“Doctor, I’m tired all the time.”
As a GP, I hear this a lot. In fact, tiredness is the most common problem that people see their doctor for. 1 in every 20 of my appointments are with patients experiencing fatigue1, and every year 1-2% of people in the UK consult their doctor with this as their main problem2.
Everybody feels tired from time to time. And usually it goes away after a good night’s sleep. But sometimes it doesn’t. When tiredness goes on and on, it negatively impacts on every aspect of our lives – our studies and physical health, our family life and mental health, our relationships and emotional self, our spiritual self and sex life. In other words, tiredness is detrimental to our entire wellbeing.
Working out why is the first step your doctor takes after you tell her you’re feeling tired. There are three main causes:
- Physical causes
- Physiological causes
- Psychological or psychosocial causes
In my experience of general practice, physical (or ‘medical’) problems are the least common reason for feeling tired. Medical problems such as anaemia (not having enough oxygen-carrying haemoglobin in the red blood cells), hypothyroidism (the thyroid gland not producing enough thyroxine hormone) and diabetes (the body not being able to manage sugar) certainly cause tiredness, but they don’t happen as often as the other causes. If you complain to your doctor about feeling tired, he’ll usually do a set of blood tests to exclude these physical causes.
Not getting enough sleep because you’re burning the candle at both ends is a surprisingly overlooked reason for feeling fatigued. Student life is demanding. You’re on campus from the early morning until late afternoon. You then spend the evening maintaining relationships and socialising, squeezing in daily exercise requirements, perhaps volunteering your time or helping your community, and working on some other project or interest you also have on the go. And all the while you’re keeping up with mandatory day-to-day activities like doing the shopping, preparing food, and maintaining personal hygiene. This leaves very little time for sleep, meaning most of us fail to achieve the fabled 6-8 hours we need to feel rested in the morning.
Psychological or psychosocial causes
But there are often reasons for inadequate sleep other than not allowing enough time for it. Psychological and psychosocial problems are by far and away the most common reasons why my patients feel fatigued. Mood disorders such as depression and anxiety, uncontrolled stress and tension caused by studies or exams, recent bereavements, relationship breakdowns, and alcohol or drug abuse are the usual suspects for why people don’t get enough Z’s.
So how can we manage tiredness? Here’s some advice on how to address those modifiable psychological, social and general health factors that we, as autonomous individuals, all have control over.
Tips to manage tiredness
The safest approach to alcohol with regards to your overall health (including dealing with tiredness and fatigue) is to avoid it entirely. The recommended maximum alcohol intake is no more than 14 units a week for both men and women. If you do choose to drink this amount, it’s best to spread your units over 3 days or more, ensuring consecutive drink-free days each week.
The exact number of snoozing hours needed to achieve restorative sleep varies widely between individuals, but is generally around 6-8. Disrupted sleep, not enough Z’s, or sleeping during the day can all lead to feeling tired, fatigued and unrested. Simple sleep hygiene such as creating a quiet, cool and dark sleeping environment promotes healthy shut eye. It’s important to avoid drinking caffeine and eating heavy meals in the hours before bedtime, and so is sticking to an agreed bedtime and get-up time. The big one for me is the use of digital screens before bed. Staring at a brightly lit tablet or smartphone tricks the brain into thinking it’s daytime. This causes a surge in the stress hormone cortisol which makes sleep physiologically impossible. Put your iPhone away 1 hour before bed, and tell your brain it’s sleep time.
The list of benefits that exercise brings to our physical, mental and emotional health is endless. The prevention of longstanding tiredness features prominently on that list, as exercise promotes a regular sleep patterns, boosts available energy supplies, and improves mood while relieving anxiety.
Meditation, deep-breathing and mindfulness are simple methods that can be done at home without any specialist equipment or training. Devoting 10 minutes each day to care for your mind switches the body into a relaxation state which brings with it countless benefits, including elevated energy levels and prevention of fatigue.
Avoiding dramatic peaks and troughs in blood sugar can help keep tiredness away. Eating regular, small meals is one way to do this. Remember to include a daily breakfast rich in complex carbohydrates each morning (porridge is my favourite). Sugary snacks like chocolate and sweets might taste delicious and give you a much-needed sugar rush, but the inevitable crash afterwards causes overwhelming tiredness and fatigue.
To conclude: If you’re feeling tired, I suggest seeing your doctor. But while you’re waiting for that appointment, try to address the lifestyle factors mentioned above. You might find that you fix the problem yourself.
1 Hamilton, W., Watson, J. and Round, A. (2010) Investigating fatigue in primary
care. BMJ 341(), c4259.
2 Gallagher, A.M., Thomas, J.M., Hamilton, W.T. and White, P.D. (2004) Incidence of fatigue symptoms and diagnoses presenting in UK primary care from 1990 to 2001. Journal of the Royal Society of Medicine 97(12), 571-575.