Exhaustion has multiple causes - you need to get to the root of it to begin to recover. [Photo: Bigstock]

Q&A: Why am I so tired all the time?

17 August, 2012

Q – I seem to get plenty of sleep but I am so tired all the time. I’m beginning to worry there is something wrong. Can you give me some advice?


A – General tiredness and fatigue has become such a feature of modern life that most of us don’t even see it as a health problem, until of course it becomes a debilitating problem such as chronic fatigue syndrome (CFS).

Although fatigue is a part of life that we’re all familiar with, it can be difficult to describe and people express it in a variety of ways, using terms such as tired, weak, exhausted, weary, worn-out, fatigued, burnt out, wiped, etc. Health professionals describe fatigue using terms such as asthenia, fatigue, lassitude, prostration, exercise intolerance, lack of energy, and weakness.

Generally we can put the many ways that people express and experience fatigue into two categories: physical and mental. Although these two kinds of fatigue are sometimes difficult to separate and and they can overlap, the language we use to describe our own fatigue can usually provide a clue to it’s origins

Physical fatigue is just that, our physical bodies are tired because of either too much physical work, including not enough time to recover from physical work, or lack of sleep, including jet lag.

Mental fatigue can occur when we’re emotionally or psychologically worn out and not coping with the stresses and strains in our lives.

We all have finite amounts of energy and reserves, and when these are taxed, either physically or mentally, or more commonly both, we experience fatigue. Tiredness is a sign that we need to stop and recharge our batteries in one way or another.

If we don’t rest enough or get enough sleep then we suffer from fatigue until we do. In a way it’s the same with mental fatigue It won’t go away until we get some respite from whatever is causing it. In some cases, such as in chronic fatigue syndrome, the two types of fatigue run in together and we get debilitating mental and physical fatigue.

Beyond the usual suspects several things can cause chronic tiredness. These include:

  • Sleep disturbances including not enough sleep, too much sleep, sleep apnea, shift work (changing shifts, night shifts) and alcohol
  • Heart problems such as high or low blood pressure, arrhythmias, angina and other dysfunctions of the heart muscle), congestive heart failure (fluid in lungs,
  • Respiratory problems including asthma and allergic reactions as well as chronic bronchitis and emphysema.
  • Nutritional disorders, being underweight or overweight, vitamin deficiency (thiamine, B12, B6, folate, vitamin C)
  • Electrolyte disturbances including low potassium, magnesium, low or high calcium and low sodium
  • Endocrine disorders including low blood sugar or high blood sugar (diabetes), under or overactive thyroid, low cortisol (Addison’s disease), high cortisol (Cushing’s disease)
  • Gastrointestinal disorders such as gastroesophageal reflux disease (GERD) and peptic ulcer disease
  • Any chronic disease including urinary tract infections, hepatitis, mononucleosis, chronic fatigue syndrome, anaemia (blood loss or not making enough blood) HIV/AIDS, tuberculosis and cancer
  • Connective tissue disorders like arthritis (osteoarthritis and rheumatoid arthritis), lupus (SLE), fibromyalgia, acromegaly
  • Psychological conditions such as depression (loss of interest, ambition), anxiety, grief, stress

A huge number of medications can also cause fatigue including:

  • Blood pressure medications such as Beta-blockers, Calcium channel blockers, Diuretics, ACE inhibitors
  • Psychological medications  including Antidepressants, Antipsychotics and Antianxiety medications (such as diazepam [Valium] or zolpidem [Ambien])
  • Narcotics such as Acetaminophen and codeine (Tylenol with Codeine), Hydrocodone and acetaminophen (Vicodin), Oxycodone and acetaminophen (Percocet, Propoxyphene and acetaminophen (Darvocet)

As the information above shows there are dozens of different causes of daily fatigue. Most research on debilitating exhaustion has been centred on chronic fatigue syndrome (CFS) a severe persistent fatigue that is very severe and not relieved by rest.

The origins of CFS are not clear and may be a mixture of oxidative stress, genetic predisposition, post viral syndrome (for instance when we do not allow ourselves to recover from colds and flu fully ) and immune dysfunction.

Problems in the hypothalamic-pituitary-adrenal axis – a major part of the neuroendocrine system that controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure – as well as psychological and psychosocial factors can also feed into CFS.

Because there are so many causes of fatigue, you may need to use more than one method to manage it and if it is severe and persistent you should seek professional help.

If your instinct is that you are just run down, or you are going through a period of stress in your life, you can support your body saying no to extra activities and long hours, by ensuring you sleep well (see our feature How to Get a  Good Night’s Sleep) and by using adaptogenic herbs. Adaptogenic herbs are best suited to those whose fatigue either is caused by, or is causing stress in their lives. See our feature on the Chinese Tonic Herbs for more.