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, the flu, or some other viral infection. But when you have a constant lack of energy and ongoing fatigue, it may be time to check with your doctor.
What Is Fatigue?
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, chronic kidney disease, liver disease, lung disease (COPD), a bacterial or viral infection, or some other health condition. If that's the case, then the long-term outlook is good. Here are 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 find out, 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:
- Nasal steroids
- Oral antihistamines
- 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 3 to 5 years.
Anemia and Fatigue
Symptoms: Fatigue, dizziness, feeling cold, crankiness
Anemia is the most common blood condition in the U.S. It affects more than 5.6% of 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 is a condition in which you don't have enough red blood cells. It can happen for many reasons. For instance, it may 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 lack 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. You can also add iron-rich foods such as spinach, broccoli, and red meat 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.
Postpartum depression can happen 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:
- Trouble sleeping
- Worrying too much
- Feeling "on alert" most of the time
- Feeling of impending doom
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 talk with you about treatment options, and 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.
Viral or Bacterial Infection and Fatigue
Symptoms: Fatigue, fever, head or body aches.
Fatigue can be a symptom of infections ranging from the flu to HIV. If you have an infection, you'll probably have other symptoms like fever, head or body aches, shortness of breath, or appetite loss. (They'll vary depending on what infection you have.)
Infections that may cause fatigue include:
Treating the infection often relieves your fatigue. But some infections, including mononucleosis and COVID-19, can lead to long-lasting tiredness.
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 feeling that makes it hard to concentrate.
Constant daytime fatigue with fibromyalgia often results in people not getting enough exercise. That causes a decline in physical fitness. It can also lead to mood-related problems. The best way to offset these effects is to try to exercise more. Exercise has tremendous benefits for 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. Avoid overdoing it, which could add to your fatigue.
Food Allergies, Food Intolerance, and Fatigue
Symptoms: Fatigue, sleepiness, continued exhaustion
Although food is supposed to give you energy, 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. Celiac disease, which happens when you can’t digest gluten, may also cause fatigue.
Ask your doctor about the elimination diet. This is a diet in which you cut out certain foods linked to a variety of symptoms, including sleepiness within 10 to 30 minutes of eating them, for a certain period of time to see if that makes a difference. 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 from an activity that should be easy
If you’re 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 treatments can usually help correct the problem, cut 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 shots and other forms of treatment.
Other autoimmune disorders, such as lupus and Sjogren's disease, may also cause fatigue.
Sleep Disorders and Fatigue
Symptoms: Chronic fatigue, feeling exhausted upon awakening, snoring
Sleep disorders are a group of conditions that disrupt or prevent restful, restorative sleep. That can take a toll on your health and quality of life, so it’s important to look out for signs and symptoms.
Sleep apnea is one of the most common sleep disorders. If you or your partner notices loud snoring and you wake up tired and stay that way, you could have sleep apnea. More than one-third of adults in the U.S. snore at least a few nights a week. But if the snoring stops your breathing for seconds at a time, it could be sleep apnea. Learn more about the best sleep positions and see if sleeping on your stomach is bad or not.
Obstructive sleep apnea causes low blood oxygen levels. That's because blockages prevent air from getting to the lungs. The low oxygen levels also affect how well your heart and brain work. Sometimes, the only clue that you might have sleep apnea is chronic fatigue.
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 a stroke or heart attack.
But sleep apnea is just one of many sleep disorders that cause fatigue. Other common types include:
- Insomnia: You can’t get to sleep or stay asleep through the night.
- Narcolepsy: You feel extremely sleepy during the day and may fall asleep suddenly.
- Restless legs syndrome (RLS): Your legs feel uncomfortable and you have an urge to move them as you fall asleep.
- REM sleep behavior disorder: You act out dreams in your sleep with talking, walking, or swinging your arms.
Talk with your doctor about a sleep study (polysomnogram) to find out if you have a sleep disorder. 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 stop mild sleep apnea.
Diabetes and Fatigue
Symptoms: Extreme fatigue, increased thirst and hunger, more urination, unusual weight loss
The incidence of type 2 diabetes is rising 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 if you want to stay well with type 2 diabetes. They include quitting smoking, controlling your blood pressure, and reducing your 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, about 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.
If you have been diagnosed with cancer, fatigue is often part of the disease itself or a side effect of some treatments. Cancer-related fatigue is far more severe than feeling tired if you don’t have cancer. You might feel too tired to move around, and you may also feel weak. It can happen with the more common types of cancer (such as lung cancer, colon cancer, or breast cancer); with the rarer types, such as cancers of the brain and spinal cord; and with blood cancers, which include leukemia, lymphoma, and multiple myeloma.
If you haven’t been diagnosed with cancer, feeling very tired can be a symptom, but there are many other more likely causes. If you have other symptoms, or if your fatigue doesn’t ease after you get more rest and make other lifestyle changes, see your doctor and tell them how you are feeling.
What Causes 'Your' Fatigue?
Many physical and mental illnesses, as well as lifestyle factors, can cause your fatigue, and that can make it hard to diagnose. In some cases, it might be something simple and easy to fix, like having caffeine at bedtime. But other causes, like heart disease or COPD, are serious, and you may need to start long-term treatment right away.
Your doctor can help you sift through your health issues, as well as diet, exercise, and other lifestyle habits, in order to zero in on the cause and help you on the road to recovery.