Fatigue is a feeling of tiredness that may also occur with other symptoms, such as a lack of motivation and energy. It can result from various conditions.
Many people experience feeling ‘tired all the time,’ making fatigue a common concern. Often, it is not a medical issue but one that can be reversed by a change of lifestyle.
Tiredness can negatively impact performance at work, family life, and social relationships. Fatigue has a reputation as a vague and difficult problem for doctors to investigate, and many people with fatigue do not report it to their doctor.
Doctors who are conscious of this take the problem seriously and attempt to determine an underlying cause. There are many reasons people become tired, and, consequently, there are many ways to rectify the situation.
Simply put, fatigue is the feeling of being tired.
It is generally different from the sleepy feeling of drowsiness or the psychological feeling of apathy, although these might both accompany fatigue.
Other terms to describe fatigue include:
- reduced or no energy
- physical or mental exhaustion
- lack of motivation
Next steps: When to seek help
Feeling tired is common and often no cause for concern. However, a person should seek medical assistance if:
- they have been consistently tired for a week or more
- tiredness affects their daily life
- tiredness occurs with other symptoms such as weight loss
- they have symptoms of sleep apnea
Physical, psychological, and physiological factors can lead to fatigue. The list of physical or medical causes is long, making it important to see a doctor for an accurate diagnosis based on an individual’s personal and medical history.
The list of potential medical reasons for fatigue includes:
- obesity
- obstructive sleep apnea
- insomnia
- anemia
- cancer
- kidney disease
- liver disease
- lung disease, such as COPD
- heart failure
- thyroid disease
- diabetes
- Addison’s disease
- arthritis, including rheumatoid arthritis
- autoimmune diseases such as systemic lupus erythematosus
- fibromyalgia
- infection, especially long-term
- AIDS, tuberculosis, and mononucleosis
- malnutrition
Fatigue is also a possible side effect of different medications and treatments.
Mental health conditions
Chronic fatigue is a common side effect of a number of mental health conditions including:
Fatigue is a common experience – all humans become tired. There are numerous medical and non-medical causes of fatigue, including personal dietary and lifestyle habits, including,
- excessive physical activity
- emotional stress
- boredom
- lack of sleep
Lifestyle habits
The
- staying up too late
- having too much caffeine
- drinking too much alcohol
- eating junk food
Some people are more likely than others to experience fatigue. For instance, females more often report fatigue. People who live in poverty and those with mental or physical illness are also more likely to present with fatigue.
There is no single treatment for fatigue, because the management approach depends on the cause of the tiredness.
If the diagnostic process unveils no underlying medical explanation for the fatigue, the following lifestyle and dietary modifications may help resolve it:
- Improving sleep habits and ensuring adequate sleep.
- Exercising regularly and balancing rest and activity.
- Cutting out caffeine and drinking plenty of water.
- Eating healthy to avoid becoming overweight or underweight.
- Setting realistic expectations for workload and schedule.
- Taking time to relax, perhaps trying meditation or yoga.
- Identifying and dealing with stressors by, for example, taking time off work or resolving relationship problems.
- Avoiding the use of alcohol, nicotine, and illegal drugs.
For some people with fatigue, doctors may consider offering a referral for counselling or a talking therapy known as cognitive behavioral therapy (CBT).
They will offer a consultant opinion for occupational reasons for fatigue, or may provide a structured, multidisciplinary approach to management, including supervised graded exercise therapy.
Fatigue is a difficult issue for doctors. It may be a physical problem rather than a psychological one.
Sleep history
The doctor might take a ‘sleep history’ to work out whether a sleep disorder is leading to the fatigue:
- How much sleep do you get each night?
- Do you have trouble getting to sleep, or do you wake up during the night?
- Has anyone told you that you snore?
- Has anyone noticed that you stop breathing for short periods of time during sleep?
These sleep history questions are designed to determine the sleep quality, quantity, patterns, and sleep routine.
Physical examination
The doctor may also examine a patient physically or check their mental state to find physical and mental causes. If no specific cause is indicated, there is a set of standard tests used to help narrow down the diagnosis. Based on the patient’s complaints, these may include:
- full blood count
- erythrocyte sedimentation rate or C-reactive protein
- liver function tests
- urea and electrolytes
- thyroid stimulating hormone and thyroid function tests
- creatine kinase
- urine and blood tests for glucose
- urine test for protein
Next steps: Preparing for doctors’ questions
When patients present with fatigue, doctors will try to develop a more precise description of symptoms, typically by asking the following types of questions:
Have you felt drowsy, or has the fatigue been more of a feeling of weakness?
The answer can give clues to the diagnosis because drowsiness may be a symptom of a sleep disorder, while weakness may be a sign of a neuromuscular cause.
During the past month, have you often felt down, depressed, or hopeless?
Positive answers may indicate depression.
Has your fatigue developed gradually or suddenly?
It is important to diagnose whether fatigue is acute or chronic, as these types of fatigue have different causes.
Does your tiredness come in cycles?
For example, depression is indicated if the fatigue is worst in the morning but persists all day, whereas fatigue associated with exercise suggests a neuromuscular issue.
What are your concerns about the fatigue? What do you think may be the cause?
The doctor may be looking for a connection with any distressing life events, for example.
Any tiredness that persists for a long time can be termed chronic, but medical papers and guidelines define chronic tiredness as fatigue that lasts at least six months.
A diagnosis of chronic fatigue syndrome (CFS, also known as myalgic encephalopathy or ME) is made when tiredness persists and cannot be explained by another diagnosis.
The person with CFS/ME must display one or more of the following symptoms:
- difficulty with sleeping
- muscle or joint pain without evidence of inflammation
- headaches
- painful lymph nodes
- sore throat
- cognitive dysfunction
- physical or mental exertion makes symptoms worse
- general malaise or flu-like symptoms
- dizziness or nausea
- palpitations in the absence of identified heart disease
A diagnosis of CFS/ME should be reconsidered if none of the following features is present:
- fatigue or malaise after exertion
- cognitive difficulties
- sleep disturbance
- chronic pain
Fatigue is a persistent feeling of tiredness, weakness, or lack of energy that is not easily fixed by rest. It is an overall exhaustion that can be physical, mental, or both.
There are many possible causes of fatigue. If a person experiences fatigue for an extended amount of time, for example, a few weeks to months, they should contact a doctor.