I am so tired? WHY!?!
What is Fatigue?
Feeling tired from time to time is a normal part of everyday life. We lead busy lives, might not get enough sleep, have pressure from work or get sick which can leave us feeling tired for a few days. However, when fatigue becomes persistent or begins to interfere with daily life, it may indicate an underlying health issue.
Fatigue is more persistent than simple tiredness, it tends not to be improved by taking a nap and affects your ability to participate or complete your usual activities. Fatigue can be physical or mental. It can be associated with difficulty concentrating, muscle weakness and reduced physical endurance. It can be distressing in that it can affect one’s relationships, employment and quality of life.
Fatigue is one of the most common presentations seen in general practice and is usually benign and related to lifestyle factors. However, when persistent, it is important to consult your doctor as occasionally persistent fatigue can be the first sign of a more serious underlying medical condition.
When should I see a doctor about fatigue?
If you are getting enough sleep, eating healthily and exercising but still struggle with motivation, concentration and going about your daily activities.
If the fatigue is persisting longer than a few weeks, does not improve with rest, and appears without an obvious cause.
If there is unexplained weight loss, night sweats or persistent fevers.
If there is any change in bowel habit.
If there is any associated shortness of breath or chest pain.
If you experience associated persistent headaches.
If there are associated swollen lymph nodes
What are the common causes of fatigue?
There are many causes of fatigue in general practice and often the cause if multifactorial. The most common causes your physician will consider are:
A sleep disorder
Insomnia or sleep apnoea
Shift work or irregular sleep patterns
Mental health issue
Anxiety and/or depression
Chronic stress or burnout
Poor lifestyle choices
Poor diet
Lack of exercise
Dehydration
Excessive alcohol intake
Excessive caffeine intake
Poor work/life balance
Medical conditions
Iron deficiency anaemia
Low thyroid function (hypothyroidism)
Chronic kidney disease
Diabetes
Autoimmune diseases
Vitamin deficiencies
Chronic heart disease
Chronic liver disease
Cancer
Post infectious states. chronic fatigue syndrome, long COVID
Medication side effects
Antidepressants
Pain medications
Anticonvulsants
Antihypertensives
Annoyingly, sometimes there is no cause found
What can I expect when I see my GP for fatigue?
Your GP will ask a lot of questions about your fatigue, when it started, what makes it worse and how it impacts on, you day to day. Your doctor will want to perform a physical examination to look for swollen lymph nodes, signs of anaemia, liver disease, heart disease and kidney disease.
Your GP may want to do some blood tests to check for anaemia, your thyroid function, liver and kidney function and check for any infections.
Your GP will likely also consider a urine analysis and possibly an electrocardiogram to look at the electrical activity of your heart.
Your GP will probably assess your mood and may also consider a sleep study, to see if you have sleep apnoea.
Can my fatigue be treated?
Managing fatigue really involves treating the underlying cause, whatever that might be. Strategies include:
1. Improving Sleep
a. Maintaining good sleep hygiene including a regular sleep schedule, limiting screen exposure before bed, limiting caffeine late in the day, creating a comfortable sleep environment
b. Doing a sleep study to see if there is evidence of sleep apnoea or other sleep irregularities and having these treated if diagnosed.
2. Maintaining a well-balanced diet
a. Adequate iron intake
b. Adequate hydration
c. Reduce processed food
3. Regular exercise
a. Good for mood, energy and sleep
4. Managing underlying medical conditions, as may be indicated
5. Managing mental health
a. Regular mindfulness or meditation
b. Regular review with a psychologist
c. Improving work /life balance
d. Antidepressants if needed
6. Treating any underlying medical condition(s)
a. Once an underlying medical condition is treated, the fatigue often resolves
b. More complex conditions, such as chronic fatigue syndrome require a multidisciplinary approach.
7. Managing medications and their side effects
Even when there is no cause for the fatigue found, in the vast majority of cases the fatigue tends to improve over time.
Why is it important to address fatigue?
It is important to treat fatigue as it can have knock on effects. Fatigue is a significant cause of accidents such as car accidents and workplace accidents and it can reduce our performance at work.
Take home messages
Fatigue is common
There are many causes such as lifestyle, sleep issues, medical conditions, medications and psychological conditions.
It is time to see a doctor when it is persistent, not improved by rest, when it affects your daily activities or quality of life or is associated with other worrying symptoms such as weight loss.
In the great majority of cases fatigue resolves on its own or when the underlying cause is treated.
In general, fatigue needs to be thought of as a symptom, not a condition and the underlying cause needs to be sought.
References
Health Direct. Fatigue [https://www.healthdirect.gov.au/fatigue]. 5/3/26.
Better Health Channel. Fatigue. [https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/fatigue].