Constantly exhausted? Look out for these telltale signs that something serious is amiss.
Medically reviewed by Dr Roger Henderson and words by Rhalou Allerhand
Dog-tired all the time and don’t know what to do about it? If you find yourself pressing the snooze button every morning and battling the post-lunch slump every afternoon, you’re not alone. But while it’s normal to feel a bit sleepy every now and then, if you’re constantly fighting the urge to drop into a deep and dreamless slumber, then something with your health could be amiss.
We spoke to Dr Kat Lederle, Head of Sleep Health at Somnia, about battling exhaustion and what constant tiredness really says about your health:
Why are you tired all the time?
Frequently feeling tired for long periods of time takes its toll, and can affect your mental health, your physical health and your quality of life. But for most of us, a good night’s sleep is all it takes for our energy levels to be restored. However, if rest and a holiday don’t fix it, something could be up with your health. If you’re not sure, it’s important that you seek help sooner rather than later.
Here are 13 key reasons why you might feel tired all the time and when to seek help:
If you feel like you’re permanently running on empty, you could be suffering from burn-out. The World Health Organisation (WHO) now recognises burn-out as a medical condition, defining it as a syndrome resulting from chronic workplace stress.
‘Sleep is a basic human health behaviour that everybody needs in order to perform during the waking hours,’ says Dr Lederle. ‘All animals show a rest-activity rhythm. Without downtime, the body is unable to repair and restore its functions. What follows are physical and mental illnesses and health problems.’
To sidestep burn-out include more downtime in your daily routine and set aside some time for rest and relaxation.
- Poor diet
The old adage “you are what you eat” rings true, as both being overweight and also not eating enough calories can contribute to flagging energy levels, so follow a healthy diet and don’t skip meals to keep your engine running smoothly.
‘Going to bed hungry as well as being overweight can reduce the quality of your sleep,’ says Dr Lederle. ‘A personally healthy diet and regular meal-times with an eating window of 12 hours will support sleep.’
- Sedentary lifestyle
Leading a sedentary lifestyle can negatively impact sleep quality and make you feel more tired than usual, so it’s important that you include exercise in your daily routine. ‘Extensive periods of sedentary behaviour are associated with poor sleep quality,’ says Dr Lederle. ‘Get up every hour and move or stretch a little. Regular exercise will also help to promote healthy sleep.’
❗How much exercise do you need? The NHS recommends 150 minutes of exercise per week for adults aged 19-64.
- Vitamin deficiency
Being tired all the time can be a sign of vitamin deficiency, including low levels of vitamin D, vitamin B-12, iron, magnesium, or potassium:
- Vitamin D deficiency
Vitamin D is essential for healthy bones and teeth, but research also links a lack of the vitamin with a host of issues, including heart disease, depression, and chronic fatigue syndrome. ‘Vitamin D deficiency is associated with an increased risk in developing sleep disorders,’ says Dr Lederle. ‘High quality supplements may be able to ameliorate this risk.’
- Iron deficiency
Iron deficiency anaemia is one of the most common medical causes of tiredness, particularly in women who are pregnant or menstruating. Symptoms can include heavy-feeling muscles, heart palpitations and shortness of breath. Your GP should be able to diagnose iron deficiency anaemia using a simple blood test and may prescribe iron supplements.
- Magnesium deficiency
Magnesium is an essential mineral that is also important for energy production. Key symptoms include feeling tired, muscle cramps, aches and twitches, restless legs and problems sleeping. It’s hard to test for magnesium deficiency but the symptoms are red flags in themselves.
- Vitamin B-12 deficiency
A lack of vitamin B12, also known as folate deficiency anaemia, comes with a wide range of symptoms including muscle weakness, pins and needles, disturbed vision, mouth ulcers, memory problems and depression and can lead to a number of health problems. If you have symptoms seek urgent medical assistance, as some problems caused by B-12 deficiency can be irreversible if left untreated.
- Potassium deficiency
Potassium is a mineral found in the foods you eat that helps your muscles work. Fatigue is often the first sign of potassium deficiency, but common symptoms also include muscular aches and pains, heart palpitations and breathing difficulties. If you are concerned speak to your GP, as potassium deficiency can be linked to a number of serious health issues including hypertension and kidney disease.
💊 Vitamin deficiency diagnosis: A routine blood test can help identify a vitamin deficiency. Ask your GP to run a full blood count (FBC) which checks for levels of red and white blood cells in the body. A diet overhaul and supplements can make a huge difference with vitamin deficiency – ask your GP for advice.
