The Medical Minute: Why am I always so tired?

Feeling tired all the time? Constantly longing for an afternoon nap?

You’re not alone.

Dr. Katelynn Sheaffer, family medicine physician at Penn State Health Duncannon Outpatient Center, often sees patients who struggle with persistent fatigue.

“It doesn’t matter what they do, they’re just always exhausted, and they’re not sure why,” she says.

Feeling tired all the time has become a common fact of modern life. A National Sleep Foundation “Sleep in America” poll found that, on average, Americans feel sleepy three days a week. Poll participants reported that being tired affects their mood, mental state and productivity.

But you don’t have to resign yourself to a life of constant fatigue. Sheaffer says, “Usually there is treatment.”

Tiredness can be grouped into three main categories: lifestyle and stress, nutrition and underlying health reasons.

Are you practicing self-care?

Life’s constant demands often lead to chronic stress and exhaustion, according to Sheaffer.

“We women are very good at overextending ourselves, not saying no and staying in this perpetual state of busyness,” Sheaffer notes. This is especially true for working moms and health care workers, who often prioritize others’ needs over their own well-being.

“What I will say to patients is, ‘When’s the last time you remember not feeling tired?’ And a parent might say, ‘Before I had my daughter or son’ or ‘When I slept through the night.’ And I’ll say, ‘Let’s look at that and see how you can still fulfill your obligations as a parent while making time for sleep.’”

Sheaffer suggests incorporating lifestyle changes, such as:

• Taking regular time off. “We studied nurses who took their paid time off versus those who didn’t,” Sheaffer says. “Those who took time off were less likely to have heart disease, heart attacks, strokes and depression.”
• Setting boundaries between work and personal time.
• Making self-care a priority, not just a luxury.

Sheaffer also says it’s important to practice good sleep hygiene. That means:

• Sticking to a consistent sleep schedule.
• Timing meals properly. “Dinner should be more than two hours before lying down to prevent reflux,” Sheaffer advises.
• Limiting fluids before bedtime. This helps prevent waking up in the night to use the bathroom.

Could it be your diet?

Poor eating habits and vitamin deficiencies can masquerade as general fatigue.

“Many people experience that 2 p.m. crash,” Sheaffer explains. “It’s usually because their lunch was high in carbohydrates, causing blood sugar to spike and then fall.” Other common causes of fatigue are Vitamin D and B12 deficiencies.

A sedentary lifestyle can also contribute to low energy levels.

To get some pep back in your step, Sheaffer recommends:

• Maintaining balanced blood sugar with complex carbs. Reach for whole grains like quinoa, barley or whole wheat rather than white bread or white rice.
• Avoiding processed sugar, especially close to bedtime.
• Staying hydrated: “Get two 16-ounce bottles of water. Finish one by lunch and one by the end of the workday,” Sheaffer says.
• Exercising consistently. Don’t be a weekend warrior.

If fatigue persists after making these changes, Sheaffer recommends vitamin testing for any hidden deficiencies.

What about underlying health issues?

Undiagnosed sleep disorders are a big culprit when it comes to persistent tiredness.

“Sleep apnea is very much underdiagnosed,” Sheaffer warns. “And it’s not just overweight men who are affected. We’re seeing it more frequently across all populations.”

Thanks to Bluetooth technology, sleep studies can be done at home rather than in an uncomfortable lab. “With that home study, we’re usually able to pick up obstructive sleep apnea and get treatment started very quickly,” she says.

The first line of treatment for sleep apnea is the continuous positive airway pressure (CPAP) device. “Once they start sleeping with that, they say, ‘Oh, this is what it’s like for everybody else during the day!’ They’d become so acclimated to being exhausted that they weren’t aware there was a difference,” Sheaffer says.

Hormone disruption in menopause is another common cause of fatigue, but Sheaffer says you don’t have to deal with it for the next five to 10 years of your life. “There are treatments which can help temporarily or long-term, and they’re very similar to what we use for anxiety, SSRI medicines primarily. If applicable, sometimes we’ll use hormone replacement.”

When should you see a doctor?

“If tiredness has lasted more than six months without an obvious cause, it’s time to start the conversation with your doctor,” Sheaffer advises. “Being tired all the time isn’t benign. It can affect your mental health, sexual health and overall quality of life.”

Treatment can make a dramatic difference. Sheaffer recalls a patient who discovered and treated a vitamin deficiency: “She told me, ‘I’m not falling asleep at my desk anymore, and every day doesn’t seem like a chore.’”

Bottom line? You don’t have to live with exhaustion. With the right treatment, Sheaffer says, “You don’t have to just survive. Instead, you can thrive.”

Related content:

• Sleep apnea increases risk of sudden death, cardiovascular conditions
• Timing and regularity of sleep may be key for adolescent heart health
• The Medical Minute: When working from home equals lack of sleep

The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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