeded up or slowed down -- dominate the picture.

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While feeling low from time to time is normal,major depression needs medical treatment; it is a risk factor for suicide. This medical problem is usually recurrent, with repeated depressive episodes. With major depression, you might be in a depressed mood most of the day with little interest in normal activities, Fieve says. "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."

Fieve says that the diagnosis of depression begins with a physical exam by a doctor. If a physical cause for the depression is ruled out, your doctor may prescribe medication or refer you to a psychiatrist or psychologist for a psychological evaluation.

While the specific causes of depression are unclear, depression is a highly treatable medical problem with antidepressant medications, psychotherapy, or a combination of the two. In some cases, electroconvulsive therapy or ECT is used to treat patients who are unable to take antidepressants, or who suffer from extreme depression.

Chroniuc Fatigue Cause No. 10: Undiagnosed Heart Disease

If you find yourself becoming exhausted after activity that used to be easy, it may be time to talk to your doctor about the possibility of heart disease.

According to Nieca Goldberg, MD, director of the NYU Medical Center Women's Heart Program and associate professor at the NYU School of Medicine, when overwhelming fatigue sets in after ordinary tasks -- such as vacuuming the house, doing yard work, or commuting from work each day -- your heart may be sending out an SOS that it needs medical attention.

"This doesn't mean that you should panic every time you yawn," says Goldberg. "Most of the time, fatigue is not the first sign of heart disease, and it's usually linked to something far less serious."

At the same time, Goldberg points out that heart disease is the leading cause of death in women. "If fatigue following activity is significant, and no other possible reason comes to mind, see your doctor for a checkup," she advises. 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.

WebMD Feature Reviewed by Brunilda Nazario, MD on February 25, 2008

Sources

SOURCES:

Harris H. McIlwain, MD, rheumatologist, adjunct professor, University of South Florida, Tampa; author, TheFibromyalgia Handbook, 3rd Edition.

Ronald R. Fieve, MD, psychopharmacologist, professor of clinical psychiatry, Columbia Presbyterian Medical Center, New York City; author, Bipolar II.

Nieca Goldberg, MD, director, NYU Medical Center Women's Heart Program; associate professor, NYU School of Medicine, New York City.

Rebecca Amaru, MD, clinical instructor of obstetrics and gynecology, Mt. Sinai Medical Center, New York City.

W. Stephen Pray, PhD, RPh, Southwestern Oklahoma State University, Weatherford, Okla.

Rudy Rivera, MD, author, Your Hidden Food Allergies Are Making You Fat.

WebMD Feature: "Living with Fibromyalgia and Chronic Fatigue."

WebMD Feature: "Why Am I So Tired?"

WebMD Medical Reference from Healthwise: "Sleep Apnea --Treatment Overview."

WebMD Medical Reference provided in collaboration with Cleveland Clinic: "Depression: Detecting Depression."

WebMD Medical Reference from Healthwise: "Hypothyroidism."

© 2008 WebMD, LLC. All rights reserved.

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