Why Are You So Tired?

During annual physicals, I typically ask a series of questions as I’m doing my exam. Headaches? Dizziness? Hearing problems? Vision problems? Chest pain?

The questions typically correspond to the area I’m examining so I won’t forget something important. Most of my review of system elicits a bland negative response. The most common affirmative is if I ask I the person if they are tired. To this end, I now will ask if they have any “unexplained fatigue.”

The list of potential causes of fatigue is extremely long. This blog will start a series of blog posts giving the reader a framework so that they can figure out the primary and secondary causes for them.

Many common causes of chronic fatigue can be missed by even the most conscientious and dedicated primary care provider. We should not accept a lack of energy. This is not normal.

The list we will work from includes: dehydration, lack of hours of sleep, lack of quality of sleep, unmanaged sleep apnea, managed sleep apnea with the wrong continuous positive airway pressure (CPAP) settings, depression, medication side effects, thyroid dysfunction, adrenal fatigue, iron deficiency, B12 deficiency, mineral deficiencies and imbalances, chronic Lyme disease and other tickborne illnesses, and chronic mold/biotoxin illness. There are others, of course, but this is a fairly comprehensive list.

Most doctors would take a history and then check some routine labs including those to rule out anemia, kidney disease, liver disease, hypothyroidism and possibly B12 deficiency. These labs, if not interpreted properly, would miss even those conditions on the short list.

The best place to start is probably sleep. I am still surprised by how many patients come in for a visit dedicated to chronic fatigue who do not correlate their tiredness with chronic insomnia. If a person is averaging 4-5 hours of sleep for months or years, that will be the most likely cause of chronic fatigue.

There are many causes of inadequate sleep but our modern stressful life is likely number one. We keep artificial lights on too late with electronic stimulation much beyond what are brains are evolved to handle. An essential first step is often to shut off the phone, television and computer so that the final stretch of time before bed is quiet and restful.

“Sleep hygiene” is the term for the basics of getting regular, deep sleep. It includes: avoiding caffeine later in the day; going to bed at the same time every night; getting up at the same time every morning; leaving the bed if you are awake; and others. (You can search the internet for more details on sleep hygiene.) Our brains are incredibly sensitive to light, so any ambient light, even the small green dot on our laptops can interfere with sleep. Blackout shades that block out any light from the outside may be the greatest investment one can make to improve the quality of sleep and feel more awake and alert during the day.

Stay tuned. More blogs on fatigue to follow.

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