Fatigue is a common complaint. Everyone feels tired sometimes. The term fatigue refers to a diffuse pattern of complaints, consisting of quickly becoming tired during exertion, sleeping problems, lack of energy, a concentration disorder and general malaise. Fatigue poses a special challenge for doctors, partly because it can have a very wide range of physical and psychological causes. After coughing and fever, fatigue is the most common reason to contact a doctor. In Western Europe, 14-24% of men and 20-38% of women reported feeling tired in the past 30 days. Symptoms of fatigue include looking pale, circles around the eyes, falling asleep and lethargy.
Table of contents
- Forms of fatigue
- Social cause of sleep problems
- Psychological cause of sleep problems
- Physical cause of sleep problems
- Medication
- Chronic fatigue syndrome
- Medicines for sleeping problems
- When to go to the doctor if you are tired?
Forms of fatigue
Physiological fatigue
This fatigue is a natural response of the body to certain circumstances. This is characterized by a clear relationship with stressful circumstances, well suited to normal life and a normal response to rest and sleep. Causes of stressful circumstances include intensive physical exertion, disturbed sleep, overwork, pregnancy and jet lag. Fatigue as a result of a natural reaction does not require treatment and recovers when the aggravating cause disappears.
Sleep problems
This is the most common cause of fatigue. Sleep is essential for good health. There is no good definition of the number of hours of sleep that each person needs, there is a big difference. One person needs 6 hours more than enough, while another sleeps 10 hours a night. The duration of falling asleep also varies greatly individually. Usually this takes 10 to 20 minutes. It is normal to wake up several times during the night, especially in the morning.
Older people in particular sleep shorter and more superficially. Poor sleep has various forms, including difficulty falling asleep, lying awake for a long time and waking up too often or too early. This results in a lack of energy during the day, poorer concentration and fatigue.
Causes of sleep deprivation
To determine the cause, a sleep diary can be kept. A simple search query with this term will provide examples of this. This can, for example, describe the time of going to bed and getting up, the time it takes to fall asleep, the number of times you wake up at night and the activities at that time, the number of naps during the day, caffeine/alcohol use, the extent to which there are concerns. and recently looking at a screen before going to sleep. Sometimes a cause can be found based on this that plays an important role in falling asleep. This makes it possible to discuss the problem more objectively with a GP.
What can I do about sleep problems?
These causes of a poor night’s sleep that need to be addressed can be divided into preparation, sleep hygiene and the time of day. If you have a lot of worries and concerns, it can help to discuss these with someone.
Preparing for sleep
- Make sure you are also physically tired before going to sleep. This is especially the case with problems falling asleep. Make sure there has been sufficient physical activity during the day.
- Avoid eating solid food 2-3 hours before going to sleep
- Do not drink coffee or substances with caffeine (such as energy drinks), strong tea, nicotine or drugs in the evening
- Taking alcohol does not have a good effect on sleep. The sleep this creates is superficial.
- Try to avoid mental and physical exertion. Engage in relaxing activities.
- Avoid the screen of a TV, computer, tablet or smartphone an hour before going to sleep.
Sleep hygiene
This refers to measures that prevent sleep disruption as much as possible.
- Blackout curtains when there is too much light or shielding LED lighting from chargers
- Insulation or hearing protection against noise
- A pleasant bedroom with good ventilation and not too dry air
- Comfortable sleepwear, bed and pillow
Time of day
- It is good to maintain a fixed sleep rhythm.
- Get up around the same time every morning and don’t go to bed unnecessarily late
- Try to avoid sleeping during the day
- Keep up the rhythm after a night of not being able to sleep well
- As a result of air travel
- Continue to maintain the old sleep rhythm (i.e. the times) at home when this is possible during a short visit
- Eat relatively light meals during the flight
Shifts
Try to be assigned clockwise as much as possible (i.e. from morning to evening to night shift). If these tips do not help, you should definitely consider contacting your GP. There is also a sleeping course from the GGZ. If the work itself is a source of the sleep problem, consultation with a company doctor is an option.
Social cause of sleep problems
This occurs when there is an abnormal burden in the living environment, such as problems at work, in the family or in the relationship. These problems can disrupt normal sleep to such an extent that it results in feeling tired during the day. It is important that the cause is specifically treated. It often helps to talk about this with someone (possibly a professional).
Painting van Gogh made during a depressive period / Source: Vincent van Gogh, Wikimedia Commons (Public domain)
Psychological cause of sleep problems
The most common mental health conditions that cause fatigue are depression and anxiety disorders. This includes guidance from a general practitioner, psychiatrist or psychologist.
Depression
Depression is characterized by sadness, lethargy and reduced interest in activities that were previously enjoyed. People who are depressed sometimes want to stay in bed all day and may still feel tired after a long night’s sleep.
