Posted by: drrozkaplan | October 23, 2010

Doctor, Why Am I So Tired?

I took an extra day off from work today, giving me a 4-day weekend, since I don’t work on Thursdays.  At least, that is, I don’t work in my medical practice.  I really needed this extra day to do some errands, take my daughter to an appointment, and get some control over chores in my house.  I’m also really, really tired.  And I figure that if I can get some of these tasks done today, maybe I can actually get some rest over the weekend.  I have been unusually tired the past couple of weeks, to the point that I fall asleep in the middle of the evening reading or watching TV, way before I planned to go to bed, on some nights.  I even started wondering if there could be something wrong with me, since this is a different degree of fatigue than I usually live with.

But then I thought about what I’ve actually been DOING, and the word that comes to mind is ‘duh’.  Of COURSE I’m tired!  This fall has been a crazy marathon.  I’m seeing patients fours days a week, with a full schedule every day that I’m in the office.  I’ve been accompanying my daughter on her college visits many weekends. Monday evenings I’m at writing workshop until 10 pm.  I spend a good part of Thursdays in the Pilates studio, observing and teaching.   I’m attempting to promote a book, albeit rather incompetently (thank G-d, now I’ve got some help, but I’m still networking, sending out packets, setting up readings and talking, talking talking it up…), and I turned 50, which makes me tired just on principle.  Oh, and there was the 9 hour car trip to Toronto a couple of weekends ago for a family event, and there were the out-of-town visitors last weekend, and the college kid coming home for fall break, and….. Well, you get the idea.   And through it all there is the constant drumbeat of  laundry that  has to be washed and groceries that need to be bought and meals that need to be cooked and relationships that need to be tended and I don’t think I need to have anything wrong with me to be tired.

I’m not very much different than a lot of the people who come in to see me because they are fatigued and want to know why.  Do I need more exercise? Less exercise? Different diet? Vitamins? Iron? Or am I sick?  Anemic? Hypothyroid? Do I have heart disease? Cancer? Depression? Marchiafava-Bignami Syndrome?

Here’s the bottom line on the fatigue issue.  It is possible for illness to present simply as fatigue.  Viruses, including the hepatitis C I once had, can have only fatigue as a symptom.  So can leukemia, since it causes a low red blood count (anemia), which can cause fatigue. Liver disease, kidney disease and heart disease can all cause tiredness.  But these are not LIKELY causes of ongoing fatigue in someone without other symptoms.  In the otherwise asymptomatic person, I do an examination, and if there are no obvious signs of illness, I’ll check a blood count and a thyroid level.  But more importantly, we’ll talk about lifestyle and sleep.  Over 90% of patients complaining only of fatigue have no explanation for it other than lifestyle factors.

I can’t believe the number of people who tell me they sleep 6 hours or less.  Some of them have insomnia.  But many just aren’t going to bed.  There are parents who come home from work at 7, manage dinner,  help with homework, do laundry, put kids to bed, make lunches for the next day, and still have emails to answer and paperwork to do after all that.  There are teenagers who have sports practice until 6 pm, wolf down their dinners, and start on 5 hours of homework for their multiple advanced placement classes.  There are also people who start surfing the net at 10 pm and find themselves still awake and overstimulated at 2:30 am.  Whatever the reason, many Americans are working on a serious sleep deficit.

Not only is sleep deprivation a huge issue, but general lack of self-care is something I commonly note among patients who complain of fatigue.  I will plead guilty to sometimes falling into this trap.  We need sleep, but we also need proper fuel, in the form of regular, healthy meals.  Running on caffeine and sugar, or skipping meals, or restricting calories excessively, is a certain path to exhaustion.  Just like a car would sputter and stop if it ran out of gas, our bodies can’t keep running without regular infusions of appropriate fuel.  Every meal needs to contain some amount of (preferably complex) carbohydrate for immediate energy, some protein to get us to the 4-hour-later mark, and a little bit of fat (preferably heart-healthy fat from nuts or olive oil or fish,etc.) in case there is not another feeding until the 6-hour point.  Smaller, more frequent feedings are better for some people, but however the food is going in, it needs to be consistent for our bodies to trust us and keep our metabolism running smoothly- and thus feeling optimally energetic.  Like many people, I sometimes let myself get too hungry, and then I eat too much, which makes me feel more sluggish.  Or I use caffeine to wake me up when I’m tired.  But the result of that is needing more caffeine later, and if I have caffeine after lunch, it might keep me awake at night, and then…. I’m TIRED!!!!  Sugar has that same effect of providing quick energy, but then causing a ‘crash’ an hour later, causing more sugar craving.  Bad cycle to be in if you’re trying to keep your energy up.

