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FROM THE EDITORS

Fatigue: Clues and news


Robert D. Sheeler, M.D.
Medical Editor, Mayo Clinic Health Letter


One of the most common complaints we hear in clinical practice is fatigue — a feeling of tiredness and lack of energy. Most people feel some degree of fatigue at some point in their lives, particularly when their energy levels seem to fall short of what they would ideally like to have to accomplish daily tasks. The concern about fatigue becomes more prominent as people grow older for a number of reasons.

While there are many medical causes of fatigue, some of which are discussed in this article, there are also common life issues and situations that may cause fatigue. Both types of causes need to be considered and can often be addressed as you try to alleviate a persistent lack of energy in your everyday life.

Medical causes of fatigue
Some common causes of fatigue include:

  • Anemia — When you have low red blood cell counts in your bloodstream, your body has to work harder to deliver oxygen to your cells, causing fatigue. Iron deficiency is also associated with fatigue. If you're diagnosed with anemia, then it's important to understand the cause in order to correct the problem. Bleeding from the colon or stomach are frequent causes of anemia in older adults. It would be prudent to investigate whether colon cancer at an early treatable stage could be the cause of new onset anemia and be cured. Monthly blood loss in menstruating women and frequent blood donations are other causes of anemia.

  • Sleep disorders — Sleep apnea and other conditions that interfere with sound sleep are frequent, often profound, causes of fatigue. People with sleep apnea typically snore, and their bed partners may note that they stop breathing for several seconds and then gasp for breath. Other treatable sleep problems that may lead to fatigue include restless legs syndrome and nocturnal limb movement syndrome. Consultation with a sleep specialist is appropriate if it appears you may have one of these problems. Treatment can lead to dramatic improvement in daytime energy. Many who receive treatment say they feel years younger.
     
  • Depression — Another frequent cause of fatigue is depression. If you're experiencing a persistent state of irritability or sadness, sleeping either too much or too little — especially if you're waking up in the middle of the night and can't get back to sleep — and have lost interest and pleasure in usual activities, then you should seek evaluation for depression. Depression is treatable and, with proper diagnosis and management, most people return to normal energy levels.
     
  • Thyroid problems — Low thyroid function, or hypothyroidism, becomes more common with age and often presents itself subtly. The classic symptoms are being cold all of the time, constipation, weight gain and hair loss, but not all of these symptoms are always present or they may come on so slowly that they don't draw your attention. Replacement of the thyroid hormone can help restore former energy levels. Surprisingly, high thyroid function, or hyperthyroidism, can also cause fatigue by continuously running your metabolism at a higher than normal rate. Blood tests to determine your thyroid function can be of great help in identifying this condition.
     
  • Chronic pain — Chronic pain can sap your energy, making day-to-day living difficult and being a constant drain on your emotional state. Whether the pain is due to arthritis in the joints or to a structural problem such as a back disorder, the condition can limit your quality of life and leave you feeling constantly tired. Working with your doctor to appropriately treat pain can help your overall energy level.
     
  • Inflammatory disorders — Rheumatologic problems like rheumatoid arthritis, lupus and related conditions can cause fatigue, along with inflammation of joints and other tissues. Specific tests for rheumatoid arthritis and lupus are available, but more general markers for inflammatory disorders such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tests are often significantly elevated in these disorders as well.
     
  • Cancer — Patients with cancer often experience fatigue and loss of energy. This is due in part to the metabolic effects that cancer cells have on the body. Since cancer cells are rapidly growing, they use up energy and resources needed for other cellular processes.
     
  • Chronic fatigue syndrome — This is a poorly understood syndrome that causes ongoing fatigue over many months or years. There may be several subtypes of this illness but the specific causes remain elusive. For some, it may be a response to certain viral infections that either trigger changes in the body or result in chronic low-grade infections. A cure has not been found but certain management strategies have shown promise for improving the symptoms.
     
  • Chronic infection — Around the world, chronic infection from processes such as tuberculosis and HIV are very common causes of fatigue. Other chronic infections such as Lyme disease can also be marked by significant fatigue. Treating the underlying infection is the best care in these circumstances.

Working closely with your doctor to investigate possible medical causes of fatigue is a good first step toward alleviating the tiredness and lack of energy. An exam can also be used to rule out depression and to make sure you have up-to-date cancer screening tests. If you've done all of this and still remain fatigued, then it may be time for personal reflection and to ask yourself a few probing questions.

Underlying emotional causes of fatigue
People often feel most energized and alive when they're doing something they consider of value and importance. How connected they feel to other people and to processes that give meaning to their lives are also important aspects to consider when they're feeling invigorated.

Do you feel that you're making a difference in the world? Are you doing things that you believe are of value to yourself, your family and the world? Answering these questions is difficult but may get to the root cause of fatigue. If you're feeling disconnected from sources of personal power, then you're not likely to be able to sustain a high level of energy. If your relationships are out of balance, they'll drain your energy rather than recharge you.

Likewise, if you're bored or feel burdened with too many tasks that seem overwhelming or without meaning, you'll likely feel trapped. It's common to feel tired, edgy and unfulfilled when your days are taken up with tasks that you find limiting rather than empowering. Modern life can easily become too complex and dissociated from many aspects of your basic human nature. When you find yourself doing things because someone else has told you it's required to do so, it may not be something that adds to your personal strength and energy. Running endless errands, seeking to be perfect at lawn care and housecleaning, and fulfilling every obligation that's thrust upon you can often leave you with an empty feeling. 

Sometimes, fatigue is a form of procrastination. If you're convinced that you're too tired, then you won't have to face the pile of papers you don't want to address, or you won't have to attend a social obligation that you find stressful. Examining your deeper feelings — either on your own, with your closest friends, or even with a counselor — can help you understand the root problem that's causing your fatigue. Quiet time, contemplative prayer and communion with nature can all help you slow down enough to hear your inner voice.

Grasping what in life connects you to your personal sources of power and fulfillment allows you to get closer to these sources. Simplifying your life by walking away from complex and meaningless materialism helps you get closer to your personal center. When you connect with inner values and can share this joy with those you love, then you're more likely to feel engaged and maintain a higher level of energy on a day-to-day basis.

If you find yourself without as much energy as you would like to have on most days, then take a good hard look at how you organize your time. You may find that, gradually, you can restructure your days to include more things you look forward to — things that you enjoy getting up in the morning to do. When that happens, you'll likely be in better health and have energy that will spill over into every aspect of your life. You'll invigorate those around you and create a positive cycle in which your good energy boosts their outlook and their good energy boosts yours.


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