Anxiety and panic disorder
An anxiety disorder can have major consequences in life. Mentally preoccupied with fear of a certain situation can greatly disrupt sleep. In general, there is a so-called disproportion, the fear is so present that it can no longer be regarded as normal.
Physical cause of sleep problems
In a relatively small proportion of people who present to their GP for the first time, a clear physical cause is found as the basis for the condition (approximately 1-3%). Nevertheless, it can be worthwhile to do thorough research, such as blood tests. Indications that indicate a physical cause include:
Anemia
A reduced number of red blood cells, measurable by the hemoglobin level (Hb), can be a cause of fatigue. Particularly when the Hb falls below 6.5. The causes include:
- Reduced absorption (In case of a gastrointestinal disorder, reduced iron intake in food)
- Increased loss (for example, during heavy menstruation or loss due to gastrointestinal bleeding)
- Decreased production of red blood cells (for example in case of a hematological malignancy)
Complaints include paleness, tendency to faint, light-headedness, fatigue and reduced exercise tolerance. Sometimes clear blood loss may be visible, but this is not necessarily the case.
Thyroid function disorder
An underactive or overactive thyroid gland can also cause fatigue. The thyroid gland regulates metabolism (burning) throughout the body. This is regulated by hormones. A problem may arise in this regulation. The function of the thyroid gland can be assessed in the blood by measuring the TSH (Thyroid Stimulating Hormone). Medicines can supplement the shortage.
- Hypothyroidism: The thyroid gland works too slowly, people feel cold, tired more quickly and gain weight.
- Hyperthyroidism: The thyroid gland works too fast. People feel warmer than usual, have more energy and lose weight.
Problems with the heart or lungs
A condition of the heart or lungs can also cause fatigue. If there are indications of this, specialist examination can be carried out, for example by means of a lung photo or an ultrasound scan of the heart. Indications of a cause in this area include:
- Nocturnal dyspnea and edema, these complaints may indicate heart failure
- Fatigue increases with heavy exertion
Chronic infection
Chronic inflammation can be a cause of fatigue. This cause can be ruled out by means of a blood test (CRP: C-reactive protein) of an inflammatory value. It is usually not immediately clear which organ is inflamed. An indication of inflammation or infection may be the presence of fever. There are numerous infections that can cause fatigue, such as viral (for example, Morbus Pfeiffer) and bacterial diseases (such as a chronic, asymptomatic urinary tract infection and a chronic Lyme infection).
Tumor
Severe fatigue can also be an indication of the presence of cancer. Additional symptoms often include weight loss, loss of appetite and night sweats. In particular, older age and exposure to risk factors such as smoking increase the risk of this. If you suspect a tumor, it is wise to contact a doctor.
OSA
OSAS (obstructive sleep apnea syndrome) is a phenomenon in which breathing is interrupted several times during sleep. Supportive devices are available for purchase to reduce the severity.
Diabetes Mellitus
Diabetes is a condition in which the body’s glucose regulation is disrupted. Insulin plays an important role here. People where insufficient glucose is absorbed into the cell can feel very tired due to a lack of energy.
An exploratory blood test into the physical cause of fatigue can, for example, consist of a Hb (anemia), glucose (diabetes), TSH (thyroid function disorder) and CRP (inflammatory value) determination.
Medication
The use of certain medications can cause fatigue. It may be wise to consult the package leaflet and discuss the current medication policy with the prescribing doctor, for example with an overview of the pharmacy.
Chronic fatigue syndrome
One speaks of the so-called chronic fatigue syndrome (CFS) if the following criteria are met:
- Complaints of extreme fatigue. Existing for at least 6 months.
- A significant limitation (>50%) in work, social or personal functioning
- No physical cause can be found in the history, physical examination or laboratory examination
In summary, this refers to long-term complaints of fatigue without an objective cause being found.
Example temazepam tablets / Source: Adam, Wikimedia Commons (CC BY-2.0)
Medicines for sleeping problems
There are sleeping pills. This group mainly consists of benzodiazepines. Examples include temazepam and zolpidem. Dependence may occur with chronic use. In principle, there is only an indication for high levels of suffering or serious daytime dysfunction. After starting, it is always wise to aim for phasing out and a stop date. Sleep medications are not a long-term solution to sleep problems. Addressing the cause is usually more effective.
When to go to the doctor if you are tired?
In any case, please contact us if you are tired for more than 3 months or if you are concerned for any other reason. Other additional reasons in combination with fatigue for an urgent doctor visit are: Frequent coughing, loss of appetite, loss of weight, pain, feeling depressed, drowsiness or confusion.
