Everyone feels tired sometimes. But how do you know whether your tiredness is a problem worth seeing a doctor about? And with all the mental and emotional strain we have been under from the pandemic, isn’t it just normal to feel tired?

Tiredness is subjective; what’s normal for one person won’t be for the next. Many people see their GPs reporting tiredness (a recent study in Ireland found that it was present in 25% of patients).

As a GP, my first question to someone who feels tired is: “how well can you function?”.

If tiredness is interfering with your everyday life and your ability to do what you like to do, it should be explored further.

If your level of tiredness is outside the range of normal for you, chat to a GP about it. Shutterstock​

Some common causes of persistent tiredness​

Poor sleep is an obvious and very common cause of tiredness. Often patients tell me “Oh, lack of sleep is not the cause, I sleep fine, possibly too much!” But on questioning they admit they don’t wake up feeling refreshed.

That’s a bit of a giveaway because it means their sleep quality is poor, even if the quantity seems enough. They could be suffering from sleep apnoea, where breathing stops and starts while a person is asleep. Apnoea can lead to serious long-term health problems, so it’s worth investigating.

Alcohol can also wreak havoc on a person’s sleep quality and they wake feeling unrefreshed.

Another common cause of tiredness is depression – and don’t forget, someone can be depressed without feeling they have low mood. For example, they may feel irritable or frustrated, or struggle to concentrate. This is concerning, because such patients may fly under the radar and not realise this is actually depression. Unexplained tiredness may be the predominant symptom of depression, with other symptoms only coming to light with careful questioning.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a serious long-term illness that, among other symptoms, causes people to feel extreme fatigue – well beyond the range of “normal” tiredness. It can begin with patients noticing a degree or type of tiredness different from their past experience, and can be difficult to diagnose in the early stages.

There are other potential causes of tiredness – problems such as low iron, thyroid disease, diabetes, kidney disease, heart disease and many more. Treatment for these can alleviate the tiredness too.

Tiredness also accompanies many illnesses, but should not persist after recovery.

The take-home message is this: if tiredness is interfering with your life, there are many possible causes and it’s worth speaking to a GP about it.

Poor sleep is a very common cause of tiredness. Shutterstock​

What does ‘interfering with life’ actually look like?​

Screening tools for a concerning level of tiredness include the Epworth Sleepiness Scale and the STOP-BANG score. You can do both tests at home and take the results to your GP.

But even if you have normal scores, your tiredness is worth investigating if you:

• feel too tired to exercise (this can be a vicious cycle because regular exercise can actually give you more energy – however, it can be risky for people with ME/CFS to exercise, so caution is required for these patients)
• feel too tired to go out, see friends or do activities you once enjoyed
• hit the alarm snooze button a lot because you don’t wake feeling refreshed
• doze off in front of the TV regularly
• spend the whole day wishing you could go back to bed.

If, along with tiredness, you also have any of the following “red flags”, it is vital you see a GP sooner rather than later: unexplained weight loss, shortness of breath, recurrent fevers, bleeding from your bowels or gums, swollen and sore joints, or other new symptoms concerning you.

I sometimes get asked if wanting an afternoon nap is a red flag. That’s a tricky one; a late afternoon energy slump is pretty normal physiologically (we have whole cultures built around the idea of a siesta, and I often wish Australia was more open to the idea!).

And, of course, many of us lead busy lives and are subject to crushing expectations around work, study and parenting. Tiredness may not always be sign of a physical health problem, but rather that the balance between work and rest is not right.

Do you feel refreshed when you wake up? Shutterstock​

OK, I’m starting to realise my tiredness might be a problem. What now?​

Talk to your doctor. What happens next depends on the individual and unique factors at play.

Some people need investigating immediately if possible serious underlying causes are suspected.

However, there are often obvious ways to address lifestyle factors, and we’d start there. Is alcohol or caffeine interfering with your sleep? Do you have good sleep hygiene habits? Is your exercise level appropriate and your diet not too high in sugar?

After we’ve tackled lifestyle factors, we can look at whether to investigate for health conditions that might be contributing to the tiredness.

Do you often fall asleep on the couch watching TV? Shutterstock​

What about post-COVID fatigue?​

As I have written before, fatigue is about more than feeling just tired:

Tiredness can get better with enough rest, while fatigue persists even if someone is sleeping and resting more than ever.

If you’re especially concerned about fatigue after recovering from COVID and are worried about long COVID, definitely talk to a doctor.

