Tiredness and Fatigue

Many of depression's symptoms - exhaustion, insomnia, nausea, headaches, weight loss, weight gain

- are physical ailments.

Gayle Forman


Although feeling tired all the time is very common, it isn't exactly 'normal',

and it shouldn't be something you have to live with.


For three years recently,  I suffered from extreme fatigue.


How do I know?


I was sleeping 10 – 12 hours per night, would not awaken refreshed, and within

an hour of waking I would have nodded off again. Unless I was busy, then if I

would sit down, even in a hospital waiting room, or on a short bus ride, I would

instantly nod off again and not just for a few moments; unless someone roused

me, I could nod off for 1 – 2 hours. Sometimes, on buses or trains, I would end

up at the end of the line.


Concerned, on numerous occasions, I went to my GP, and each time the story was something along the lines of, “You’ve reported this before. I don’t know what it can be.” And the subject would be changed by him by looking up his computer and then diverting discussion to one of the other medical conditions I had. And then there followed, “So if it doesn’t improve in a week, come back and see me.” And round and round the rugged rock of fatigue.


No examinations, no referrals. And in my time with poor health I met many other patients who reported similar treatment from their GP.


(I am aware that in a ten minute consultation a GP cannot always go digging with you – but the system needs to change to allow him or her the time.)


For, for fatigue of this nature, if this is somewhat like your situation, it needs exploration. Something is causing it, it is not just old age or a simple side effect of a medication you are taking. Tiredness and fatigue seriously impact the quality of your life and your ability to hold down a job and if you drive or use mechanical equipment, it can be downright dangerous.



Feeling tired all the time – sometimes known as TATT - may simply be because you're not getting enough shut-eye, are doing too much eg you are a parent, with a job, and caring for your children and for an elderly relative with no assistance, and also you can’t say no to other peoples’ requests. So sometimes the cause does not need medical intervention but personal, practical or attitudinal resolve. Seeking drugs to “pick you up” may also have side effects which bring you down. Sometimes you may need to lessen the hours you work, delegate some of your work, have children, if they are of an age, share the workload and so on.


Depending on your particular circumstances, this kind of tiredness should be easy enough to address. And time and changing circumstances may also help.


But if you're feeling truly exhausted, and can't pin it on any obvious cause, and if it is by now troublesome to your mental well-being, in that you are becoming worried about the situation, or it is affecting your regular quality of life, then you should seek medical help and also go to a consultation having considered possibilities so that if you get the “nothing we can do” treatment you can be a bit more forceful.


Tiredness or Fatigue


It is important to distinguish between tiredness and fatigue.


Tiredness will usually result from perhaps not sleeping long enough or well enough each night, perhaps a period of physical exertion more than your norm, burning the candle at both ends. This can often be rectified by getting a good night's sleep, eating well, keeping hydrated, and making a few lifestyle changes – delegating family tasks, working fewer hours, working smarter not longer, learning to say “no!”


Fatigue – could stem from so much more . In my own case my GP could have considered (as I had to do myself) whether it was related to a pre-existing health condition, for me that would have been diabetes type 2, sleep apnoea, anxiety, or depression. But there is so much more that could have been considered (which in the end I explored myself.)

Reasons you feel tired all the time


If your tiredness doesn’t go away, even after a good night's sleep,  and especially if you're experiencing other symptoms, or suspect you have an underlying condition, and have been tired for more than four weeks, ie it is becoming chronic fatigue, it’s time to seek help to investigate the situation more closely.

Recognise that on-going tiredness isn't a disease, it's a symptom – an indication that something is going on and it may be accruing and be potentially damaging the longer you delay seeking help.


Physical causes

Most people, in my experience, first consider whether the cause of extreme chronic fatigue is a physical one – yet ironically, physical causes are less common than the psychological ones.

A physical cause, or underlying condition, may be something such as anaemia, coeliac disease, diabetes type 2, glandular fever, hypothyroidism, or sleep apnoea.

Physically, tiredness can also be a side effect of certain medications, eg some anti-depressants have the effect of making you feel  tired and feeling like a zombie.


Being overweight as well as being underweight can both make you chronically fatigued


If you're currently pregnant, or have gone through surgery or chemotherapy, tiredness is to be expected.


It may be two conditions which some doctors are still reluctant to consider:-

Chronic Fatigue Syndrome (sometimes known as ME) - characterised by extreme tiredness along with symptoms such as foggy-headedness and muscle pain. It is only diagnosed when other conditions are ruled out. But I never got as far as the ruling out process.

Fibromyalgia - characterised by:-

Cognitive and memory problems (sometimes called "fibro or brain fog")



Irritable bowel syndrome

Mood issues

Musculoskeletal pain (which migrates to different parts of the body)

Numbness or tingling of hands and feet

Painful menstrual periods

Restless legs syndrome

Sleep difficulties

Stiffness of joints


Psychological causes

It’s estimated that one in ten of us will have prolonged, debilitating fatigue at any given time. Quite how they figure that out I do not know especially if, as my GP does, symptoms go unheeded.


Often, the causes are psychological, and that is not to say, as I have had it said to me by medical professionals, “it’s all in your head.” It most certainly is not imagination. Who would wish extreme, debilitating tiredness upon themselves?

Causes worthy of exploration could be:-


Figures vary, but up to 90 percent of doctor visits may be due to stress-related illness.

The stress responses that once existed primarily to keep our bodies out of harm's way (called our "fight, freeze, or flight" responses), and only occurred at select instances in time, like when we were under danger, have now, in our hi-tec, pressure-driven societies, become persistent, pervasive and an incessant part of daily life.


