Fatigue: navigating from exhaustion to energy
We all get tired from time to time, sometimes for more than a little while. But it’s worth taking action if you suffer from continual and severe lack of energy that has become a major constraint in your life and prevents you from doing what you need or would like to do. Many factors can contribute to or cause fatigue.
Self-check
Before deciding you have fatigue serious enough to seek treatment, it can be helpful to first look at your daily habits.
The obvious one is whether you are getting enough sleep. Number of hours of sleep needed varies significantly and is also a factor of age. But generally, if you don’t feel refreshed after waking naturally (that is, without an alarm) and/or you fall asleep easily during the day, then you may not be getting sufficient sleep.
Substance use or abuse (alcohol, caffeine, nicotine, recreational or mind-altering drugs) can significantly impair energy levels.
A lengthy list of prescription and over-the-counter pharmaceuticals can interfere with sleep patterns and cause fatigue: antidepressants, antihistamines (for allergies), anti-emetics (for controlling nausea and vomiting), antipsychotics, anticonvulsants (used to treat seizures or depression), certain blood pressure medications, anxiety and insomnia medications, muscle relaxants, opioids and other prescription pain medications[i] If you think certain prescription medications might be the culprit, check with your prescriber(s) to see if they can be changed.
Shiftwork and other disruptions of your circadian rhythm such as jetlag can interfere with your sleep and cause fatigue. (These are often work-related, which might have to prompt a potentially difficult decision).
Both insufficient exercise and excess exercise can disrupt sleep patterns and trigger fatigue.
Eating habits (such as heavy late-evening dinners) as well as poor nutritional value of what you eat can contribute significantly to fatigue. If you suspect this as a cause, think about cleaning up your nutrition (there is no downside to this!).
Some common causes of fatigue
If you have made some of these necessary changes or have eliminated them as potential causes and are still experiencing fatigue, you may want to investigate a range of other relatively common causes through your primary care provider[ii]. Any one or more of these could be the source of your fatigue.
There are several types of anemia that cause sustained loss of energy. Most can be verified through blood tests.
Thyroid underfunction (hypothyroidism) or overfunction (hyperthyroidism) can contribute to fatigue; of these two, hypothyroidism is more common. Again, blood tests can help confirm whether thyroid function is the root of the problem.
Sleep apnea is a condition where the airway is obstructed to the point that breathing stops from time to time and air cannot reach the lungs. The result is generally poor sleep along with snoring, choking, gasping, nighttime waking and daytime sleepiness. Sleep apnea is more common among people who are overweight or obese. The best way to find out if you might have this problem is to arrange for a sleep study through a local sleep clinic.
Obesity can cause fatigue as a result of an unbalanced metabolism or endocrine system.
Another common cause is chronic anxiety that can result in excessive fatigue, including what is sometimes called “adrenal fatigue”. Your primary care provider or counselor could help identify if anxiety or ongoing stress might be at the root of the problem.
Fatigue is a frequent symptom of depression, since this condition is often characterized by lack of motivation and energy. Again, your primary care provider or counselor can screen you for depression.
For women, hormonal fluctuations caused by pregnancy, perimenopause and menopause cause multiple symptoms including fatigue.
Chronic pain is often associated with fatigue because pain itself is exhausting. Of course, the cause of the pain would need to be identified and addressed.
Other causes
Other causes of fatigue can be more serious.
Cancer, as well as some of the therapies used to treat it can cause severe fatigue.
Not surprisingly, failure of certain organs such as liver, kidney and the lungs (due to COPD or emphysema) can bring on fatigue.
Other chronic conditions such as heart disease, inflammatory bowel disease and multiple sclerosis, all affecting different body systems, can be associated with fatigue.
Head injuries that result in concussions-- or worse, traumatic brain injury-- can bring on serious fatigue due to potential interference with function of the hypothalamus, which is located in the brain and controls sleep cycles.
