Fatigue
What is Fatigue?
Periodic fatigue is a very common symptom for which patients seek medical care. Nearly everyone struggles with being
overtired or overworked from time to time. Such instances of fatigue usually have an identifiable cause and a likely
remedy. In some cases, fatigue is a symptom of an underlying medical problem that requires medical treatment. Most of
the time, however, fatigue can be traced to one or more of your habits or routines. With a few simple lifestyle changes,
it is likely that you have the power to put the vitality back in your life.
Chronic fatigue, on the other hand, lasts longer and is more profound. It’s a nearly constant state of weariness that
develops over time and diminishes your energy and mental capacity. Fatigue at this level impacts your emotional and
psychological well being too. The main symptom of chronic fatigue is that it lasts for more than 6 months.
Fatigue isn’t the same thing as sleepiness, although it’s often accompanied by a desire to sleep and a lack of motivation
to do anything else. People who are sleepy are temporarily aroused by activity, at least for the short term. Patients with
sleepiness will feel better after a nap. In patients with fatigue, physical or mental activities often make the symptoms
worse, and rest usually doesn’t improve the symptoms.
Causes:
Thinking about the things that may be responsible for your fatigue is the first step toward relief. In general, most causes
of fatigue may be attributed to three areas:
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Lifestyle factors
o Alcohol use or abuse
o Caffeine use
o Excessive physical activity
o Inactivity
o Lack of sleep
o Medications, such as antihistamines, cough and cold remedies, prescription pain medications, certain
heart medications and blood pressure medications, and some antidepressants
o Unhealthy eating habits
Psychological problems
o Anxiety
o Depression
o Grief
o Stress
Medical conditions
o Acute liver failure
o Anemia
o Cancer
o Chronic fatigue syndrome
o Chronic kidney failure
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COPD/Emphysema
Heart disease
Under/overactive thyroid (hypothyroidism/hyperthyroidism)
Obesity
Pregnancy
Restless legs syndrome
Sleep apnea
Diagnosis:
Your health care provider will evaluate you to attempt to figure out what is causing your fatigue. You will be asked
questions about your symptoms, past medical history, medications, and lifestyle habits. A physical examination will be
done to identify anything that may suggest that a medical condition is causing your fatigue. In some cases, laboratory
studies may be ordered, although it is important to know that the findings affect treatment recommendations in only
5% of patients.
Management:
If no secondary cause for fatigue is found during your evaluation, lifestyle modifications will be recommended to
manage your fatigue.
 Adequate sleep is often the most important step in the management of fatigue. For most adults, this means 7-8
hours per night. Sleep hygiene can help you get the sleep that you need. This includes the following:
o Go to bed at the same time each night and rise at the same time each morning.
o Make sure that your bedroom is a quiet, dark, and relaxing environment. Remove all TV’s, computers,
and “gadgets” from the bedroom.
o Make sure your bed is comfortable and use it only for sleeping and sex, not for other activities such as
watching TV or reading.
o Avoid large meals before bedtime.
 Limit medications that may contribute to fatigue.
 Improve your diet. Eating a well balanced diet may increase your energy level. Don’t skip meals, especially
breakfast.
 Reduce your use of alcohol or other drugs, such as caffeine or nicotine.
 Naps may help, but limit them to less than one hour in the early afternoon.
 Improve your physical fitness. In most people, exercise will lead to increased energy levels. However, avoid
exercise within 3-4 hours of your bedtime.
 Take steps to control your stress and your workload.
If a secondary cause for fatigue is discovered, your plan for treatment will depend on these findings.
Sources: Mayo Clinic, American Academy of Family Physicians
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