We all feel tired from time to time, but the kind of tiredness and fatigue that leaves you struggling to live a normal life, can be a warning sign, and needs investigating.
This problem is remarkably common. According to the Royal College of Psychiatrists at any one time one in five people feels unusually tired, and one in 10 have prolonged fatigue.
There are a range of medical conditions that can cause this kind of debilitating exhaustion. We’ve looked at some of the most common, with their symptoms.
When tiredness is ever-present or starts to interfere with normal living, it needs to be investigated properly. First, you need to rule out a physical cause with the help of your GP. The commonest ones are:
- glandular fever
- thyroid problems
Most doctors will take blood and urine tests to check for these.
However, it's estimated that comparatively few cases of fatigue actually have a physical cause.
It's more likely to be down to stress, depression, boredom, poor sleep habits or simply being very busy. Getting the right amount of exercise and relaxation, eating the right food at the right times and having the necessary amount of sleep can all help you to get your energy back.
Tired all the time (TATT) is a wide-ranging condition and causes and treatments will vary from one person to another. Conventional medicine may help some people, but for others a complementary medicine approach may be more successful.
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Medical conditions that could be causing tiredness
Anxiety, stress and depression
Mental health issues can play havoc with your sleep. If you are feeling stressed or anxious it can be hard to get off to sleep because of the thoughts and worries buzzing about in your head. You can also struggle with disturbed sleep, and wake up throughout the night, or have nightmares, and even start sleep walking.
If you struggle with these sleep problems for some time, they can then be the cause of more anxiety and/or phobias about getting off to sleep. This can make your sleeping problem even worse.
Depression can also lead to sleep disruption, particularly disturbed sleeping patterns, especially sleeping through the day. Oversleeping can bring on insomnia, exacerbating your sleep problems. And if you aren’t sleeping well, or for long enough, this can leave you feeling utterly exhausted, and struggling with daily life.
Talk to your GP about ways to help tackle the underlying problems of anxiety, sleep and depression, and take a look at the article on how to sleep better at night.
Iron deficiency anaemia can make you feel tired because having this condition means that you have fewer red blood cells than you should have. Iron is used to create your red blood cells. These then help to carry oxygen in your blood to organs and body tissue. Not having enough red blood cells means that vital parts of your body don’t get enough oxygen, which leaves you feeling exhausted.
Talk to your GP about having a blood test. If you are anaemic they may suggest taking iron supplements to bring your iron levels back to normal.
Chronic Fatigue Syndrome (CFS)/Myalgic Encephalomyelitis (ME)
The main symptom of this condition is long-term tiredness (fatigue), which is so extreme that its effects are disabling. The fatigue that comes with CFS/ME has a starting point – you may remember when you suddenly started feeling overwhelmingly tired – and feels quite different to other kinds of tiredness. If you’ve had a physically active day, you’re likely to feel even more fatigued on the following day. This can last for a few days before it starts to improve.
Other symptoms can include:
- poor and erratic sleep patterns
- painful joints and muscles
- poor concentration
- poor memory
It’s estimated that about 260,000 people in the UK have chronic fatigue syndrome, but that figure could be higher. The symptoms can start to show quite gradually, but can also come on more suddenly, over just a few days.
CFS/ME can develop at any age, and can wax and wane, lasting from a few months, to decades. The symptoms can go, and you can have long periods feeling better, but it can reappear, and knock you for six again.
The severity of symptoms can vary too. Some people go through periods when CFS/ME fluctuates, so they have good and bad patches. The bad periods can be brought on by high stress levels, high or low temperatures, and illness or surgery.
A smaller group of people with CFS/ME has more severe symptoms that means that they need long-term help and support.
A fairly small section of all of those affected with this condition do regain their health, although this can take quite a long time.
In a few cases, people with CFS/ME can carry on deteriorating, which is unusual in this condition. In these cases it’s important to see an expert, so that other conditions can be ruled out.
According to the ME Association, there is no accepted cure for this condition, and there is no robust evidence for an effective treatment that works for all people with ME.
