Always tired

Dear Alice,

I'm always tired. I get plenty of rest (at least eight hours a night), eat healthy, and exercise regularly. I went to my doctor and he took blood only to conclude that I am perfectly healthy. But every day, I am exhausted constantly to the point that it affects my everyday activities. Any suggestions as to what I can do?

Dear Reader,  

Kudos to you for reaching out to a health care provider to investigate your ongoing and unexplained tiredness. As you mention, constantly feeling exhausted or fatigued can interfere with daily activities and overall well-being. There are a host of factors that could impact levels of tiredness such as underlying medical conditions, lack of key nutrients, sleep disorders, medication side effects, and stress levels (more on these in a bit). Sleep, diet, and physical activity are all key components of feeling refreshed and energized. However, the specifics of these factors such as the amount of sleep needed for each individual or nutrients in a person’s diet can impact feelings of tiredness. If medical conditions have been ruled out, your health care provider might recommend making some adjustments to one or more of these influences to see if they impact your fatigue.   

With that in mind, meeting with a health care provider was a great first step in trying to determine the root cause of your tiredness. Typically, they will conduct a physical exam, review your medical history including any medications, ask you about your symptoms, and discuss your habits related to diet, exercise, and sleep. This information can help them understand if symptoms of fatigue are linked to another medical condition or a side effect of a medication. As with your experience, health care providers often do blood work to test for underlying medical conditions such as hypothyroidism or nutrient deficiencies such as iron or vitamin D that could cause feelings of exhaustion. Based on the test results they may refer you to other specialists, such as a dietitian. Another potential cause is chronic fatigue syndrome in which feelings of fatigue last for more than six months and aren’t associated with another medical condition or improved with sleep. It’s also possible that occasional and mild sadness, not to mention stress, can significantly impact energy levels and possibly prolong fatigue. 

While the amount of sleep you get plays a role in feeling rested, so too does the quality of sleep, which is marked by the depth of the slumber and sleep disruptions. Letting a health care provider know if you experience any of these challenges can help inform recommendations or referrals to other providers. For these reasons, you and your health care provider may consider other factors including:  

  • Stress and anxiety: Have you been feeling stressed out lately? Stress can really take a toll on a person’s energy level. There are a wide variety of stressors, from personal finances, to workload, to relationships. Managing your stress (one stressor at a time) may help you regain your energy and get you back on top.  
  • Depression: Singing the blues can significantly impact your energy, as well as your sense of confidence. Have you been feeling more irritable, sad, or hopeless than usual? Making sure you mention it to your provider can help you get informed support. For more information, you can check out the Blues and Depression category in the Go Ask Alice! archives.    
  • Packed schedule: Have you had any “me time” to just relax and enjoy yourself? Going non-stop through a million green lights can be exhausting if you don’t have a moment to pause. Perhaps take some time to consider whether you’re allowing yourself the relaxation you need. A little down time can go a long way when it comes to revamping your energy level!    
  • Sleep quantity and quality: Seven to nine hours of sleep is recommended for adults between ages 18 to 64. That being said, each person has unique sleep needs, so you might try adjusting the number of hours you sleep to see how it impacts your energy. You might also talk with your health care provider to see if you’re experiencing any symptoms associated with sleep disorders such as sleep apnea, narcolepsy, and insomnia, as they’re common culprits of low-quality sleep and fatigue.   

Continuing to feel tired, despite seemingly doing all you can do can be frustrating. It may take some time to try a few adjustments to your sleep, diet, and physical activity routines to find a balance that works best for you. Taking notes on what you've tried and reflecting on how you felt on the days you tried those strategies may be useful to help you find patterns. They may also be helpful if you decide to follow up with your health care provider for recommendations or a referral to other specialists, such as a dietitian or mental health professional. 

Be well, 

Last updated Jul 02, 2021
Originally published Sep 26, 1996

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