Why am I always tired?

“I am always so tired these days.” “I just don’t seem to have the energy I used to.” “I’m exhausted by 8 o’clock at night.” Ring a bell? One of the commonest reasons for seeing a doctor is fatigue – tiredness that interferes with daily living and seems abnormal compared with others or with previous energy levels.

There are some serious medical reasons for this, but there are also many lifestyle issues which can result in incapacitating fatigue.

The high level of heat and humidity in Singapore can sap energy and acclimatization is often only partial. Long work hours and the frequent socializing associated with an expat lifestyle and loss of fitness if there is no time for an exercise program are contributing factors. The arrival of a baby can take its toll either by interrupting sleep or simply due to the extra workload. Even if a maid does the housework, just playing with a young child all day is more tiring than a full-time job. Frequent travel especially if changing time zones is another factor affecting many people here.

The most common pathological causes of fatigue are depression, anxiety, thyroid disorder, iron deficiency, anaemia and viral infection. Diabetes may also present in this way.

Depression is often insidious and may not necessarily produce intense sadness. Features such as loss of enjoyment in life, loss of libido, irritability, anxiety and sleeping difficulties may be more prominent, and fatigue is very often the most obvious feature. The stress brought on by an international move, separation from loved ones, enforced leaving of satisfying jobs, and the difficulty of living in a different environment without the support of close friends, can all help to precipitate an episode of depression. This is more likely if there is a family history or previous experience of depression. Symptoms may first appear after the birth of a child, either the first or any subsequent baby. Treatment has greatly advanced in recent years, with relief from symptoms resulting rapidly and often without serious side effects. Counselling and psychotherapy are often very helpful.

Anxiety is a close relative of depression. Prolonged anxiety leads to depression. Multitude of worries have a tendency to weigh people down and perfectionists have a tendency to report more fatigue due to being demanding on themselves, needing to maintain peak performances at all times and worrying about whether the work they produce is good enough. Like depression, there may be a genetic predisposition and like depression, anxiety can be treated very effectively with psychotherapy and medication.

Both over- and underactivity of the thyroid gland can result in fatigue, and are more common in women. A family history of thyroid disease may be present. Hypothyroidism (underactivity) may produce weight gain, intolerance to cold, and dry hair and skin. Hyperthyroidism will often result in weight loss, tremor, and intolerance to heat. A blood test will reliably diagnose these conditions. Underactivity of thyroid can sometimes occur during pregnancy and after delivery, which sometimes go undetected as tiredness can be expected during and after pregnancy. Extreme tiredness or persisting tiredness usually warrants a check.

Dietary iron deficiency is becoming more common as we eat less and less red meat and more and more fibre. Red meat is still the best source of iron, although fish, chicken, egg yolk, pulses and green vegetables contain reasonable amounts. The problem with dietary fibre is that it binds iron in the intestine and prevents it from being absorbed. Women are at particular risk of iron deficiency due to regular blood loss from menstruation. Vitamin B12 deficiency can occur in some individuals who do not absorb Vitamin B12 well, this can result in tiredness and sometimes anaemia.

Diabetes is becoming an increasingly serious health problem world-wide as Western diets become adopted. Early mortality from associated cardiovascular disease, blindness, kidney failure and gangrene can all result from undiagnosed diabetes, which may have no distinct symptoms other than fatigue.

Feeling sleepy after a meal? Especially after lunch? A huge sugar surge can cause sleepiness and a simple solution is to reduce simple sugar and increase fibre to slow down a sugar rush. Sugar rush can result in sugar ‘crash’ in some individuals, causing excessive tiredness. Sleepiness after lunch can be attributed to a large carbohydrate meal and also to normal or physiological circadian or sleep rhythm whereby the body is in lull mode after noon and at night. This explains why siesta is widely practised in some countries.

In some individuals, fatigue may persist despite exclusion of all the above causes. This may date from the time of a viral infection or commence without any obvious precipitant. Fatigue lasting at least 6 months, not due to any other medical condition, and significantly interfering with daily life, are the diagnostic criteria of chronic fatigue syndrome. A wide variety of treatments have been suggested for this, but the most effective have been shown to be a graded exercise program where physical activity is gradually increased day by day, anti-depressants, psychotherapy and social support.

If you have been plagued by persisting fatigue, check with your doctor to deal with treatable causes.

Dr Phua Sin Ru MBBS Dip Derm A graduate of the University of Queensland, Australia in 1993, Dr Phua is a family practitioner who has particular interests in women’s health, paediatrics, asthma and allergies. Dr Phua holds a Graduate Diploma of Family Practice Dermatology.

International Medical clinic is located at Camden Medical Centre Tel: 6733 4440 and Jelita Shopping Centre, Tel: 6465 4440. Visit their website www.imc-healthcare.com to learn more.

Hester Aba