Are You Tired All the Time?

What’s making you tired all the time?

Medically, tiredness is a tough one because there are so many potential causes.  Anything from not sleeping well, through stress, not drinking enough fluid, over exercise, under exercise, depression, thyroid disease and pregnancy, to anaemia, celiac disease, Multiple Sclerosis and cancer can cause tiredness and fatigue.

Here we’ll look at 5 common medical reasons for tiredness as well as how you can help your doctor get to grips with your diagnosis.

  1. Thyroid disease

This disorder is more common in women than in men and there are 2 forms: the over active thyroid and the underactive thyroid.  Each has very different symptoms but fatigue features in both.

The thyroid is a little gland that sits at the front of the throat and produces the hormone thyroxine.  Thyroxine is responsible for the energy and rate of all the reactions in the body – from how fast your heart beats to how fast your brain cells work.  So you can see that if you have too much, you’re over-powered and jittery and if you have too little you’re sluggish and slow.

Look at this article on for more on the underactive thyroid, and here at this article on the underactive thyroid.  You’ll be able to see if your tiredness symptoms match with any for these 2 disorders.

Either type of disease can be detected on a simple blood test – called a thyroid function test or TFT.

2. Anaemia

Anaemia/anemia is a very common reason for feeling tired.  It is often a symptom of another disease rather than a diagnosis in its own right.  It’s detected on a routine blood test (a complete blood count or CBC in the US or full blood count/FBC in the UK).

The red blood cells are the part of the blood that makes it appear red.  It’s red because these cells carry iron and with the iron they carry oxygen.  If there isn’t enough iron in the blood the cells can’t carry the oxygen and you feel tired and out of breath more easily than usual.

Your skin may also look pale and if you open the palm of your hand wide and look at the creases, in severe cases these are pale rather than red/pink (don’t try this when you’re cold as the creases are often paler then).

Anaemia is most common in young women who have heavy menstrual periods.  Their natural blood loss is greater than the iron replacement from the diet.  Your doctor may give you iron tablets as a diet supplement to help with this iron deficiency anaemia, as well as look at the cause and treat the heavy periods.

Good diet is also essential to prevent this sort of anaemia and iron is most readily absorbed from red meat or for vegetarians, from dark green leafy vegetables such as spinach.

However there are other types of anaemia and it can be caused by other diseases so it’s important that you talk to your doctor and get all the tests s/he thinks you need.

  1. Sleep apnea.

Many people snore and some of those snorers have sleep apnea.  Snoring is harmless (unless the person you sleep with isn’t happy about it!) but sleep apnea can affect your health.  It can cause high blood pressure and erectile dysfunction (impotence) as well as tiredness.

Sleep apnea happens when the soft tissues at the back of the mouth and top of the throat close over the airway as you sleep.  This stops the breathing until the brain recognises the change in oxygen levels and wakes you up.  This can happen 100s of times each night so the constant waking (that you won’t remember) means you don’t get good quality sleep and therefore feel tired.

If you snore very loudly and your bed partner notices that you have periods when you stop breathing, you may suffer from sleep apnea.  Read more here.

  1. Diabetes.

Diabetes is becoming more common as we eat more refined and sugary foods and exercise less.

The pancreas is an organ near the liver.  It contains special cells that release insulin.  Insulin is an essential hormone that enables glucose (the body’s basic fuel) to get into every cell in the body.  Without the energy in the cells they die and therefore the body eventually dies.

There are 2 or 3 types of diabetes: the 2 main ones are type 1 and type 2.

Type 1 diabetes is more common in young people and children.  It happens when the pancreas stops making any insulin and the person is dependent on insulin injections.  This is also called insulin dependent diabetes.  It also happens when the pancreas is removed by surgery.

Type 2 is more common in older people, especially those who are overweight.  There is a combination of less insulin from the pancreas as well as the cells in the body becoming more resistant to effectively using the insulin so they don’t get their energy.

People with diabetes should lead a normal and active life but one of the symptoms of diabetes when it isn’t well controlled or us undiagnosed, is tiredness.  If the cells in the body aren’t getting the energy they need then you will be tired.

If you have symptoms of tiredness, excessive thirst and going to the toilet frequently, and/or get frequent infections like thrush (yeast infections) you should see your doctor to discuss it further.

  1. Glandular fever.

Glandular fever is a common viral infection.  It affects young people – teens and young adults – more often than older people and it can range from mild to quite severe.

The glands in the neck, armpits and groins are swollen; there is usually a fever of 38C/100.4F and a sore throat as well as the tiredness.  It’s not a serious disease unless there are complications, but because the symptoms last for a long time it’s quite unpleasant.  The main symptoms clear up after about 4-6 weeks but the tiredness can linger for several months.

Discuss this with your doctor.

How to help your doctor when you’re tired all the time.

When you visit your doctor it will help if you are able to answer the questions that you might be asked.  So think about the following:

  • How long have you been tired? When did you first notice it?
  • Did it come on slowly or quite quickly?
  • Has this happened before?  When and what happened?  Is there a cycle or pattern?
  • How well and how long do you sleep for each night?
  • Do you wake in the night?
  • Do you snore?
  • Do you feel tired all day or is it worse as the day progresses?
  • Are you under stress or feeling bored, depressed or unhappy?
  • How are your relationships?
  • Have you recently had a bereavement?
  • Are you caring for children or sick/elderly relatives/friends?
  • What’s your diet like?
  • If you’re a woman, do you have frequent/prolonged/heavy periods?
  • Do you take any prescription/non prescription or recreational drugs?
  • Do you have other symptoms?  If so what and when?
  • Have you had a recent change in weight?  Either planned or not planned.

Your doctor will probably do a physical exam, take blood and urine tests to see what abnormalities there may be.

Sometimes, frustratingly, the answer is slow in coming.  Keep a journal of your symptoms and maintain a healthy diet and level of exercise until you know what might be wrong.

Elspeth Raisbeck

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