You can find out more about ME/CFS at meassociation.org.uk
Type 2 Diabetes is a complex condition, and symptoms include extreme tiredness and fatigue in people with diabetes.
People with diabetes have a high blood sugar level, (either because of a lack of insulin, or from insulin resistance) which is caused when insulin levels are too high for too long. This is because the high blood sugar levels can interfere with how well your body can transfer glucose from your blood to your cells. This then affects the amount of energy you have, and can make you feel extremely tired. Ask your GP to check you for diabetes.
If you are taking drugs for diabetes, you need to monitor your blood sugar levels as these drugs can cause blood sugar levels to drop too low. This is known as hypoglycaemia, and it when it happens it will make you feel very tired. If this happens, you, someone close to you or a doctor need to raise your low blood glucose levels, quickly.
We all have a thyroid gland (it’s positioned in your neck), which produces two hormones that travel around your body in your blood. They are thyroxine (T4) and triiodothyronine (T3), and their job is to make sure that all the cells in our bodies do their jobs and work normally.
However, the thyroid gland can be damaged, by an assault from the immune system, or by the treatment for an overactive thyroid. This can leave you with an underactive thyroid gland – also known as hypothyroidism – which produces too little of the thyroid hormones you need to keep your body running smoothly.
One of the main symptoms of an underactive thyroid is tiredness, but you may also have a slower than normal heart rate, depression, and aching muscles.
In the UK about 2% of the population has hypothyroidism, and 5% of over 50s, however the number could be much higher, with many people not realising that they have a thyroid disaster. Women are more likely to have an underactive thyroid than men.
A blood test can check your hormones, and confirm if you have an underactive thyroid gland. Your doctor will be able to prescribe hormone replacement tablets – levothyroxine – which boosts your thyroxine levels, and should make you feel better.
Vitamin D deficiency
Vitamin D is important for our health in many ways – keeping our bones and teeth strong and healthy for instance. It’s only relatively recently that scientific studies have found that lack of vitamin D can cause tiredness and fatigue in people who are otherwise healthy.
Our main source of vitamin D is sunshine. When sunshine hits our bare skin our bodies can create vitamin D. Be careful not to overdo it, and stay out in the sun for too long without protection as you may burn. Spending a short period of time in the sun every day, without suncream, and with bare arms and lower legs from April to September should be enough to make the vitamin D you need.
You can also get vitamin D from foods, including some breakfast cereals, oily fish (salmon, mackerel, sardines and herrings), eggs and red meat. Vitamin D tablets can also help top up your levels.
Lifestyle habits that could be causing tiredness
Even mild dehydration can severely hamper your energy levels: researchers at the University of Connecticut found that both men and women struggle to perform simple tasks when they haven't taken in enough fluids.
Another study, from Loughborough University, found that dehydrated drivers make the same number of mistakes as drunk drivers. So next time you're feeling tired, drink a glass of water and see what a big difference it can make.
Smokers tend to suffer poorer sleep quality than non-smokers, according to a German study. The reason? Researchers believe it may be due to the stimulating effects of nicotine. 'If you smoke and suffer from sleep problems, it's another good reason to quit,' says lead researcher Stefan Cohrs.
Pets on the bed
Nearly 60% of pet-owners allow their cats or dogs to sleep in the bedroom, according to a study at the Mayo Clinic Sleep Disorders Center in the US. And more than half of these animal-lovers admit their sleep is disrupted to some extent by their four-legged friends. Don't want to lock Rover or Tiddles out of the bedroom? It may still be wise to employ some damage limitation: you could invest in a timed pet-feeder to avoid being woken up when the cat fancies an early breakfast, for instance.
Your mattress is worn out
A bed's quality may deteriorate by as much as 70% from its new state after 10 years, according to a study carried out by the Furniture Industry Research Association. Even after just six years, your mattress could offer significantly less support than a new one, due to wear and tear from body weight, movement, sweat, skin, hair and other debris. So you spend much of the night trying to get comfortable, which means your sleep quality is impaired.
You aren't getting fresh air
Spend most of the day indoors – particularly during winter – and your brain will respond to the lack of natural light by producing more of the sleep hormone, melatonin. So you'll constantly feel ready for bed, even after a good night's slumber. The solution? Make sure you spend time outdoors every day, even if it's just pottering in the garden.
