One of the most common complaints for which a patient comes to a healthcare provider is that they are “tired all the time”.  While this might sound like a relatively simple complaint to work on, in fact, the evaluation of the person who is tired is quite complex.  When this complaint is heard, I explain to patients that there are three words we need to distinguish and to be sure what we are talking about.

     The first word to understand is called “sleepy”.  Sleepy happens at 2:00 o’clock in the afternoon after the person has had a good lunch and is having trouble staying awake at their desk.  This may not be a favorable situation but it does not represent disease.

     The second word to understand it “tired”.  Tired is what a person feels at 8:00 o’clock at night after they have had a long day, the evening meal is completed, and the person sits down to watch television before going to bed.  Frequently, the person will fall asleep watching television.  I point out to the patient that this is also not disease state and doesn’t require medical attention.

     The third word to understand is “fatigue”.  Fatigue is what you feel the next morning after you have slept all night and you are still not rested. It needs to be understood that there are “night people” and “morning people”. The night people are still going strong at 1:00 o’clock in the morning but have a terrible time getting out of bed in the morning.  The morning people are awake at 5:00 am but go to bed at 9:00 or 10:00 at night.  Taking these individual characteristics into consideration, the word “fatigue” applies to the person who is lacking energy and ambition after a good night’s sleep no matter when it starts.

     After the above three words are clarified and I understand what the person is talking about, I point out that in health surveys, more than half of the people queried are “tired” but  it doesn’t mean that they are sick.  Thus, the concern may not be medical.

     The last point to illicit is, “How is your tiredness affecting your activity?”  Many times the person will say, “Well I just go on with what I would normally do, but I am so tired.”  The person probably doesn’t have a medical condition requiring address.  If instead the person states that their chores are simply not getting done, and those duties that are attended to are sub-par, then perhaps there is a medical consideration.

     Medical considerations in the tired/fatigued person are very broad.  The first area to investigate is the quality of the person’s sleep.  Excessive snoring, sleep apnea, or insomnia due to stress factors all lead to poor quality sleep.  The tiredness can be corrected once these diagnoses are made and treatment addressed.

     The second broad category to consider in tired patients is heart problems.  Heart failure frequently presents as increasing tiredness and fatigue due to the heart simply not being able to pump enough blood to keep the body active.  By the same token, chronic lung disease in asthmatic and emphysema patients causes easy fatigue.  The associated shortness of breath leaves the person oxygen poor and the fatigue is explained on this basis.

     The third broad areas of consideration include low blood counts due to bleeding or pernicious anemia or endocrine problems such as low thyroid levels.  When a person has uncontrolled diabetes, the blood sugars run very high and the sugar doesn’t get into the cells where it is needed as fuel.  Without the fuel in the cells to the run the body, the person fatigues very easily.  Controlling the diabetic condition can be a significant help in correcting fatigue.  There are many other relatively rare conditions that cause fatigue such as cortisol deficiency, high blood pressure and kidney failure.  These can be diagnosed with various blood tests and treated when found.

     When a person comes to a physician to seek help for a tiredness problem, they never want to hear that they are “depressed”.  Almost always, they are seeking some medical abnormality that can be corrected and the tiredness will go away.  Be that as it may, depression and boredom with a person’s environment is a very common cause of the person being tired all the time.  When what the person is doing is not interesting and stimulating, the sensation of tiredness can become substantial.  By the same token, overwhelming stress saps the person’s energy and is frequently a contributor to the tiredness and depression that follow.

     A word needs to be stated about “pain”.  Individuals who have chronic pain problems are frequently fatigued.  Pain is hard work.  It saps the person’s resources to deal with the pain problem either through tolerance mechanisms or steps to correct the pain problem.  If the person is using various narcotics or other pain preparations, the person frequently faults the pain medication as causing the tiredness.  In fact most of the time, a pain medication allows the person to sleep because the pain is dealt with.  Even Morphine in modest doses to deal with pain problems is not a significant sedative so much as it is an agent that allows the person to sleep because the pain has been corrected.

     Lastly, a word needs to be added about the situations where the tiredness is due to a medical problem.  Just because the tiredness is due to heart or lung or cancer or kidney problems doesn’t seem to make the tiredness any more acceptable.  Unfortunately, when tiredness is due to a medical problem that cannot be reversed, the person is best served by adjusting activities and rest time to accommodate the need for extra rest.  While I absolutely hate to acknowledge it, age does play a part in tiredness problems.  There just aren’t any 65 year old quarterbacks in the NFL.  So the best advice I have heard came from my father who told me that as a person gets older they are going to have to work smarter, not harder.

     As mentioned above, tiredness problems need a very broad consideration.  The healthcare professionals at your local clinics are aware of this problem, it being one of the most common that is presented to them.  Appropriate blood tests and other considerations may lead to a medical condition that will help correct the problem.  We always ask that the person not be too disappointed if we tell them seven out of ten people randomly picked are tired but it doesn’t mean that they are sick.