Tiredness & fatigue

Fatigue is the feeling of being tired all the time, even after you have rested. Most of the time fatigue is your bodies way of saying "slow down".

Tiredness and fatigue can be a sign that some part of your life is out of balance.

It is unusual for tiredness on its own to be a sign that there is anything medically wrong. However, if you are getting enough sleep and generally have a healthy, low-stress lifestyle and are still experiencing fatigue. talk to your doctor. It could be a symptom of an underlying medical problem such as iron deficiency or thyroid problems. 

Key points

  1. One in 5 people feel tired most of the time and 1 in 10 people experience ongoing tiredness.
  2. Women tend to feel more tired than men.
  3. See your doctor if your tiredness is combined with any of the following: heavy periods, weight loss, a change in bowel habits, hair loss or extreme thirst.
  4. Blood and urine tests can rule out medical reasons such as anaemia, diabetes or underactive thyroid gland.
  5. Once a medical reason has been ruled out, try to identify stressors or events in your life that may have triggered or be contributing to your tiredness.

What is fatigue?

Fatigue is the feeling of being tired all the time. It is different from the feeling of sleepiness you get at bedtime or tiredness you have after a late night. Fatigue is the sense of having such low energy that you have little or no motivation to do your regular daily activities. Fatigue may be physical (in your body) or psychological (in your mind).

People at greatest risk of fatigue include:

  • women
  • people with low income
  • people with physical or mental illness.
image of woman with a headache or feeling overwhelmed

Causes

Most of the time fatigue is not due to just one thing, but rather to a combination of factors. Fatigue is an important body response to life stressors such as:

The following factors may, alone or in combination, provide some explanation for fatigue:

Physical

There are some physical problems that can make you feel tired. These include things like anaemia, thyroid problems, food intolerances and diabetes. If you have fatigue plus any of the following, see your doctor for a proper check:

These may be symptoms of an underlying medical problem.

It is also common to feel tired when you are under or overweight and when you are pregnant or breastfeeding.

Psychological

Even though we may feel symptoms of fatigue in our body, psychological causes of tiredness are much more common than physical ones. Psychological causes include:

  • Anxiety – worrying about something so much that it keeps you up at night is a major cause of sleep-deprivation and persistent fatigue.
  • Emotional shock – bad news, such as the death of a loved one or a devastating natural disaster, can leave you feeling shaken and drained.
  • Daily stressors – everyday activities, such as getting children ready for school or juggling work/life balance can be tiring. Even positive one-off events, such as planning a wedding, can be emotionally exhausting.
  • Depression – feeling tired is a common symptom of depression.

Lifestyle 

Don’t underestimate just how exhausting daily life can be. Tiredness can also be caused by personal habits, such as:

  • Drinking too much alcohol: Drinking alcohol in the evening tends to make you wake up in the middle of the night. Alcohol is also a depressant and drinking too much on a regular basis can affect your mood and your sleep.
  • Having a disturbed sleep pattern: Going to sleep at the same time every night and waking up at the same time every morning helps set your body's natural sleep-wake cycle. Shift work, looking after small children or even just sleeping in on the weekend, can throw this off balance. This means your body wants to be sleeping at times when you want to be awake.
  • Drinking too much caffeine: Caffeine is a stimulant which can stress the nervous system and cause insomnia.
  • Not exercising regularly: Keeping active is one of the best things you can do to reduce stress levels and anxiety, help you sleep better at night and improve your general sense of well-being.
  • Poor diet: Foods high in sugar or caffeine provide a short-term energy boost that quickly wears off, making you feel more tired.  A healthy, balanced diet with plenty of fruit, vegetables and whole grains provides your body and immune system with the energy and nutrients it needs to function at its best.

If you are getting enough sleep, eating a balanced diet and generally have a healthy, low-stress lifestyle – and are still experiencing ongoing fatigue, seek advice from your doctor.

