People who have just returned from a vacation often hear the same thing all day long from their coworkers: “You look so well-rested!” Whether or not it’s true (have you tried travelling with kids and/or a partner who continually complains?), that’s our standard answer to someone who’s recently taken a vacation.
There’s logic to this, too: Seventy-two percent of us are sleepy at least two days a week (excluding the windows of time immediately before bed and immediately after waking up), and forty percent of adults surveyed by the National Sleep Foundation in 2020 said that their chronic tiredness interferes with their daily activities.
Simply put, fatigue seems to be the norm for most of us, making it all the more noticeable when we seem (or at least should look) refreshed. But why do we feel exhausted all the time, and when should we start to be concerned? It turns out that getting a few extra hours of sleep each night isn’t necessarily the solution.
Fatigue can be caused by a variety of medical conditions, lifestyle choices, and environmental factors, and can have major consequences for your health. The most prevalent causes of chronic fatigue are outlined below, along with some practical suggestions for regaining your sleep.
The Distinction Between Fatigue And Sleepiness
The founder of Menlo Park Psychiatry & Sleep Medicine, Alex Dimitriu, M.D., is double board-certified in psychiatry and sleep medicine, and he says that people often use the phrases “sleepiness” and “fatigue” interchangeably when discussing sensations of exhaustion.
“Splitting the hair between ‘fatigue’ and’sleepiness’ is critical, and something I do every day as a psychiatrist and sleep specialist,” he explains. Dr. Dimitriu says, “The sleepiness one is the simple one since patients who are sleepy will often claim they could fall asleep or take a nap at some point in the day.” Feeling sleepy is the result of problems with both the quantity and quality of sleep.
On the other hand, fatigue is a very different beast. Dr. Dimitriu argues that people with exhaustion may lack energy or motivation but would not necessarily be able to fall asleep if given the chance. In a similar vein, general practitioner Chun Tang, MRCGP/DFFP at Pall Mall Medical in the United Kingdom notes that while feeling weary after a terrible night’s sleep or a hard week at work is usually no cause for alarm, feeling exhausted most of the time could be a sign of fatigue.
Dr. Tang defines fatigue as “an overpowering and prolonged feeling of exhaustion that does not improve after resting.” “Whereas tiredness normally diminishes following a comfortable sleep or rest,” The following are some of the potential causes of persistent tiredness or exhaustion.
Common Causes of Fatigue
Determining the cause of chronic or persistent fatigue is the first step in treating the condition. According to Dr. Katherine Green of UCHealth‘s Sleep Center, “fatigue is a symptom with a very wide spectrum of reasons.”
The difficulty with weariness is that different treatments are needed depending on the underlying cause. Conditions in the medical field, as well as external influences, may fall under this category.
1. Physical Health Conditions
Insomnia, thyroid problems, and vitamin inadequacy are just some of the additional medical conditions that Dr. Green mentions as potential sources of exhaustion, while sleep apnea is by far the most frequent.
Doctor of family medicine at Santa Monica’s Providence Saint John’s Health Center Julia Blank lists the following as other physical health concerns that might contribute to fatigue:
- Anemia — either related to diet (like low iron or B12 intake) or blood loss (e.g. heavy menstrual periods or ulcers)
- Conditions resulting in malabsorption of nutrients (e.g. celiac disease, inflammatory bowel diseases like ulcerative colitis or Crohn’s disease)
- Endocrine disorders can disrupt hormones that regulate important bodily functions (e.g. thyroid disease, diabetes, Cushing’s disease, hyperparathyroidism)
- Autoimmune disorders (e.g. rheumatoid arthritis, lupus)
- Side effects of certain medications, including antidepressants, anxiety medication, muscle relaxants, sleep medications, some blood pressure medications, antihistamines, and certain cancer medications
- Heart disease (e.g., coronary artery disease, congestive heart failure, certain arrhythmias)
- Lung conditions (e.g. COPD or emphysema, where oxygen delivery from the lungs is impaired and there is an increased effort needed for the lungs to continue supplying sufficient oxygen to the body)
- Infections like mononucleosis, flu, and COVID-19, as well as chronic infections like HIV and chronic hepatitis
- Being overweight
- Chronic pain
Mental Health Conditions
Dr. Dimitriu says that people whose lives are affected by mental health disorders often feel two different kinds of exhaustion. When asked about the state of his patient’s consciousness, he frequently describes a continuum between sleep and wakefulness.
People who suffer from depression and sleepiness are on one end of the spectrum, while those with anxiety are on the other end of the spectrum, being both overly alert and frequently unable to fall asleep. Fatigue, a lack of energy, and a lack of motivation are all symptoms of depression.
Dr. Dimitriu argues that people who suffer from depression are frequently not interested in doing things in the first place, in contrast to those who are fatigued but lack the energy to do it. He adds that anyone having suicidal thoughts should seek medical attention and evaluation immediately (1-800-273-8255).
People with anxiety, attention deficit hyperactivity disorder (ADHD), and, less frequently, bipolar disorder, report feeling “tired but wired,” which is exactly what it sounds like, according to Dr. Dimitriu: low energy and motivation, but being too “wired” to get enough sleep, or fall into a deep sleep.
Circumstantial Or Environmental Conditions
The majority of tiredness does not have a physical basis. Many other things and situations can also cause you to feel exhausted all the time. “Fatigue can sometimes be contextual and tied to stress at work, long-distance travel, or harmful lifestyle choices,” Dr. Tang says. “Proper sleep hygiene also includes creating a tranquil space to sleep in.
Disruptions to one’s sleep schedule and feelings of exhaustion are common outcomes of a poor sleeping environment, whether it be due to noise, light, or discomfort.” Quality of sleep is just as important to your health and daily functioning as the quantity of sleep you get. He suggests that you try to isolate the daily stresses that may be adding to your extreme fatigue so that you can eliminate some of the possible reasons.
How To Deal With Persistent Tiredness?
Once you know why you’re tired, take action. If you’re persistently weary for medical reasons, see your doctor. “A sleep study is needed to diagnose sleep apnea, and treatments range from CPAP devices to mouth guards to surgery,” says Dr. Green.
“Blood tests can indicate underlying medical issues such thyroid dysfunction or vitamin/hormone deficits. Anxiety, sadness, SAD, and migraines all have medicinal interventions that help fatigue, but it’s necessary to determine the cause.” If stress is causing your exhaustion, recommend addressing the source, which is often our work.
“In today’s fast-paced environment, many feel pressed to work long hours,” he says. Setting work boundaries and taking time to relax before bed helps encourage healthy sleep. Dr. Blank recommends sticking to a sleep schedule, exercising, and eating a nutritious diet while trying to figure out what’s making you fatigued.
When To See Your Doctor
Dr. Blank recommends seeing a doctor if your fatigue persists for longer than two weeks because of the wide range of symptoms and possible causes. Conversely, go to your doctor immediately away if you also feel chest pain, shortness of breath, persistent fever, night sweats, and/or unexplained weight loss in addition to that nagging lethargy.
Determine the root of your exhaustion as soon as possible so you can begin the healing process. According to Dr. Green, “proper identification of the underlying issue is going to be critical on successful treatment of fatigue.” If you’re receiving the recommended amount of sleep each night (at least seven hours), practicing good sleep hygiene, and yet feeling fatigued, it’s time to see a doctor.