Whilst a little bit of stress can be good for you, over time constant stress weakens your body's ability to heal itself and more. It has been linked to everything from heart disease, cancer and depression to autoimmune diseases and reproductive problems--in short, it's linked to most major diseases.

Major stressors fall in the areas of finances, relationships, health, home and security, and career. House moves, divorce, marriage, redundancy, death of a loved one are all major stressors and we each recover in our own time and ways. But if you are not coping or recovering, see your main medical practitioner or seek other therapeutic help. When your body goes into 'fight or flight' mode, it fires up a series of hormonal and physiological changes and if this response is activated frequently, you are likely to end up feeling fatigued.

Whilst mainstream doctors don’t agree with me, because of their dependency on the need for scientific evidence, this kind of tiredness may be due to adrenal fatigue ie an inability to produce the amount of adrenaline you need. Ignore the nay sayers and read up on this by consulting eg Dr James L Wilson 


Other triggers for prolonged, debilitating tiredness can be


  • Anxiety

  • Depression

  • Excess alcohol – which can exacerbate anxiety and depression and trigger insomnia

  • Insomnia

  • PTSD – Post Traumatic Stress Disorder


The sugar cause

If you are constantly tired, then a starting point may be to evaluate your eating habits and in particular how much sugar is sneaking into your system. Read food labels – sugar gets into many things.

More and more we are being shown the damage that sugar intake has on our health:-

• It overloads and damages your liver. The effects of too much sugar or fructose can be likened to the effects of alcohol.3 All the fructose   you eat gets shuttled to the only organ that has the transporter for it: your liver. This severely taxes and overloads the organ, leading to potential liver damage.

• It tricks your body into gaining weight by turning off your body's appetite-control system (it affects your insulin and leptin signalling.) Fructose -  the sweetest of sugars, a simple carbohydrate, stimulates the taste buds and produces the sweet sensation, it fools your metabolism in that it fails to stimulate insulin, which in turn fails to suppress ghrelin, or "the hunger hormone," which then fails to stimulate leptin or "the satiety (satisfaction) hormone"4 which in turn causes you to eat more and develop insulin resistance.

• It causes metabolic dysfunction. Eating too much sugar causes numerous symptoms known as classic metabolic syndrome.5 These include abdominal obesity, decreased HDL and increased LDL cholesterol levels, elevated blood sugar, elevated triglycerides, high blood pressure and weight gain.

• It increases your uric acid levels. High uric acid levels6 are a risk factor for heart and kidney disease. Uric acid level can now be used as a marker for fructose toxicity.

Allegedly in 2018 the average (whatever that is) American consumes about 26 pounds of sugar per year; in the 1700s it was about 4 pounds.


Change is needed

If you don't have an underlying condition that requires treatment, making a few nutritional and movement ie lifestyle changes might be enough.

Steer clear of refined carbohydrates, as these provide a short-lived energy spike, followed by a crash that leaves you craving your next sugar hit.


Eat fresh food – avoid processed foods, often crammed with sugar.


Exercise.  I am no fan of the gym but I do believe in ensuring I get enough exercise and movement.


Exercise reduces the risk of developing cancers, diabetes type 2, heart disease, high blood pressure, osteoporosis, stroke, improves sleep and enhances stamina, and helps to control weight and ease stress both of which as we have seen above contribute to excessive, prolonged tiredness.


But if you are an exercise aficionado, be aware …. overtraining leads to performance plateaus, a higher risk of injury, and - most importantly - fatigue.

Sleep. Consider that your sleep may also be the problem of your tiredness.


How is your quantity AND quality of your sleep?


Do you compromise it be too many energy drinks and coffee to keep you going, too much “blue” time ie hours spent on a screen, be  it TV iPhone, or iPad, or laptop especially before bedtime. How about your alcohol levels?


Whilst an occasional nap is fine, has napping become a regular even necessary habit? Falling asleep during the day is not natural and could be the sign of a sleep disorder.


The most obvious sleep disorder that causes people to fall asleep during the day is narcolepsy. This is a chronic neurological disorder caused by the brain's inability to regulate sleep-wake cycles normally. With narcolepsy, you may experience disturbed night-time sleep and an abnormal daytime sleep pattern, which may often be confused with insomnia. The person with narcolepsy is likely to become drowsy or fall asleep or just be very tired throughout the day, often at inappropriate times and places. Your daytime naps may occur with little warning and may be impossible to stop. They may occur several times a day, and for a few hours. Drowsiness may persist for prolonged periods of time. All of which totally impedes your quality of life.


If a suspected sleep disorder may be your problem, seek expert help ie a sleep specialist not just your GP.



Self care


When was the last time you asked yourself what you needed?  


Are you running on empty all the time, pushing the last vestiges of your energy to the very limits before you collapse into a coma of sleep only to do the very same thing the next day?  


The message for you right now is simply this: self-care.  You have to take time to replenish the stores of your life-force.


So ask yourself, “What do I need today that would be restful and add abundance to my spirit?”  


Go paint, play, walk by the riverside, swim, dance, take in a movie,








What is adrenal fatigue?   

CFS / ME by the NHS   

10 reasons for feeling tired – NHS  

Narcolepsy NHS   



 Young Woman Contemplating

Access the following medical sites for further information.


Seek help if suffering with anxiety, depression,  PTSD, or insomnia.

Prolonged lethargy may indicate type 2 diabetes, coeliac disease or anaemia.

Other causes of fatigue are hypothyroidism, glandular fever, or  sleep apnoea.

You may also be suffering with chronic fatigue syndrome, also known as ME,

or a related condition, fibromyalgia.