Symptoms

Fatigue can cause a wide range of additional symptoms including:

  • Physical: feeling tired all the time, headaches, lightheadedness, sore, aching or weak muscles, loss of appetite, prone to getting sick.
  • Mental: slowed reflexes and responses, poor decision-making and judgement, short-term memory problems, poor concentration.
  • Emotional: moodiness, irritability, low motivation, feeling depressed and hopeless.

Diagnosis

Finding a specific cause for fatigue can be difficult and often there is no medical explanation or diagnosis. However, it is worth working through some of the questions a doctor may ask such as:

  • Do you feel drowsy or weak?
  • Do you feel down or depressed?
  • Has your fatigue developed slowly or suddenly?
  • Is it cyclical or constant?
  • What do you think may be the cause?
  • Have you experienced any significant life events recently?
  • Is your life in balance? Consider work, relationships, physical, emotional, social, sense of worth and recreation.

To try and understand the root cause of your ongoing tiredness, your doctor may also:

  • Take your sleep history. How much sleep do you get each night? What is your sleep quality like? Do you wake or stop breathing in the night, or snore?
  • Do a physical examination to check for signs of illness or disease.
  • Tests – To rule out physical causes, blood tests, urine tests and other investigations may be conducted.

Treatment

Treatment is focused on the underlying cause of tiredness. If there is no medical cause for fatigue, treatment will focus on lifestyle factors that may be causing the problem (see: self help). Talking therapy may be useful if:

  • you are worried or anxious
  • you have experienced a shocking life event
  • you are feeling low or depressed.

Self care

Often feeling tired all the time is due to a combination of factors, including stress, not getting enough sleep and poor diet. Taking steps towards reducing the stress you are under, getting more sleep and giving your body the fuel it needs will help boost your energy. You may find it helps to:

Eat small amounts often

  • Small, well-balanced meals can help regulate your blood-sugar levels and prevent energy slumps.

Take exercise breaks 

  • Feeling tired at your desk? A short 15 minute walk can give you an energy boost.
  • Be active in the day. Regular exercise improves sleep, (but is best not done just before going to bed). Aim to exercise for 2 ½ hours per week.
  • Start small and build up.
  • If you feel too tired to exercise, this can be a signal things are out of balance and building up your exercise levels can be one of the best ways to turn this around and help you regain your energy and zest for life.

Lose weight, gain energy

  • It takes a lot of energy to carry extra weight around. Aim to keep your weight within the healthy range for your height and you’ll feel much more energetic.

Gain weight, gain energy

  • If you are underweight, your muscles may not be strong enough to support your body. You may also use more energy keeping warm.

Get a good night's sleep 

  • Go to bed at the same time and wake up at the same time even on the weekends so that you are in sync with your body's natural sleep/wake cycle.
  • Avoid caffeine and alcohol before bed. Keep your bedroom dark, cool and quiet; a place for rest only.

De-stress 

  • Stress can be exhausting. Sometimes just acknowledging that something is stressing you out can make you feel better.
  • Try to do something you find relaxing everyday, whether it be going for a walk, reading a novel, meditating, listening to music or having a bath.
  • Set aside some time just for yourself.

Cut out caffeine 

  • Gradually cut down on caffeine over a 3 week period. Stay off caffeine for a month to see if you feel less tired without it.

Cut down on alcohol before bedtime 

  • Having a few drinks before bed may help you asleep, but it makes you sleep less deeply. Even if you sleep for 8 hours, you’ll still feel tired in the morning.

Drink water 

  • Being dehydrated can make you feel tired.
  • Ongoing tiredness can rob you of your zest for life. Making changes in your lifestyle habits can help you feel more energized, but it will take time to see the full benefit.
  • If you've tried all of the above and nothing seems to be working, seek advice from your doctor.

Learn more

Tiredness Royal College of Psychiatrists, 2012
The laboratory investigation of tiredness  Best Practice Advocacy Centre New Zealand NZ

Credits: Alana Hawke for Health Navigator, May 2014.