Stress can adversely affect sleep quality and duration, while insufficient sleep can increase stress levels, so managing your mental load can go a long towards enabling a better night’s sleep and restored energy levels.
‘Stress is a common trigger of sleep problems leaving the body in an aroused state,’ says Dr Lederle. ‘Detaching from work or a stressful event in the evening is important to maintain healthy sleep. Daily meditation practices help you to learn ways to step back from worrying thoughts and feelings allowing you to remain calmer.’
We tend to think of fatigue as primarily a physical problem, but in fact, feeling tired all the time is one of the key symptoms of depression, so take stock of your mental health. ‘There’s a bidirectional relationship between depression and sleep,’ says Dr Lederle. ‘Having insomnia makes you twice as likely to develop depression for example (Baglioni et al 2011).’
‘Poor sleep and mental health issues are connected,’ she adds. ‘Irregularities in sleep timing are a potential contributor and predictor of mental illnesses. Keeping your sleep times regular is therefore important for looking after your mental health.’
❗ If you’re struggling to enjoy an uninterrupted night’s sleep and it’s beginning to impact your mental health, try our sleep tips and ask your GP for help.
- Sleep disorders
From insomnia to sleep paralysis, sleep disorders are common and play a huge role in disrupted sleep. ‘There are over 80 known sleep disorders which affect the duration and quality of sleep,’ says Dr Lederle. ‘This in turn will impact on a person’s ability to function during the day be that at home or at work, cognitively, physically or emotionally.’ If in doubt, seek expert help from your GP or a sleep specialist.
For people with chronic pain and fibromyalgia, daily life can be a struggle and this in turn can negatively impact the quality of shut-eye. If you have any concerns about fibromyalgia, consult your doctor. ‘Difficulties sleeping are common symptoms of fibromyalgia,’ says Dr Lederle. ‘It is linked to insomnia and restless legs syndrome. Finding ways to reduce the pain can help improve sleep.’
- Chronic fatigue syndrome
Chronic fatigue syndrome (CFS) is a long-term illness with a wide range of symptoms including extreme tiredness. ‘Sleep problems including insomnia are common in CFS,’ says Dr Lederle. ‘Many patients with CFS report problems falling or staying asleep.’
‘Changes in circadian rhythms might contribute to these problems,’ she adds. ‘Expose yourself to daylight preferably in the first half of the day to help strengthen your body clock and circadian rhythms.’
While it’s recommended that you don’t operate machinery or drive while you take certain medicines that are known to make you feel sleepy, conversely some medications can keep you up all night with insomnia including those for high blood pressure and asthma. ‘Some medication can affect sleep and can cause insomnia,’ advises Dr Lederle. If you suspect your meds might be keeping you up, read the side-effects and ask your GP for advice.
If you experience an increase in fatigue, thirst, frequent urination and sudden weight loss, see your GP and get tested for diabetes. According to the Sleep Foundation as many as one in two people with type 2 diabetes experience sleep problems due to unstable blood sugar levels and accompanying diabetes-related symptoms, so feeling tired all the time could be a red flag.
‘Diabetes and sleep disturbances are linked,’ agrees Dr Lederle. ‘Both night-time high and low blood sugar levels can impact your sleep. And poor sleep (particularly less deep sleep) can affect insulin levels and thus potentially contribute to the development of diabetes.’ Diabetes education classes are run in most areas now and they can help you learn to manage the condition yourself.
- Under-active thyroid
Hypothyroidism, also known as an underactive thyroid or low thyroid, occurs when your body doesn’t produce enough thyroid hormones. An under-active thyroid comes with a number of telltale symptoms including fatigue, lethargy and weight gain. The good news is with proper treatment, people with hypothyroidism are able to lead completely normal lives. If you’re concerned, ask your GP for advice.
- Post-viral fatigue
If you’re feeling tired after recovering from a viral infection such as the flu or glandular fever, you could be suffering from post-viral fatigue syndrome. Symptoms can include chronic tiredness, muscle pain, weight loss, vomiting, diarrhoea, a fever or chills, chest pain and shortness of breath.
It’s completely normal to feel tired after an illness, but if your symptoms linger for weeks or even months and prevent you from leading your life, it’s worth seeking medical advice. Experts don’t fully understand post-viral fatigue so it’s difficult to treat, but focusing on rest and self-care is a good place to start and people generally get better slowly over time.