The factors at play are complex and unique to the individual, so a good doctor can help you work out when tiredness has crossed over into true fatigue.

This article was first published on The Conversation, and was written by Natasha Yates, Assistant Professor, General Practice, Bond University

 

[Suzanne rose]

After my surgery gone wrong I suffered severe anxiety and depression, all I wanted to do was sleep.

I felt like I was in a huge black hole and didn't want to talk to anyone about it.

I was always a hard worker both in my job and at home.

Then after having surgery that went completely wrong which caused me terrible pain and discomfort, I slipped unto depression.

I would either sleep all the time or couldn't sleep at all.
I felt death around me.
I felt I wasn't normal.
For someone who was strong who helped others but who couldn't except help ...I crashed.

I spoke to my doctor who sent me to an amazing psychologist, THEN the flood gate opened .

I had feelings I had to run
I had at times feeling that I couldn't breath

Apparently I was on the verge of a breakdown.

I'm still struggling and fighting this dam illness but I will get there.

I know there are plenty of people with the same problem.

I know there are people worst off.

But I want to say You Are Not Alone and there is no shame feeling like this.

 

[Ricci]

After my surgery gone wrong I suffered severe anxiety and depression, all I wanted to do was sleep.

I felt like I was in a huge black hole and didn't want to talk to anyone about it.

I was always a hard worker both in my job and at home.

Then after having surgery that went completely wrong which caused me terrible pain and discomfort, I slipped unto depression.

I would either sleep all the time or couldn't sleep at all.
I felt death around me.
I felt I wasn't normal.
For someone who was strong who helped others but who couldn't except help ...I crashed.

I spoke to my doctor who sent me to an amazing psychologist, THEN the flood gate opened .

I had feelings I had to run
I had at times feeling that I couldn't breath

Apparently I was on the verge of a breakdown.

I'm still struggling and fighting this dam illness but I will get there.

I know there are plenty of people with the same problem.

I know there are people worst off.

But I want to say You Are Not Alone and there is no shame feeling like this.

If you ever want to talk, or just vent to someone feel free to contact me anytime.

 

[Ezzy]

I have suffered from depression all my life, have had at least 3 breakdowns, 3 stays in hospital for this & have seen several psychs. Most of these were middle aged or older & either retired or died while l was having treatment with them. (coincidence l assure you). Some sort of Counselling started when l was about 4 or 5 years old. When l was about 19yo in hosp a Dr stated that my parents were the cause of my problems. I am now 70, haven't had counseling for a few years now but sometimes feel l need this. For most of this my wife has been a tower of strength for me. While in hospital for the first time & unbeknown to me at the time, my parents told my girlfriend, now my wife, to "leave him now while he's in here so we can get him over it".

I had a year when (age about 43), l slept all day & only rose for meals. My constant company was our dog. On another occasion after that, for 12 months l self harmed every day without fail. Why did l do this? I don't know, it was painful. This came to a head the night l drew the scalpel blade quickly across my wrist, not meaning to do much harm, but l cut an artery & blood spurted. In emergency this was stitched inside & outside. I still carry scars on both arms & chest from this period of time. When the urge comes as it sometimes does to inflict pain on myself, l reflect on that last incident & the Dr who asked me if l was suicidal at the time.

At 70 yo now these memories still haunt me, l have several health problems & was today diagnosed with probable thyroid problems (to be confirmed by a 3rd blood test in 3 months), but as Suzanne rose said, there are others who are worse off & there is no shame in having these feelings. We are luckier than our grandparents when this illness was not recognised.

 

[hdhensel]

Everyone feels tired sometimes. But how do you know whether your tiredness is a problem worth seeing a doctor about? And with all the mental and emotional strain we have been under from the pandemic, isn’t it just normal to feel tired?

Tiredness is subjective; what’s normal for one person won’t be for the next. Many people see their GPs reporting tiredness (a recent study in Ireland found that it was present in 25% of patients).

As a GP, my first question to someone who feels tired is: “how well can you function?”.

If tiredness is interfering with your everyday life and your ability to do what you like to do, it should be explored further.

View attachment 5883
If your level of tiredness is outside the range of normal for you, chat to a GP about it. Shutterstock​

Some common causes of persistent tiredness​

Poor sleep is an obvious and very common cause of tiredness. Often patients tell me “Oh, lack of sleep is not the cause, I sleep fine, possibly too much!” But on questioning they admit they don’t wake up feeling refreshed.

