Tiredness

Everyone experiences tiredness (fatigue) from time to time. Tiredness that drags on for no apparent reason can be very difficult and it's an extremely common symptom.

One UK survey of over 15,000 people found that 10-18% reported tiredness that lasted for one month or longer, and a study looking at GP databases found that 1.5 in 100 people see their doctor about new tiredness every year. It's so common that doctors have an acronym for it - TATT which means "tired all the time".

Causes of tiredness

Physical causes of tiredness

Tiredness may be due to a wide range of physical illnesses. Examples include:

• A low iron level (anaemia).

• An underactive thyroid gland (hypothyroidism).

• Diabetes that is not well controlled.

• Heart failure.

• Cancer

• Chest illnesses (including asthma and chronic obstructive pulmonary disease).

• Addison's disease.

• Problems with absorbing nutrients (for example, coeliac disease).

• Vitamin D deficiency.

• Pregnancy.

• Glandular fever.

• Chronic fatigue syndrome.

• Conditions affecting the quality of sleep, such as pain, obstructive sleep apnoea, menopausal hot flushes, anxiety or an enlarged prostate resulting in needing to get up to pass urine multiple times a night.

• Side-effects of some medicines (for example, beta-blockers, some painkillers, some antidepressants).

Most physical causes of tiredness will also cause other symptoms, such as weight loss or gain, or shortness of breath, but some causes of tiredness may not cause any other symptoms.

Psychological causes of tiredness

Tiredness that cannot be explained by any physical problem is much more common than tiredness that can. Both anxiety and depression can cause significant tiredness. Eating disorders can also cause tiredness. Any cause of a sleep problem will also cause tiredness during the day.

Stress is a common cause of tiredness, either because it interferes with sleep or because of the effect of having constant high levels of stress and worry. Causes of stress may include bereavement, stress at work and relationship problems including domestic violence.

Boredom may also cause tiredness.

Lifestyle causes of tiredness

Tiredness is often caused by lifestyle. Lifestyle causes of tiredness include:

• Drinking too much alcohol.

• Having an unhealthy, unbalanced diet, including eating too many ultra-processed foods.

• Working very hard with little down-time.

• Having young children.

• Taking recreational drugs.

• Excessive exercise or total lack of exercise.

• Working night shifts, which may lead to a poor sleep pattern and result in tiredness.

• Big life events such as getting married or moving house.

In most cases no specific cause for tiredness is found.

If tiredness is persisting or if it is associated with other symptoms, medical advice should be sought in order to see if there is an underlying cause. The clinician will need to ask some questions and may arrange an examination and some blood tests.

Questions you may be asked

These are to help give some clues about the cause of the tiredness, and may include:

• Do you have any other symptoms?

• Sleep: Do you sleep well? Is your sleep interrupted? Do you snore? Has your partner noticed any changes to your breathing at night?

• Mood: Do you feel low, or more worried than usual? Are you under any stress? You may be asked to complete a specific questionnaire about your mood.

• Has your weight changed?

• Do you have heavy periods?

• How much alcohol do you drink?

• Are you on any medication?

• Do you eat a healthy diet?

• Can you remember when this started? Did it start suddenly and can you date it from a particular date, event, holiday or illness? Or did it come on more gradually?

• How is the tiredness affecting you in your everyday life?

The doctor may examine you

The clinician may check weight and height, if it seems relevant. Depending on the answers to the questions, they may think it relevant to:

• Check lymph glands to see if they are enlarged.

• Check the thyroid gland to see if it is enlarged.

• Look at the eyes to see if there is evidence of anaemia.

• Listen to the chest and feel the abdomen.

• Check the joints for swelling or inflammation.

• Check the strength of arms and/or legs.

• Ask for a sample of urine to check for sugar (for diabetes), protein or infection.

Blood tests for tiredness

Blood tests are often suggested to rule out physical causes of the tiredness. In most cases these turn out to be normal. This might include tests to rule out:

• Low iron levels (anaemia).

• Low thyroid hormone levels (hypothyroidism).

• Diabetes.

• Vitamin deficiencies such as B12, folate or vitamin D.

• Coeliac disease.

• Any inflammation.

• Any problems with the function of the liver or kidneys.

• Specific infections, such as glandular fever.

Other tests

Usually no other tests are needed but, if specific medical conditions are suspected, other tests such as a chest X-ray might be necessary.

There is no need to seek medical advice if the cause of the tiredness is obvious but if it persists, despite making appropriate lifestyle changes, then it is sensible to request a medical opinion.

Symptoms which make it more important to seek medical advice include tiredness in addition to:

• Weight loss, without trying to lose weight.

• A change in bowel habit.

• A new persistent cough (lasting more than 3 weeks) or coughing up blood.

• Heavy periods.

• Night sweats.

• Unexplained or excessive bruising.

• Persistent tummy bloating.

• Unexplained lumps.

• New unexplained pain.

There is no specific treatment for tiredness. The secret is to try to narrow down the cause and then do something about that.

Exercise as a treatment

It may seem bizarre, but exercise or physical activity can actually be remarkably effective for treating tiredness. Any moderate exercise, such as walking, swimming or cycling, can help reduce tiredness. Regular exercise is also an excellent way to stay healthy.

Try to improve your sleep

If you are not sleeping well at night, it is tempting to try to "make up for this" by taking naps during the day. This does not help and often results in sleeping less well at night due to the body clock being out of sync. There are lots of ways you can try to improve your sleep when suffering from insomnia and this should improve symptoms of tiredness.

Treatments for medical conditions that cause tiredness

Medical conditions causing tiredness can usually be treated and this often resolves the tiredness.

For example, in anaemia with low iron levels, iron supplements can be used to treat this and the tiredness will resolve as the blood count increases. However, any underlying cause for the anaemia would need to be found and treated. For example, if it is due to heavy periods, then using medicines to make the periods lighter will help. If there is a suspicion that the anaemia might be due to a serious condition, such as bowel cancer, then further tests and referral to a specialist would be needed.

Treatments for medications that cause tiredness

If the cause is a side-effect of medication, it may be that this can be changed to something without this side effect.

Treatments for tiredness caused by chronic fatigue syndrome (CFS)

If symptoms are thought to be due to CFS then a referral to a specialist team is sometimes made. This team can make the diagnosis and then help with psychological therapy and medication. This service is not always available everywhere.

Treatments for tiredness caused by anxiety or depression

Anxiety or depression can be helped by talking therapy (counselling), cognitive behavioural therapy (CBT) or medication.

Treatments for tiredness caused by stress

If stress is the cause, it is worth taking the time to think and talk about possible ways to reduce this. Is there something which can be changed? It may be that some things need to be re-prioritised.

If work is the stressful problem, it might be possible to change roles, change hours or discuss ways to reduce stress with a manager. If there isn't anything that can be done to change the situation then it might be possible to find things to balance out the stress and improve quality of life. There are a variety of ways to de-stress, such as:

• Regular "me" time.

• Scheduling some fun events.

• Booking a holiday.

• Regular exercise, ideally something fun such as dancing lessons or a weekly walk with a friend, etc.

• Taking up an enjoyable hobby eg, baking or going to a book club.

• Spending time outdoors eg, going for a walk, gardening, or even just sitting outside.

There is no single answer for treatment of tiredness. Even if no cause is found, in most people it settles on its own with time.