“I’m tired”

“I’m tired”

Fatigue is a frequent complaint.  When does it represent a potentially serious underlying condition?  As with any vague complaint, it often helps to categorize various types to assist in sorting out the underlying cause.  The first category is “physiologic fatigue.”  It is the most common type.  It is simply doing too much and not getting enough rest.  If I talk to a single mom with kids or someone else who works two jobs, the cause of their fatigue is quite likely sleep deprivation.  There is no energy drink, supplement, or other intervention that will replace sleep.  Most people need 7-9 hours per night to feel well and function normally.  To screen for this, I simply ask “How much sleep are you getting?”

The second category is “psychogenic fatigue” when for a wide variety of reasons, a person feels tired despite getting a reasonable amount of sleep.  The primary “tip off” for this category is waking up feeling tired and not refreshed.  The problem can be stress, seasonal changes, depression, or unresolved interpersonal conflicts.   As these issues are addressed, the energy generally returns to baseline.

The third category is the most well-known and frequently investigated cause of fatigue, and I refer to it as “pathologic fatigue.”  There are a wide variety of medical conditions that have fatigue as a common complaint.  Obstructive sleep apnea, hypothyroidism, uncontrolled diabetes, congestive heart failure, chronic liver or kidney disease, and anemia just to name a few.  Most individuals in this category are getting enough sleep so that they should feel rested and better upon awakening, but they have poor stamina or fatigue worsening as the day progresses and often exhibit additional symptoms to suggest a particular cause.

I find it helpful to think of fatigue along these three lines and hope it might help you.  If in doubt, take a nap. “Resting” is doing something, something essential.

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