That’s a bit of a giveaway because it means their sleep quality is poor, even if the quantity seems enough. They could be suffering from sleep apnoea, where breathing stops and starts while a person is asleep. Apnoea can lead to serious long-term health problems, so it’s worth investigating.

Alcohol can also wreak havoc on a person’s sleep quality and they wake feeling unrefreshed.

Another common cause of tiredness is depression – and don’t forget, someone can be depressed without feeling they have low mood. For example, they may feel irritable or frustrated, or struggle to concentrate. This is concerning, because such patients may fly under the radar and not realise this is actually depression. Unexplained tiredness may be the predominant symptom of depression, with other symptoms only coming to light with careful questioning.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a serious long-term illness that, among other symptoms, causes people to feel extreme fatigue – well beyond the range of “normal” tiredness. It can begin with patients noticing a degree or type of tiredness different from their past experience, and can be difficult to diagnose in the early stages.

There are other potential causes of tiredness – problems such as low iron, thyroid disease, diabetes, kidney disease, heart disease and many more. Treatment for these can alleviate the tiredness too.

Tiredness also accompanies many illnesses, but should not persist after recovery.

The take-home message is this: if tiredness is interfering with your life, there are many possible causes and it’s worth speaking to a GP about it.

View attachment 5884
Poor sleep is a very common cause of tiredness. Shutterstock​

What does ‘interfering with life’ actually look like?​

Screening tools for a concerning level of tiredness include the Epworth Sleepiness Scale and the STOP-BANG score. You can do both tests at home and take the results to your GP.

But even if you have normal scores, your tiredness is worth investigating if you:

• feel too tired to exercise (this can be a vicious cycle because regular exercise can actually give you more energy – however, it can be risky for people with ME/CFS to exercise, so caution is required for these patients)
• feel too tired to go out, see friends or do activities you once enjoyed
• hit the alarm snooze button a lot because you don’t wake feeling refreshed
• doze off in front of the TV regularly
• spend the whole day wishing you could go back to bed.

If, along with tiredness, you also have any of the following “red flags”, it is vital you see a GP sooner rather than later: unexplained weight loss, shortness of breath, recurrent fevers, bleeding from your bowels or gums, swollen and sore joints, or other new symptoms concerning you.

I sometimes get asked if wanting an afternoon nap is a red flag. That’s a tricky one; a late afternoon energy slump is pretty normal physiologically (we have whole cultures built around the idea of a siesta, and I often wish Australia was more open to the idea!).

And, of course, many of us lead busy lives and are subject to crushing expectations around work, study and parenting. Tiredness may not always be sign of a physical health problem, but rather that the balance between work and rest is not right.

View attachment 5885
Do you feel refreshed when you wake up? Shutterstock​

OK, I’m starting to realise my tiredness might be a problem. What now?​

Talk to your doctor. What happens next depends on the individual and unique factors at play.

Some people need investigating immediately if possible serious underlying causes are suspected.

However, there are often obvious ways to address lifestyle factors, and we’d start there. Is alcohol or caffeine interfering with your sleep? Do you have good sleep hygiene habits? Is your exercise level appropriate and your diet not too high in sugar?

After we’ve tackled lifestyle factors, we can look at whether to investigate for health conditions that might be contributing to the tiredness.

View attachment 5886
Do you often fall asleep on the couch watching TV? Shutterstock​

What about post-COVID fatigue?​

As I have written before, fatigue is about more than feeling just tired:

Tiredness can get better with enough rest, while fatigue persists even if someone is sleeping and resting more than ever.

If you’re especially concerned about fatigue after recovering from COVID and are worried about long COVID, definitely talk to a doctor.

The factors at play are complex and unique to the individual, so a good doctor can help you work out when tiredness has crossed over into true fatigue.

This article was first published on The Conversation, and was written by Natasha Yates, Assistant Professor, General Practice, Bond University

Another over-generalized article. As investigative scientist I just thought that I should have a look at this Epworth Sleepiness Scale mentioned above. It tries to pigeon-hole the circumstances of falling asleep. But it is pretty useless because it doesn't take into account the infinite variables that exist in the activities of the human population. For example, it tries to categorize when people fall asleep watching TV. How open is this type of question? does it not depend on how long you have been watching TV, the time of day or night, how much sleep you have had recently, whether you have eaten and how much, whether you have done a day's physical activity and whether you have consumed some alcohol, whether you are on some type of medication, whether recuperating from a sickness or injury, or whether you have had a massage on that day, and how rivetting/stimulating the TV programme is. This is probably just a small number of possible variables. So have a think about the validity of this "test" (and any other test for that matter).