We've all felt it. That feeling of not being able
to do or even think another thing, a feeling down to the bones:
Fatigue is a normal response after a marathon (or, for amateurs,
a 10K run), a night of sleeplessness due to worry or a sick child,
or a stressful day at work. Generally, though, a good night's
sleep banishes this kind of fatigue. Abnormal fatigue is waking
up tired, feeling exhausted walking up the stairs or vacuuming,
not being able to make it through a normal day, or feeling tired
for weeks on end despite getting enough rest. Fatigue can be associated
with increased stress, mood swings, or it can be a sign of physical
illness. When fatigue is chronic it is a symptom that something
is wrong and should not be ignored.
These days fatigue seems to be a way of life for many Americans.
One recent study showed that 28 percent of women who visited their
doctors complained about fatigue being a "major problem"
for a month or more. The root cause of fatigue can be difficult
to determine since physical, psychological and lifestyle factors
can all contribute to the problem. We'll examine each area to
help you do your own personal detective work.
Your Physician or Nurse Practitioner
Your doctor or nurse practitioner will take a health history
to identify possible causes for fatigue, followed by a complete
physical examination including blood tests. This will be done
to distinguish between short-term, explainable fatigue and chronic
fatigue lasting longer than six months. One common cause of fatigue
is anemia. As many as 80 percent of exercising women and 39 percent
of premenopausal women in general are iron deficient. Symptoms
of iron deficiency such as tiredness and irritability can occur
even before the onset of anemia. Other common causes include thyroid
disease (which is more common in women and runs in families),
and viral or bacterial infections.
Following are other conditions which need
to be ruled out:
1. Rheumatological diseases (such as lupus and rheumatoid arthritis).
2. Diseases such as diabetes, cancer, muscle diseases such as
polymyalgia rheumatica, or AIDS.
3. Hormonal irregularities during perimenopause and menopause.
4. Chronic fatigue and immunodeficiency syndrome (CFIDS) is a
diagnosis of exclusion--that is, we consider it when all
other conditions are ruled out. It may then be diagnosed in women
reporting fatigue for greater than six months, usually occurring
after a flu-like illness, surgery or extended treatment with antibiotics.
CFIDS is associated with muscle and joint pain, flu-like symptoms,
depression and cognitive difficulties.
5. Sleep disorders, which include snoring, restless legs and sleep
apnea (stopping breathing while asleep), can cause fatigue even
with adequate time in bed. Symptoms include not feeling well rested
in the morning, feeling sleepy during the day, and having trouble
6. Fatigue is often a presenting complaint of depression, which
is more common in women. Other symptoms include disturbances in
appetite and sleep patterns, persistent sadness without apparent
cause, or difficulty concentrating and making decisions.
Any primary illness or disease for which fatigue is a symptom
will be treated appropriately.
Here are some do's and don'ts to help you get
- Do go to bed and get up at the same time each day.
- Do adjust your total sleeping time to fit your needs--may
be as little as 4 or as much as 10 hours.
- Do keep your bedroom dark, quiet and at a comfortable temperature.
- Do sleep in the same room consistently and use your bed only
for sleep and sex.
- Do plan regular daily exercise.
- Do take medicines only as directed.
- Avoid exercising or engaging in stimulating activity (exciting
TV or novels) just before going to bed.
- Avoid routine daytime naps.
- Avoid large dinners and excessive snacking or alcohol after
- Avoid caffeine (coffee, tea, cola drinks, cocoa, chocolate)
within 8 hours of bedtime.
- Avoid using sleep medications and bedtime alcohol.
- Avoid lying in bed sleepless for more than half an hour--instead
get up, do some quiet activity, then return to bed when you
The fact that fatigue can have psychological origins does not
in any way lessen its importance or the need to treat it. Modern
environmental psychologists find that problems can arise from
both overstimulation and understimulation. Feelings of helplessness,
loss of control, or 'broken spirit' can contribute greatly to
feelings of fatigue. Fatigue may also mask depression or unresolved
past losses such as grief, wounds of a past relationship or the
move away from home.
A psychologist or psychotherapist may evaluate your situation
through a face-to-face interview about your present life, past
events and family/social supports. These will help your mental
health professional to recommend a course of treatment customized
to fit your needs. For example, fatigue relating to interpersonal
problems may indicate the need for assertiveness training or couple/family
counseling. If fatigue is masking depression, you may benefit
from cognitive therapy. If indicated, trauma recovery may include
supportive and grief counseling.
Women tend to have two interpersonal difficulties that can result
in their becoming fatigued:
- Not being able to say "no" and
- Role overload due to not delegating.
Saying "No, I'm not able to" without giving reasons
or explanations can be very effective when said in a clear, calm
and firm way. Practice saying "no" to the safest people
first before you say it to the more difficult people. To delegate
tasks and increase cooperation from others, ask: "I'd like
to know if you'd be willing to __(state what you want)__."
To manage fatigue related to worrying about others, take people
breaks. Take a walk and instead of thinking or talking about others
while you're walking, notice the sights, sounds and smells of
Traditional Chinese Medicine (TCM)
A TCM practitioner identifies two kinds of fatigue: overuse
and disease. Overusing energy is generally a short-term problem
due to lack of sleep or other modifiable cause and does not require
treatment. Fatigue due to illness or disease in the Chinese view
is a deficiency of Qi (energy) in the blood, Yin or Yang, involving
the spleen and stomach networks. Treatment would include tonifying
or strengthening the energy and blood through herbal medicines
and a course of acupuncture lasting four to six weeks.
