Why am I so tired all the time?
“Doctor, I’m just exhausted. All the time. I’m so tired, there must be something wrong with me”
Pretty much every GP or family doctor will hear this several times a day. Tiredness is ubiquitous with our fast paced modern lives, but at what point is it more than just our lifestyle and an indicator that something is medically wrong?
Feeling tired all the time, that feeling that even after a long sleep you don’t feel rested. It’s feeling like you could nap at pretty much any time of day. It’s draining for patients and can have a real knock on impact on their quality of life.
There many medical explanations for tiredness such as hypothyroidism, anaemia and depression but it’s important to also examine your own habits and patterns to work out if it’s anything you might be able to change.
In my clinic I tend to try approach both the biological and the behavioural aspects of tiredness simultaneously. Lets get you looked at, examined and tested if relevant, but lets take pause to look at you as a whole – how are your stress levels, are you worried about anything, whats happening with your weight and your appetite, when do you go to bed – to get a sense of anything else we might be able to improve upon.
Stress, anxiety and depression can all impact upon our sleep. Often it might be one of the first signs that you might be suffering one of these conditions. Whether it be that your mind is racing over the days events when you try and go to bed, or thinking about the events of tomorrow or the future. Some patients with anxiety report increased palpitations (a sense of the heart racing in the chest) in the evening/night time which enhances their difficulty sleeping. Patients with depression might experience ‘early morning wakening’ when they are unable to stay asleep and wake in the early hours.
Sleep hygiene is often overlooked in the 21st century, we’re more connected than ever with a myriad of devices and with the increasing advent of flexible working we’re checking work emails in the evening and working later and later at home. There is also some misunderstanding about how much sleep we actually need.
Our sleep pattern is regulated by something called a circadian rhythm, an evolutionary clock that tells us to be up when its light and sleep when it’s dark. In the days of our ancestors, this helped us to be productive in the hours when there was light and to rest to in the dark when light sources would have been limited.
Stimulants such as caffeine, alcohol and nicotine as well alarm clocks and devices plus the addition of later working and shopping hours can all interfere with our natural sleep/wake cycle.
How much sleep do we need? How do you stack up to the numbers below?
- Newborns (0-3 months ): 14-17 hours each day
- Infants (4-11 months): 12-15 hours
- Toddlers (1-2 years): 11-14 hours
- Preschoolers (3-5): 10-13 hours
- School age children (6-13): 9-11 hours
- (14-17): 8-10 hours
- Younger adults (18-25): 7-9 hours
- Adults (26-64): 7-9 hours
- Older adults (65+): 7-8 hours
Sleep is a priority, we need that time to allow our brains to hit the reset button. Simple but effective techniques for a better night include: sticking to a schedule – set yourself a bed time and try and stick to it, if you are someone who runs through to-do lists for the next day, make a list before you go to bed and put it to one side, getting exercise daily will help to naturally tire you out, make your bedroom as restful as possible – limit those electronic devices and televisions in the room and turn off your phone
Techniques such as deep breathing or meditation can help to quieten your mind to prepare your body for sleep. Try inhaling for three seconds and exhaling for six. Repeat this five times. Then try to tense your toes as tight as possible, then relax, work up your body – tense and relaxing groups of muscles in turn. This helps to give the body a sense of relaxation.
When is tiredness caused by more than a few late nights? We’ve looked at a few of the more common reasons we see in clinic:
Iron deficiency anaemia.
This is the most common nutritional deficiency in the world and is common in women having regular, heavy periods. Blood loss causes us to lose iron, and if we are not able to get enough iron back in through our diet, we can build up a deficit. Besides tiredness, symptoms can include skin that appears more pale, feeling cold, feeling dizzy or lightheaded, hair loss and brittle nails. Picked up on a blood test, your doctor can advice on a cause of replacement and may recommend further testing to discover the cause.
The thyroid, a small gland in the neck, is responsible for producing hormones required in many different bodily functions. Symptoms include an inability to tolerate the cold, weight gain, constipation, low mood and of course, tiredness. Again, picked up on a blood test and treatment involves replacing the deficient hormone – usually as a daily tablet.
Chronic fatigue syndrome
Something that has divided medics for years. A condition that causes long-term fatigue, it’s cause is not known. It is thought that it starts with a flu-like illness and there have been suggestions is can have links with mononucleosis, lyme disease and chlamydia. There are no definitive tests to confirm this, so often the process will start by looking for other conditions that might cause tiredness.
A gluten intolerance that can cause weight loss, bloating, bowel habit changes as well as tiredness. Gluten is found in foods such as breads, cakes and cereals. It’s thought around 1 in 100 people in the UK have coeliac disease, but 90% of those affected do not know they have. Diagnosis involved blood tests and biopsies and is most often managed by avoiding gluten in the diet.
More common in people with a higher body mass index, where the breathing tube is compromised when patients are lying down, but can also be linked to alcohol intake and smoking. In sleep apnoea patients will have periods of interruption in their breathing when asleep. Partners might report snoring – or evening being able to hear the moments when breathing is interrupted. Testing involves sleep studies and oxygen monitoring during sleep. Patients with confirmed sleep apnoea will be given advice about how to reduce their risk factors and in more extreme cases a machine (CPAP – continuous positive airway pressure) to wear overnight which helps to move air into the lungs and keep the airways open.
We could all do with taking stock of our sleeping habits and taking steps to improve our sleep hygiene. But if you think that there might be something underlying the tiredness, you should always discuss this with your own doctor.