Different types of narcolepsy can cause excessive tiredness, daytime sleepiness and “sleep attacks”, hallucinations and other symptoms. This diagnosis would need to be confirmed by your primary care provider.
Two other causes of fatigue are perhaps the most feared: fibromyalgia and chronic fatigue syndrome (also known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) as well as systemic exertional intolerance disease). Both can be challenging to diagnose; a fibromyalgia diagnosis takes an average of five years[iii].
Fibromyalgia involves persistent chronic muscular pain at specific “pressure points”, as well as a host of other symptoms including fatigue, depression, insomnia and headaches.
Chronic fatigue syndrome is characterized by severe debilitating fatigue, and excessive weakness following even minor exercise. Like fibromyalgia, chronic fatigue syndrome is often diagnosed after other potential conditions have been excluded.
Conventional treatment of fatigue
Since fatigue can be a symptom of many different conditions, conventional medical treatment is dependent on the diagnosis[iv].
Of the more common causes, anemia and thyroid dysfunction are usually treated by pharmaceuticals and supplements.
Anxiety, depression and chronic pain are often treated pharmaceutically, but psychotherapy and counseling are frequently recommended, and can be powerful interventions.
Because sleep apnea tends to be a mechanical problem, the solution is usually mechanical: various types of oral appliances that are worn at night, including a CPAP machine.
Obesity, along with other conditions often accompanying it that comprise metabolic syndrome (high blood pressure, high cholesterol and Type 2 diabetes) are typically treated with prescription drugs. Various types of bariatric surgery can be recommended for obesity alone so that the stomach is either bypassed or reduced in size. Nutritional counseling might also be recommended, which assists with changing eating habits, including improvement of nutrition and portion modification.
Organ dysfunction or failure (liver, kidney, lungs) is treated pharmaceutically, and in extreme cases by means of mechanical interventions (such as kidney dialysis or oxygen supplementation for lung failure).
If heart disease, inflammatory bowel disease or multiple sclerosis are causing the fatigue, each of these has its own prescription drug treatment regime.
Concussion, traumatic brain injury and narcolepsy can be complex conditions that each have pharmaceutical-based treatments.
Both fibromyalgia and chronic fatigue syndrome can be challenging to treat, and prescription drugs are typically the main intervention. Since depression is usually in the mix for both of these conditions, therapy or counseling can be an important component of treatment as well.
An integrative approach to treating fatigue
Alongside conventional and functional medicine options, homeopathic remedies, which are federally recognized in the US, can often be helpful.
The first step is a lengthy conversation that includes a detailed analysis of your symptoms, as well as a review of any assessments and recommendations from your doctor(s) or naturopath resulting from blood tests and other diagnostic tests.
Like conventional care, the appropriate integrative approach to resolving fatigue depends on the cause(s) and contributing factors.
The first line of defense is to make sure none of the issues listed above in the “self-check” continue to contribute to your fatigue.
Almost all the conditions that are the main drivers of fatigue can be assisted with the use of chronic and organ support homeopathic remedies, including anemia, thyroid dysfunction, sleep apnea, anxiety, depression, menopause and perimenopause, chronic pain, as well as more challenging conditions such as narcolepsy, fibromyalgia and chronic fatigue syndrome.
To learn more about how I could help you with your fatigue symptoms, call me for a free 15-minute consultation or schedule one on the online scheduler.
[i] https://www.health.harvard.edu/drugs-and-medications/what-to-do-when-medication-makes-you-sleepy
[ii] Ho, D, R Zheng (2022) “Approach to fatigue in primary care” Singapore Medical Journal 63(11):674-8 https://journals.lww.com/smj/fulltext/2022/11000/approach_to_fatigue_in_primary_care.6.aspx
[iii] https://www.hopkinsarthritis.org/arthritis-info/fibromyalgia/diagnosis/
[iv] Rosenthal, T, B Majeroni, R Pretorius, K Malik (2008) “Fatigue: An Overview” Am Fam Physician 78(10):1173-1179 https://www.aafp.org/afp/2008/1115/p1173.html