Relaxation Techniques and Massage Therapy
Unrelieved stress is a common cause of fatigue. Taking the time
to engage in mindfully relaxing activities can help to manage
that stress-related fatigue. A regular program of relaxing massage
performed by a qualified massage therapist can be a vital part
of your fatigue-fighting program.
Strategies to re-focus and re-energize include special breathing
techniques. Form your mouth into an "O" and take long,
slow breaths in and out. Focus inwardly: notice the air moving
in and out, notice the movement of your chest as it rises and
falls, notice how deep your inhalation goes as it causes your
stomach to push out. Take those deep breaths and hold them for
as long as you can, then slowly release. Focus on relaxation on
the out breath.
(For more information, see Help Yourself . . . Stress/Burnout).
Interestingly, both too little and too much exercise can
contribute to fatigue. If you're an athlete or in training
and begin to experience unusual fatigue or change in sleeping
patterns, you are showing signs of overtraining. Rest is the cure.
However, most busy women suffer from 'hypokinetic disorder', or
low levels of physical activity. Women with extremely low levels
of cardiovascular fitness may be taxed simply by walking through
a parking lot with a load of groceries. Regular aerobic exercise
increases your endurance, improving your physical condition by
increasing delivery to and utilization of oxygen by your muscles.
Physical activity also stimulates a feeling of wellbeing and helps
your body to better handle the everyday physical and emotional
stress of life.
Here are some tips for using exercise to
- For improved health and fitness, try to accumulate 30 minutes
of physical activity most days of the week. Start with short,
comfortable bouts of 5 to 10 minutes if you've been inactive.
- To shake off the "blahs" in the morning or during
the day, try a 10-minute brisk walk.
- If you're beginning to suffer from tense, tight muscles at
your desk, take a 5-minute break to stretch back, neck, shoulder
and forearm muscles.
- Avoid intense exercise if you are extremely stressed. Instead,
try a more calming activity such as stretching or consciously
relaxing your muscles.
Poor eating habits can cause fatigue in two ways: by creating
vitamin and mineral deficiencies in the long term, and energy
fluctuations on a daily basis. Shortages of iron and other minerals
as well as the B vitamins and vitamin C appear to have the most
significant effects on energy levels. You can improve your intake
of other minerals and B and C vitamins by increasing your consumption
of fruits, vegetables, whole grains, legumes, nonfat dairy products
and lean proteins. A good general vitamin and mineral supplement
complements but does not replace healthy foods. To
avoid iron deficiency and anemia, premenopausal women should consume
15 to 18 mg daily, while postmenopausal women require 10 mg per
day. A moderate dose supplement of 18 mg per day should improve
iron status and energy levels within three weeks. Higher doses
for severe iron deficiency should be taken only under your physician's
Here are some tips for improving your iron
- Iron-rich foods in order of iron content per serving include:
oysters, beef liver, tofu, kidney beans, swiss chard, black
beans, lean beef, acorn squash.
- Eat vitamin-C-rich and iron-rich foods together since the
vitamin C enhances absorption of iron.
- Avoid drinking tea and coffee with meals since they can inhibit
iron absorption by 80 percent.
- Take iron supplements on an empty stomach and avoid taking
zinc or calcium at the same time.
Caffeine, sugar and alcohol can also rob you of energy. While
a small amount of caffeine can be a pick-me-up, greater than three
servings per day can create a vicious cycle leading to fatigue-causing
dehydration by day and poor sleep quality by night. Highly sugared
snacks such as sodas, candy, and baked goods (low or high fat)
cause blood sugar to rise rapidly. This triggers an often exaggerated
insulin response, returning blood sugar to lower levels than before
the snack and accompanied by sagging energy levels. Finally, alcohol
interferes with sound sleep, dehydrates the body's cells and suppresses
the nervous system, causing inability to concentrate and fatigue.
Here are some tips to avoid those daily
- Avoid very low calorie diets or diet plans that require you
to eat only a few specific kinds of food.
- Eat high-quality breakfasts daily and replace sugary snacks
with slow-release foods such as fruits or vegetables combined
with protein or whole grains. Try to limit sugar intake to fewer
than 10 percent of your daily calories (sugar-sensitive women
may do well to eliminate it entirely).
- Eliminate caffeine or limit yourself to three servings per
- To improve your concentration and avoid a mid-afternoon slump,
try eating more protein and reducing carbos at lunch. An ideal
blend would be 3 to 4 ounces of lean protein with salad or veges,
nonfat milk and no more than one small serving of bread or starch.
- Drink plenty of water or fluids to avoid mild dehydration-induced
fatigue. Eight to ten glasses per day is the rule of thumb.
- Avoid alcohol or limit your consumption to not more than five
servings per week.
Create Your Own Fatigue Profile
To help identify your own personal sources of fatigue, try keeping
a journal. Record the times of day that you are the most and least
energized and in the best and worst moods. Next, look at the activity
or situation that preceded your highs and lows. Include diet,
stress, sleep, exercise or other activities. You may see a pattern
begin to emerge that you can use to find ways to combat those
periods of low energy and/or mood.
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