Why Am I so Fatigued?

"Why am I so fatigued?" How many times have you asked that question?

Fatigue is that not-so-delightful younger sibling of our old nemesis, Pain. Sometimes, it doesn’t matter how much you rest, Fatigue doesn’t get the message that it’s time to go away. So why do we experience fatigue? And what can we do to alleviate it?

What are the symptoms of fatigue?

As you know, fatigue is more than simple tiredness. In fact, fatigue exists on a continuum, with tiredness on one side and exhaustion on the other.

If you've had a couple of late nights, you'll recognize tiredness at the point at which you start feeling sleepy, forgetful and irritable. After a good night's sleep, you wake up feeling rested and restored.

Tiredness is a normal and temporary response to stressors (such as physical exertion or lack of sleep). If we can nip that in the bud, we return to our normal state – whatever that may look like for us.

But if we can't alleviate our tiredness, for whatever reason, we can become fatigued, and fatigue isn't so straightforward.

When we're fatigued, we lose energy more quickly than expected, and disproportionately to how much activity we've done. This shows up when small amounts of activity or exertion wipe us out. For you this may be anything from a short walk, to taking a shower or reading a few lines of a book.

Fatigue presents itself in a multitude of ways. Do you feel sleepy, heavy in your body or nauseous? Does it show up as brain fog, as trouble concentrating, or as anxiety? Are you sensitive to light, noise, touch, smells or taste? These, and many other discomforts are all ways we might experience fatigue.

Fatigue shows us that we're no longer adapting or managing our stressors. If we keep trying to push through, we wear ourselves out more and more and run the risk of ending up exhausted. At this point, the confusion and physical challenges we face may be overwhelming – even to the point of delirium, numbness and total withdrawal. Mere tiredness will sound like a luxury.

But, we can learn to manage our stressors and our energy reserves. Your fatigue may never completely go away, but you can gradually move from fatigue, through tiredness, and eventually back to a more-energized version of yourself.

Why am I so fatigued?

Nearly everything we do uses some energy. Petrol cars are powered by engines burning fuel and in our body the equivalent is mitochondria, often referred to as the powerhouse of the cell.

These microscopic engines inside our cells take fuel and use it to create ATP (adenosine triphosphate), which is the energy molecule that our cells use to function.

Over the course of a day, we continually use and replenish our energy resources. But if the mitochondria can't create ATP quickly enough, we start to use our energy resources faster than we refill them, and this leads to tiredness.

Needing periods of rest is a normal part of life. Just look around you! Deciduous trees drop their leaves and become dormant in colder weather, while many animal species hibernate when food is scarce. This allows them to preserve their energy resources for core survival functions until the threat (such as winter and lack of food) has passed.

When we are sick or injured, we can activate a similar response, and focus our energy on healing and attending to essential activities only. Even top athletes often sit down during breaks in play, and have careful recovery routines after training and events.

So, with enough of the right type of rest, fatigue should get better. But...

What causes fatigue in the first place?

Fatigue is complicated and can have many different initial causes and ongoing contributing factors. In fact, fatigue is an umbrella term, which makes it hard to explain or solve.

There's general fatigue, which is often a symptom of chronic pain conditions such as fibromyalgia. There's myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS). There's fatigue that is part of a serious health problem such as cancer. There's fatigue fueled by dietary problems or too much of any type of stress.

In each case is a delicate interplay between the body's biological clock, metabolism, nervous system and immune system. Challenges affecting these can both cause and result in difficulties with sleep and brain function. The initial cause of chronic fatigue – an illness, injury or even a psychological trauma – may be long gone and yet the symptoms still persist.

What we do know is that in most cases ongoing fatigue is similar to persistent pain. Both are protective responses that encourage us to rest and heal, but both have overstayed their usefulness – and their welcome! Although you need to be careful not to overdo things at the risk of making your fatigue worse, resting and avoiding activity altogether usually doesn’t help either.

What can I do to stop feeling fatigued?

The first step is to understand what drives your own fatigue: which activities and events make it better and which make it worse. Maybe you already have a good sense of this, or perhaps you're not sure what to look for.

When we think about tiring activities, we often think about physical challenges. But physical exertion isn’t the only thing that can be tiring, other types of activity can challenge us in similar ways and our bodies might react to those with pain or fatigue. Mental exertion, sensory overload and emotional stress can also make us tired and give us pain.

Let’s look at mental exertion. Maybe you have a problem to solve at work, or a seminar to attend. The cognitive (mental) load required for that activity can take energy and may be stressful or challenging for your body and nervous system. Afterwards, even getting ready for bed might seem too hard. Perhaps you even – accidentally – make the fatigue worse by going to bed late either because of the effort to get ready or maybe the dread of not easily falling asleep. And it can be the same with sensory overload (when external stimuli such as high or low temperatures, bright lights or loud noise are unpleasant and fatiguing) and intense emotions – even pleasant ones can be draining.

Each of us have a certain amount of energy at the start of the day. Some have more, some less. And it might change at different times of your life. The activities in your day will give and take energy, depending on how draining they are for you. The trick is to work out how much energy you have, and how your activities affect you. Then, arrange your schedule so that you don't use all your energy by lunchtime and crash. This is a way we can think about pacing ourselves to reduce our fatigue, without avoiding activity altogether.

However ‘in-tune’ you are with understanding how your energy and what things deplete and replenish it, we recommend that you keep a fatigue and activity log for a week or more. This will highlight the relationship between your activities, the things that cause your fatigue, your warning signs and your symptoms, so you can clearly see what brings on fatigue and how much you can do in a day.