Then there’s the whole issue of exercise and energy.  If I’m tired, how am I going to exercise?  In fact, if I have no energy, isn’t it a bad idea to exercise?  Trick question, of course.  The whole thing is a trick with exercise.  Many of us are so busy that finding time for exercise in our lives, much less the energy,  seems an impossible task.  Yet having a regular exercise routine, the right regular exercise routine, actually seems to create both time and energy for me.  Yes, I know, it’s magic.  It has to be the right balance.  I can’t over-exercise, or it does wear me out and make me hurt.  Every once in a while I do some weekend warrior thing- a long bike trip or an excessive climb- and I FEEL it.  I can’t get away with that anymore like I used to.  I might do it occasionally because it’s fun, but for the most part, I stick to a few reasonable 45 minute aerobic sessions- walking, elliptical, biking, or a Zumba class, and a few Pilates or Yoga sessions each week.  If I do too little, I feel stiff and sluggish.  As far as where to fit this into my schedule, well, let’s just say the weekends are top-heavy with exercise, and also that it is alot easier now that my kids are older and more self-sufficient.  Having equipment in the house helps, and using the great outdoors for walking is very convenient (it’s also multi-tasking- I can take a dog or two).

Okay, now let’s get down to the toughest issue:  stress.  Lots of people are just plain worn out from stress.  Too much work, financial worries, family concerns, trying to multitask like crazy… and chaos just seems to reign no matter how hard we try to stay on top of everything.  Living in an eternal adrenaline rush, waiting for the next disaster.  Sound familiar?  I think all of us have gone through periods of time like this, and some people are stuck there for longer stretches than others.  It is exhausting.  If you are living like this, you can easily become depressed.  And if you are actually depressed, that is an illness in itself that requires treatment.  But if you are just exhausted from plain old stress, you might assume there’s nothing to be done.  And that’s not really true.  The thing to do is attend to your self-care.  It is more important than ever.  Proper nutrition and moderate exercise does help to manage stress.  If you don’t have insomnia, make sure you are getting to bed as early as possible and getting a little more sleep.  If you can’t fall asleep or can’t stay asleep, talk to your doctor about it.  Medication might help, but it’s not the only solution for sleeplessness.  Think about a stress management program- such as a mindfulness-meditation based stress-management class or a yoga-based class.  Talk to your friends and/or family about your stress, if you can.  Even if they don’t have solutions, it helps to avoid isolation.  And finally, consider writing about your stress- keep a journal, or make a list of your worries and then put it aside.  I’m a little biased on the writing thing, but I know it helps me.

So if you’re tired, I hope this helps you sort out the reasons a little.  And if you weren’t tired before reading this, you’re probably tired now, after reading it.  I know I’m exhausted, so I’m going to turn off my computer before I’m tempted to stay up half the night surfing the net.





  1. Does excessive fatigue also make it harder to fight off viruses and infections, or is that just a myth?

  2. I really don’t know why I stay tired the whole time, mostly it catches up with me in the evenings, I work a 08:30 – 17:00 job from monday to friday and then waiter 3weakends of the month to help with the bills, but somehow I am always tired, we have some friends over for braais often aswell, and my boyfriend can’t understand why I cant stay awake after 21:00, can you help me please….
    I have gained weight and am trying to lose it while not reall doing a hectic workout…

    • I don’t know enough about you to say much (like how old you are, or whether you have kids, and whether your weekday work is physical, etc.), but even if I did, I would tell you that the first step is to see your doctor and have a checkup. Simple things like low iron (anemia) or low thyroid hormone, both of which can be easily treated, can cause fatigue. So can stress and depression, or it might just be that you are doing as much as you can physcally handle. Everyone has their own natural energy level, and it may be that you are at your limit with your workday and working weekends. If your doctor doesn’t find anything wrong, you should also examine your eating habits and make sure you are giving yourself adequate nutrition for your activities.


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