Zakariya Waqar-Uddin column: why am I tired all the time?

Despite the millions of pounds spent on blood tests, more than ninety percent will be normal. That is not to say these do not have their place in the investigation of tiredness.

They are useful in detecting conditions from an under active thyroid, to heart failure. They will flag up iron deficiency, the condition most associated with fatigue. In addition, they can check for reduced levels of other vitamins and minerals, including B12, folate, zinc, and selenium that may be linked with tiredness.

These and other investigations will identify more serious causes of fatigue and unwell.

Yet faced with a full set of normal investigations, where do the doctor and patient turn to next?

Chronic tiredness, lasting more than a few months, is a complex interaction of physical and psychological symptoms that are often difficult if not impossible to separate out.

Lifestyle often plays a significant role. You are what you eat, as the saying goes. A diet high in processed foods and refined sugars will worsen tiredness. You may consider that morning coffee may a necessity. Yet caffeine has a half-life of roughly five hours. So, if you consume coffee at midday, a quarter of the caffeine will still be in your system at midnight.

Alcohol is a common way to wind down at the end of a long day. It may make getting to sleep easier than if you had not had a drink. However, that sleep is more likely to be poor quality and disturbed, with you waking up less refreshed than if you had not consumed alcohol.

We used to think that snoring was an irritation to your partner, albeit harmless. It occurs when the soft tissues of the throat close over and the person temporarily stops breathing. We now know that it is linked with an increased likelihood of accidents behind the wheel and in the work place.

Untreated it puts you at a significant risk of high blood pressure, diabetes, and heart failure. It is estimated that 85% of cases of obstructive sleep apnoea remain undiagnosed, despite the treatment being a simple machine, worn at night, that continuously pushes air into your nostrils to keep the passages open.

Sleep itself is vital for our very existence. Although many will argue otherwise, studies show we need a minimum of seven hours sleep a night. This improves the flow of cerebrospinal fluid, which surrounds the brain. The fluid washes away plaques whose build up is associated with Alzheimer’s disease, one of the commonest forms of dementia.

Why you cannot sleep is a topic all on its own. Mood issues including anxiety and depression often interfere with our ability to wind down and achieve peace before we drift off. Identifying and treating these conditions often improves sleep for many.

Sleep hygiene is a topic frequently discussed, yet less commonly put into practice. It involves a calming environment, free from electrical devices such as tablets and mobile phones, which should be placed in another room if possible. Ideally you should have a bedroom routine that involves retiring at roughly the same time each night, perhaps reading for half an hour before sleep to promote relaxation. Shift work and irregular hours are linked with more complaints of fatigue and the associated health problems. Night shift work has been linked to an increased risk of breast cancer.

Sensible exercise, in moderation, is perhaps one of the best habits you can develop. It can promote a sense of wellbeing. Yet over exercising is frequently associated with fatigue, muscle ache and mental unrest. Exercising too close to bed time worsens sleep.

Sometimes it is impossible to pinpoint an actual cause for fatigue, and a diagnosis of chronic fatigue syndrome (CFS) may be considered. This is usually after multiple consultations, extensive investigation and with the input of a doctor who specialises in the condition.

If you are struggling with tiredness that just will not go away, it is certainly worth discussing it with your GP, though it may take more than one consultation to identify all the relevant issues.

Useful Websites

https://patient.info/signs-symptoms/tiredness-fatigue

https://versusarthritis.org/about-arthritis/managing-symptoms/managing-fatigue/

“Tired all the Time,” or TATT for short… is estimated to affect at least one in twenty individuals, yet many never seek help.

Chronic tiredness, lasting more than a few months, is a complex interaction of physical and psychological symptoms that are often difficult if not impossible to separate out.

Sleep itself is vital for our very existence. Although many will argue otherwise, studies show we need a minimum of seven hours sleep a night

Dr. Zakariya Waqar-Uddin, General Practitioner