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How tired is too tired?

How tired is too tired?

Lauren Wuthrich

Do you feel like you're always tired? Most of us know what it's like to be tired, especially when we have a cold, flu, or you’ve been cheating on your sleep time. But when you suffer from a constant, severe lack of energy and ongoing fatigue, it’s probably time to go see your doctor.

Fatigue is a lingering tiredness that is nearly constant and limits what you can do on a day-to-day basis. With fatigue, you have persistent exhaustion that cannot be explained away. It's similar to how you feel when you have the flu or have missed a lot of sleep. If you have chronic fatigue, you may wake in the morning feeling as though you've not slept. Or you may be unable to function at work or at home. You may feel as though you can’t do anything!

In the majority of cases, there is a reason for the fatigue. It might be allergic rhinitis, anemia, depression, fibromyalgia, or some other health condition. The good news: these things are all treatable, the only catch is you have to be diagnosed first! Let’s talk about some of these common culprits for overwhelming tiredness.


Allergies, Hay Fever, and Fatigue

Symptoms: Fatigue, headache, nasal congestion, and drainage

Allergic rhinitis is a common cause of chronic fatigue, and can often can be easily treated and self-managed. Your doctor can determine through a detailed history or testing whether your allergies are triggered by pollens, insects (dust mites or cockroaches), animal dander, molds and mildew, weather changes, or something else.

One way to reduce symptoms of allergic rhinitis -- including fatigue -- is to take steps to avoid your particular allergen. In addition, proper medication (nasal steroids, antihistamines, etc.) can help with symptoms. Allergy shots – “immunotherapy” -- may help in severe cases. Ask your doctor if you think allergies could be the cause of your fatigue.


Anemia and Fatigue

Symptoms: Fatigue, dizziness, feeling cold, irritability

Anemia is very common – in fact, it is the most common blood condition in the U.S.! Especially for women in childbearing years, anemia is a common cause of fatigue. This is especially true for women who have heavy menstrual cycles, uterine fibroid tumors, or uterine polyps.

In anemia, red blood cell production is decreased. This can also be the result of hemorrhoids or GI problems such as ulcers, or cancer. NSAIDs such as ibuprofen or aspirin can also lead to GI problems and bleeding. Other causes of anemia include a deficiency of iron, folic acid, or vitamin B12. Chronic diseases such as diabetes or kidney disease can also cause anemia.

To confirm a diagnosis of anemia, your doctor will give you a blood test. If iron deficiency is the cause of your fatigue, treatment may include iron supplements. Iron-rich foods such as spinach, broccoli, and red meat can also be added to your diet to help relieve symptoms. Vitamin C with meals or with iron supplements can help the iron to be better absorbed and improve your symptoms.


Depression, Anxiety, and Fatigue

Symptoms: Sadness, feeling hopeless, worthless, and helpless, fatigue

Sometimes, depression or anxiety is at the root of chronic fatigue. Depression often runs in families and commonly begins between the ages of 15 and 30. Women can get postpartum depression after delivering a baby. Some people get seasonal affective disorder in the winter, with feelings of fatigue and sadness.

With depression, you might be in a depressed mood most of the day. You may have little interest in normal activities. Along with feelings of fatigue, you may eat too much or too little, over- or under-sleep, feel hopeless and worthless, and have other serious symptoms.

Anxiety symptoms may include:


difficulty sleeping

excessive worrying


If you have any of these symptoms, talk to your doctor and get a physical exam. If there is no physical cause for the depression or anxiety, your doctor may prescribe medication. Or your doctor may refer you to a psychiatrist or psychologist for an evaluation.


Fibromyalgia and Fatigue

Symptoms: Chronic fatigue, deep muscle pain, painful tender points, sleep problems, anxiety, depression

Fibromyalgia is one of the more common causes of chronic fatigue and musculoskeletal pain. With fibromyalgia, you may feel that no matter how long you sleep, you never feel rested. And you may feel like you are always fatigued during the daytime. Your sleep may be interrupted by frequent waking. Yet, you may not remember any sleep disruptions the next day. Some people with fibromyalgia live in a constant 'fibro fog' -- a hazy, mental feeling that makes it hard to concentrate.

Constant daytime fatigue with fibromyalgia often results in diminished exercise, causing a decline in physical fitness and mood. The best way to offset these effects is to try to exercise more. Exercise has a tremendous beneficial effect on sleep, mood, and fatigue.

When starting an exercise routine, start slowly!


Heart Disease and Fatigue

Symptoms: Fatigue with an activity that should be easy

If you find yourself becoming exhausted after an activity that used to be easy, like walking up the stairs, it may be time to talk to your doctor about the possibility of heart disease. Heart disease is the leading cause of death in women. If your fatigue is related to your heart, medication or treatment procedures can usually help correct the problem, reduce the fatigue, and restore your energy.


Rheumatoid Arthritis and Fatigue

Symptoms: Fatigue, morning stiffness, joint pain, inflamed joints

Rheumatoid arthritis (RA), a type of inflammatory arthritis, is another cause of excessive fatigue. Because joint damage can result in disability, early and aggressive treatment is the best approach for rheumatoid arthritis. Ask your doctor if you think you have rheumatoid arthritis.


Sleep Apnea and Fatigue

Symptoms: Chronic fatigue, feeling exhausted upon awakening, snoring

Obstructive sleep apnea results in low oxygen levels in the blood. That's because blockages prevent air from getting to the lungs. The low oxygen levels also affect your heart and brain function. Sometimes, the only clue that you might have sleep apnea is chronic fatigue.

Talk with your doctor to determine if you have sleep apnea.  Lose weight if you are overweight, and if you smoke, stop. Both obesity and smoking are risk factors for sleep apnea. Sleeping on your side instead of your back may help eliminate mild sleep apnea.


Underactive Thyroid (Hypothyroidism) and Fatigue

Symptoms: Extreme fatigue, sluggishness, feeling run down, depression, cold intolerance, weight gain

The problem may be a slow or underactive thyroid. This is known as hypothyroidism. The thyroid is a small gland that sits at the base of your neck. It helps set the rate of metabolism, which is the rate at which the body uses energy.

According to the American Thyroid Foundation, approximately 17% of all women will have a thyroid disorder by age 60 - and most won't know it! The most common cause is an autoimmune disorder known as Hashimoto's thyroiditis. Hashimoto's stops the gland from making enough thyroid hormones for the body to work the way it should. The result is hypothyroidism, or a slow metabolism.

Blood tests known as T3 and T4 will detect thyroid hormones. If these hormones are low, synthetic hormones (medication) can bring you up to speed and you should begin to feel better fairly rapidly. The good news: hypothyroidism is common and very treatable.



The purpose of this article is not to make you have a panic attack when you feel tired. The overwhelming majority of the time, we feel tired because we are over-worked and we don’t get enough sleep!

The bottom line: If you have unexplained and extreme fatigue, get it checked out. You could have a condition you’re not aware of. Early treatment = better treatment.

To see the article referenced in this blog post, click here: