Are you ALWAYS tired? Common medical causes of exhaustion

It’s estimated that 1 in 5 people feel more tired than usual most days of the week, and 1 in 10 experience fatigue that never seems to go away. If you’re feeling tired all the time, there might be more to your fatigue than simply having too much to do…

GP Dr Ronald McCoy says that constant tiredness and fatigue is one of the most common problems GPs see.

So when’s the right time to see your GP when you do feel tired or worn out?

“If you’ve been managing and then suddenly feel more tired, or you’re tired all the time, see your GP,” says McCoy.

“Or if you take things easy for a few days, get some rest, but still feel tired then it’s also time for a check-up.” Here, we explain some common health reasons why you might be feeling tired all the time.

An underactive thyroid

Signs & symptoms of an underactive thyroid:

Feeling lethargic, having no energy, needing more sleep than usual, constipation, weight gain, intolerance of the cold.

What is an underactive thyroid?

The thyroid gland sits in the lower neck and produces thyroid hormones that keep our metabolism working effectively. “If you have an underactive thyroid, you don’t have enough thyroid hormone and this slows your metabolism. So you have less energy and feel sluggish,” says Dr Jennifer Wong, an endocrinologist. An underactive thyroid is more common in men and women over 40 and affects about 1 in 10 women over the age of 65. You’re more at risk if you have a family history of this problem, too.

Managing an underactive thyroid:

A blood test can measure low thyroid hormone levels and a doctor will prescribe thyroid hormone replacement tablets.

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Anaemia

Signs & symptoms of anaemia:

Tiredness, breathlessness, a drop in fitness level, pale skin.

What is anaemia?

Iron produces haemoglobin which helps carry oxygen around in our blood. Anaemia leads to low iron levels and this reduces the amount of oxygen available to be carried around our body to give us energy. “Anaemia can be caused by blood loss, such as during heavy periods,” says Whitechurch. “It can also be caused by not getting enough iron in your diet.”

Managing anaemia:

Your GP can do a simple blood test to check your iron levels. If they’re low, have some lean red meat in your diet two or three times a week and eat green, leafy vegetables that also contain iron. Have vitamin C with your iron-rich foods, too – it helps iron absorption. Your GP may also recommend a daily iron supplement

Coeliac Disease

Signs & symptoms of coeliac disease:

Fatigue, feeling weak, diarrhoea or constipation, flatulence, bloating, stomach cramps, weight loss.

What is coeliac disease?

Coeliac disease affects the small intestine, which plays a key role in helping our body absorb nutrients. The lining of the small intestine is damaged by gluten – a protein found in foods containing wheat, rye, barley and oats. About 1% of the world’s population have coeliac disease. “You become tired and weak because your body isn’t absorbing nutrients properly,” explains McCoy. “And the bowel can become inflamed, leading to some of the other symptoms.”

Managing coeliac disease:

A blood test can indicate coeliac disease, followed by a biopsy of the small intestine to confirm the diagnosis. “You have to restrict gluten in your diet,” says McCoy. “If you’ve lost vitamins, you may also need supplements to replenish those.”

Perimenopause

Signs & symptoms of perimenopause:

Insomnia, forgetfulness, bloating, hot flushes, night sweats, irregular periods, mood changes.

What is perimenopause?

Leading up to menopause the ovaries start to run out of eggs, and this leads to hormone fluctuations. Perimenopause can last 4 to 6 years and some women have severe symptoms while others have none at all. “Tiredness isn’t caused by fluctuating hormone levels per se, but those hormones can cause heavy periods, hot flushes and night sweats that disturb sleep,” says GP Dr Vivienne Whitechurch. “Perimenopause can also coincide with a time in life when women are really busy with work, children and running a home.”

Managing perimenopause:

“Have a blood test to check there’s no other cause for your tiredness and then focus on your lifestyle,” says Whitechurch. “Eat a balanced diet, reduce your alcohol intake, find relaxation strategies and exercise regularly to help you get a good night’s sleep.”

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Type 2 diabetes

Signs & symptoms of type 2 diabetes:

Tiredness, listlessness, thirst, urinating frequently, skin that heals slowly.

What is type 2 diabetes?

It’s often a result of people being overweight and inactive. It’s most common in the over 45s but, increasingly, younger people are being diagnosed. “Glucose is our main energy source and it needs to enter our body’s cells to be burnt up as energy,” says Catherine Prochilo, a diabetes nurse educator. “Insulin is the hormone that helps this process. When people have type 2 diabetes, insulin can’t do that job so sugar levels rise and our cells are starved of energy.”

Managing type 2 diabetes:

Eat a diet based on fruits, vegetables and lean protein to help manage sugar levels, and aim for 30 minutes of physical activity each day. Increase incidental activity, too, says Prochilo. “A Finnish study found losing 5-7% of your body weight helps reduce the incidence of type 2 diabetes and improves blood sugar levels,” she says. Tablets or insulin to manage diabetes and its symptoms may sometimes be necessary.

Obstructive sleep apnoea (OSA)

Signs & symptoms of obstructive sleep apnoea:

Feeling sleepy and lethargic during the day, snoring, morning headaches, poor concentration, needing a daytime nap.

What is obstructive sleep apnoea?

The airways of people with OSA become obstructed during sleep as their tongue and airway muscles relax. This causes airways to narrow and breathing becomes harder. People with a narrow airway, enlarged tonsils or who are overweight – particularly around the neck – are more likely to have OSA.

“People can stop breathing briefly and this causes them to wake, and they take in air again,” says McCoy. “They go to sleep and it happens again, so sleep is disrupted.”

Managing obstructive sleep apnoea:

Weight loss removes excess pressure from the airway, helping it to remain open. Avoid alcohol as it relaxes muscles which can contribute to airway narrowing.

A sleep specialist may recommend you use a continuous positive airway pressure (CPAP) machine, which pumps air through a mask worn over the mouth and nose to keep airways open.

Viral infections

Signs & symptoms of viral infections:

Prolonged fatigue, muscle aches, weakness, swollen glands, sore throat, high temperature.

What is post-viral infection tiredness?

A range of viral infections can leave you feeling wiped out and it can be months before energy levels return to normal, says McCoy. “For example, teens and young adults may get glandular fever and the post-viral tiredness can last for months as their body continues to produce immune chemicals to fight it,” he says.

“The after-effects of these chemicals cause tiredness.” McCoy says similarly with influenza, post-viral tiredness can last up to six months.

Managing post-viral infection tiredness:

Sometimes medication won’t help and you just need to rest, get a good night’s sleep, eat a balanced diet and stay hydrated, says McCoy. Avoid caffeine and alcohol to rest your liver as it fights off the remains of the virus. “Gradually introduce exercise to improve energy levels again,” says McCoy.

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Depression

Signs & symptoms of depression:

Fatigue, difficulty getting to sleep, slowed thoughts, irritability, withdrawal from loved ones, loss of interest in things you usually enjoy, moodiness.

What is depression?

About 1 in 6 people will experience depression during their life. It can be caused by difficult life events, such as unemployment or an abusive relationship, and people with a family history of depression are also at greater risk.

“People with depression often can’t sleep at night because they’re anxious,” says Whitechurch. “They wake in the middle of the night and can’t get back to sleep, or struggle to fall asleep in the first place.”

Managing depression:

Depression can be managed with psychological treatment and medication. Cognitive behavioural therapy (CBT) teaches people to think rationally about their concerns and to manage negative thoughts and feelings in a more positive way.

Antidepressant medication acts on chemicals in the brain that play a role in depression. “Your GP can refer you to a counsellor or psychologist and prescribe medication to help, if necessary,” says Whitechurch.

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