“Tired” can mean falling asleep at your desk, struggling to climb stairs, losing interest in everything or feeling utterly spent after an ordinary shower. It may seem easy to take a “tonic” or vitamin, but the underlying cause must be determined.
Someone may spend eight hours in bed and still wake up exhausted. Loud snoring, witnessed pauses in breathing, gasping during sleep and morning headaches raise the possibility of obstructive sleep apnoea. The person asleep may know very little about it, but their hapless partner may have been conducting the overnight assessment for years. Shift work, a baby, pain or caring for an ill relative often lead to fractured sleep.
Tiredness accompanied by breathlessness, palpitations, dizziness or pallor suggests anaemia. Heavy menstrual bleeding is a possible cause in women. People sometimes describe their periods as “normal” because they have been heavy for years.
Iron deficiency needs an explanation. Blood loss from the digestive tract can be hidden. An occult cancer should be excluded in men and postmenopausal women with this issue. Do not start a long course of iron merely because tiredness feels like “low blood”.
Fatigue, pins and needles (“junjuni”), poor balance, a sore tongue, memory lapses or difficulty concentrating could herald B12 deficiency. Risk factors include a strict vegan diet, problems with absorption and medicines such as metformin.
Lethargy and weakness could be non-specific presentations of heart disease. This is often missed in the elderly, women and people with diabetes.
An underactive thyroid can cause hoarseness, weight gain, fatigue, constipation, cold intolerance and dry skin. An overactive thyroid can also leave someone exhausted, despite feeling restless, hot or shaky, with a racing heart or weight loss. This basic blood test should probably be included in an annual physical examination.
Excessive thirst, frequent urination, blurred vision, recurrent infections or unexplained weight loss should prompt consideration of diabetes.
Pregnancy and menopause may have tiredness as a non-specific symptom.
Some allergy tablets, sleeping medicines and other treatments can cause drowsiness or fatigue. Alcohol may help someone fall asleep while disrupting the quality of the night that follows.
Depression, stress and anxiety often hunt in packs. Clinical features of these silent pandemics include exhaustion, poor concentration, altered appetite, low self-esteem, suicidal thoughts, disturbed sleep and loss of pleasure. Men are less likely to admit to these challenges.
Long COVID can include fatigue, difficulty concentrating and a marked worsening after physical or mental effort. In some people, the crash is delayed until the following day and lingers. That pattern, called “post-exertional malaise”, is important. Telling someone to push harder can make matters worse. Activity may need to be paced to the person’s capacity.
“Adrenal fatigue” is not an established medical diagnosis, and the commercial tests offered for it lack scientific validation. “Adrenal insufficiency” is a real, potentially fatal condition that requires appropriate investigation.
Muscle weakness is not the same as tiredness. Difficulty rising from a chair, lifting the arms, chewing or keeping the eyes open could indicate an uncommon illness such as myasthenia gravis. New swallowing or breathing difficulty requires hospitalisation.
Expect questions about when the problem began, sleep, bleeding, appetite, weight, mood, infections and medication. Explain how it affects work, family life and basic tasks. An examination may identify clues that no questionnaire or internet search can supply.
Basic tests include a blood count, iron studies, glucose, thyroid, kidney or liver tests. Other investigations are selected when indicated.
Seek urgent help if tiredness accompanies chest pain, severe breathlessness, fainting, new confusion, vomiting blood or black, tarry stools. Unexplained weight loss, persistent fever, night sweats or abnormal bleeding warrant prompt medical assessment.
If the problem is less urgent, keep a brief diary before your appointment. Record sleep times, meals, medicines, activity and when the fatigue is worst. Note whether rest helps and whether exertion causes a delayed deterioration.
Meanwhile, aim for regular meals, adequate fluids and a consistent opportunity to sleep. Reduce late caffeine and excessive alcohol. Choose activity suited to your capacity; severe or unexplained fatigue is not an invitation to punish yourself in the gym.
Sometimes treatment is straightforward. Sometimes several problems need attention, including a workload no person could comfortably sustain.
The important thing is to describe the change, investigate sensibly and follow up. If tiredness lasts a few weeks, worsens or shrinks your daily life, arrange a medical review and explain exactly what has become difficult.
