ALWAYS TIRED?
CRUCIAL CAUSES (MOST) DOCTORS DON’T CONSIDER
Are you in fine health and get enough sleep—yet you’re dead-tired all the time? Then you’ve come to the right place. Together with a number of top experts, id has compiled a series of tests to help you discover the reasons for mystery fatigue. You can use them to reveal the cause of your chronic weariness and find out what you can do about it.
It might just be the body’s worst enemy, negatively impacting almost everything we do—yet most doctors don’t seem to know what to do about it. We’re talking about persistent fatigue: a feeling that can sometimes seem to take control of our lives, impairing our perception and performance almost like a drug. To cite just one example: A study at Washington State University found that police officers’ night shifts were not only likely to result in fatigue but also in seven times the number of public complaints about conduct. According to another study, being awake for 18 hours can result in impairments comparable to those produced by having a blood alcohol concentration of 0.05. (A BAC of 0.08 is the legal limit for driving.) Researchers measure feelings of fatigue in days per month and ask their subjects how often they feel tired. If the answer is five days or more a month, they generally recommend seeking therapy.
But what exactly do we mean when we talk about fatigue? Like hunger or thirst, fatigue is one of the bodily mechanisms that helps us survive, preventing us from overdoing things either physically or mentally. Fatigue that occurs as part of this protective mechanism usually has a clear cause: It might be due to a strenuous day at the office, a tough workout at the gym, or an exhausting trip. Sometimes such fatigue can even feel pleasant, resulting in a sense of accomplishment and the firm conviction that all we need to recover from a hard day’s work is a good night’s sleep. But there are other types of fatigue too—the kind for which the cause isn’t immediately clear. These types of fatigue are a sign something is not right. So what could be wrong?
WHY DOCTORS SEEM SO POWERLESS AGAINST UNEXPLAINED FATIGUE
Doctors generally see unexplained fatigue as one of the most complex symptoms they have to deal with because the cause could be almost anything. Dr. Norbert Rosenthal is a general practitioner who has been in private practice for more than 20 years. Whenever a patient complains of ongoing fatigue, he starts by progressively ruling out the most likely reasons. He checks the patient’s pulse and blood pressure, listens to the heart and lungs, and asks about recent symptoms that may have been experienced, such as fever, weight loss, or any sort of pain. Then he’ll order blood work to get a complete blood count and a basic metabolic panel. He orders tests for liver, kidney, and thyroid function and checks the patient’s levels of iron, various vitamins, and inflammatory markers. But in many cases the tests reveal essentially nothing about the cause of fatigue, with the possible exception of an iron deficiency or an underactive thyroid. If neither of those is the culprit, what then? Generally a primary care physician will then refer the patient to a specialist. If the first specialist finds nothing, the search continues with the one after that, which can lead to a prolonged odyssey of doctor’s appointments. Often enough, however, they produce no clear result. That is less the fault of the individual doctors, each of whom is working within a rather limited range of possible diagnoses, than of the circumstances. None of the specialists is likely to have more than superficial knowledge of the patient’s lifestyle and habits, let alone the capacity to put those aspects into meaningful context. But this knowledge may be key to understanding a patient’s fatigue, which might not fit into any standard and familiar diagnosis. Sometimes it is a seemingly unimportant detail about the patient’s life that is causing the fatigue, which is even harder to understand if the effect is being produced by a combination of several of them.
A PUZZLE WITH MANY PIECES
As different as the various causes may be, doctors and researchers generally agree that many of the symptoms of ongoing fatigue can be attributed to the levels of stress to which patients are subjected, what they eat, and how they sleep. In putting together the checklists that follow, id consulted experts from several fields, including sleep medicine, nutrition, and stress and burnout research to find out the most common reasons for feelings of low energy and fatigue in everyday life. Some of the answers were surprising: Who would have thought that eating a croissant for breakfast or working at a messy desk could make a person feel tired? The responses were used to develop four tests that can help you determine the cause of your own recurring fatigue. The experts also explain the most effective ways of dealing with it.
“Sleep can relieve a healthy feeling of fatigue. But there are other kinds as well, the kinds that plague us constantly, and for these sleep may not be enough.” Dr. Norbert Rosenthal
Stress is one of the most widespread causes of feeling tired or exhausted, according to psychologist and bestselling author Dr. Ilona Bürgel. Stress arises when the body releases too much of its primary stress hormone, cortisol, which is produced in the adrenal glands. They function as an alarm system, responding to stress by boosting cortisol to help you handle stress and then returning it to normal levels when the stress has passed. But if you are under constant stress, the alarm remains on. That can lead to chronic problems, including anxiety and depression, headache, heart disease, memory and concentration issues, insomnia, and weight gain. Purported reduction of cortisol production in response to chronic exposure to stressful situations was once described as “adrenal fatigue,” but systematic review has been unable to find hard evidence for the existence of this “syndrome.”