You're too sedentary
Sitting in the same position for long periods of time can make you feel sleepy. Even if your brain is engaged in looking at the computer or TV, you need to remind the rest of your body you're awake. Do remember to get up, stretch and move around as often as you can. Two minutes of exercise every hour has been found to have a positive impact on your health.
You're drinking alcohol before bed
Even just one or two alcoholic drinks close to bedtime can interfere with your sleep quality. On a normal night, you'd usually have six or seven cycles of deep slumber alternating with lighter, rapid eye movement (REM) sleep. But if you've been drinking, you'll typically only have one or two, so may wake up exhausted.
How to prevent tiredness
If you are constantly feeling tired it is best to speak to your doctor to first rule out any medical conditions. However, if your GP has found no medical issues to cause tiredness there are some steps you can take to boost your energy levels.
"Lack of energy can be down to a poor choice of foods," says Jayne Nelson, former spokesperson for the British Association of Nutritional Therapists.
"Stimulants and sweet items, such as coffee, cigarettes and sugars, can make glucose levels go very high then fall very low, and can lead to long-term fatigue and nutritional deficiency," says Nelson.
"Hypoglycaemia occurs when blood sugar levels drop very low and the person becomes weak, tired and dizzy." This can result from choosing foods that have you lurching between high-energy and low-energy modes.
To boost energy, says Nelson, we need to swap stimulants for slow-release carbohydrates and fresh, unprocessed foods.
She also warns that ‘habit foods' - things we eat all the time that may not be particularly good for us - can cause problems. However, she stresses that fatigue is a huge subject and that individual solutions need to be sought.
"Tiredness is usually associated with something else,' she says. If you can't find the answer on your own or with the help of your doctor, a professional nutritional therapist might be able to help."
Why am I so tired all the time? 10 possible culprits
"We need oxygen for all the activities of the body. If breathing is inhibited it affects the whole system," says yoga teacher, Joy Mankoo. "This can happen because of poor posture and stress. Emotions can get trapped in the muscles of the body - if we are upset, for example, our abdomens tighten. Sometimes, emotions get left over and inhibit the movements of the muscles. Learning to release these and let go frees them up."
Learn more about yoga
Practitioners of traditional Chinese medicine believe TATT is most often the result of the digestive system becoming depleted of energy: nutrients aren't being absorbed and more fatigue results.
The treatment, according to Richard Blackwell, Principal of the Northern College of Acupuncture, will involve acupuncture and advice on diet, including eating more cooked foods. "Tiredness is also associated with kidney function," Blackwell adds. "This is best understood as the energy reserves in the body and can become depleted with age, particularly after periods of physical and emotional stress.
"These energy reserves have to work hard at times of major change – the menopause for example. It's a deficiency that takes longer to treat and would be done with a combination of herbs and acupuncture, rather than diet. It's also important to get the right balance between rest and activity. Very gentle exercises such as tai chi and yoga, which have a meditative quality, will slow down the mind and encourage deep breathing."
You may also feel tired when your body has enough energy, but it has become blocked. In this case, acupuncture, massage and more active exercise, such as swimming or walking, would be recommended.
"If you feel tired all the time, the most obvious thing is that you have been doing too much and could be nervously run down," says herbalist Ann McIntyre.
"Herbs can be very nourishing for the nervous system. The obvious one is Korean ginseng (Panax ginseng) or Siberian ginseng (Eleuthrococcus).
"These help mind and body to be more resilient to stress. Oats are also very helpful. We make a medicine out of them called avenasativa, or you can just eat porridge.
"People who are menopausal can feel very, very tired. Remedies like Chinese Angelica (Angelica sinensis) are an excellent rejuvenating tonic for women.
"Black cohosh, sage and wild yam are all good hormone-balancing herbs."
"Adding warming spices to your diet, drinking aromatic teas before meals or chewing a little bit of ginger gets the digestion going and makes you more likely to absorb nutrients."
Learn more about herbal remedies