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Fighting Fatigue

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If you have felt like you are dragging lately, you may be wondering what is going on. Fatigue is a common symptom that can be caused by a whole host of factors, from medical conditions and stress to poor sleep, says Dr. Stephanie Tung, an instructor in psychiatry at Harvard Medical School and an attending psychiatrist at Dana-Farber Cancer Institute.

The good news is that in many cases you can make changes that will help bring your energy back, but you need to get to the root of the problem in order to treat it.

Fatigue triggers

Part of the challenge when it comes to a general symptom like fatigue is that it's so commonplace and can be triggered by so many different things. This makes it hard to pinpoint what's causing the problem. However, there are a few main culprits that often cause fatigue in women, says Dr. Tung.

Stress. Some people have reported feeling increasingly fatigued these days. This might be an effect of the COVID-19 pandemic — or more specifically, of the stress it has caused. Changing responsibilities, added work, struggles with child care, financial pressures, and reduced social opportunities are just some of the stressors people now face, says Dr. Tung. And chronic stress can lead to fatigue. When you are under stress, it can cause levels of a hormone called cortisol to rise, which can trigger problems sleeping as well as feelings of anxiety and other symptoms.

Hormonal changes. "Hormonal changes can also contribute to shifts in metabolism and sleep disturbances, which lead to fatigue," says Dr. Tung. A decline in female hormones, such as oestrogen, during the menopause transition may induce hot flashes, which can lead to broken sleep. Hot flashes are brief episodes during which your body feels like it's overheating. They can last for a few seconds or minutes. During a hot flash, your skin may flush, and you may start to sweat. If these occur at night, they can make it hard to sleep soundly and leave you dragging the next day.

Problems associated with the thyroid gland, a butterfly-shaped gland located at the front of your neck that regulates your metabolism, may also cause fatigue, says Dr. Tung. When the thyroid gland is underactive and produces inadequate levels of thyroid hormone (a condition called hypothyroidism), it can make you feel tired, in addition to other symptoms. Women are more likely than men to have thyroid disease, and incidence rises with age. Almost 20% of women over age 65 have an underactive thyroid gland.

Your diet. If you are not eating a well-balanced diet, it may result in vitamin deficiencies that can sap your energy. Two of the most common are vitamin D and vitamin B12 deficiencies, says Dr. Tung. Fatigue is also sometimes brought on by dehydration.

Poor sleep habits or sleep disorders. Perhaps the most obvious reason you might be feeling tired is that you are not getting adequate sleep. Sometimes this results from bad sleep habits. "Staying up late at night, too much screen time — those habits can definitely affect people's energy level," says Dr. Tung. People who have work schedules that require staying up all night may also have difficulty getting a consistent block of time to achieve restful, deep sleep. But inadequate sleep can also be caused by insomnia or poor sleep quality triggered by stress, or sleep disorders, such as obstructive sleep apnoea. If you have obstructive sleep apnoea, tissues in your throat relax during sleep, periodically blocking your airway, causing breathing interruptions that disrupt sleep.

Medical conditions and medications. Fatigue may be the predominant symptom in people with depression. Numerous medical conditions, including infections, anaemia, heart disease, chronic kidney disease, cancer, neurological conditions, and autoimmune conditions also cause fatigue, says Dr. Tung. Certain medications can also make people feel tired or drowsy.

Overcoming fatigue

If you are experiencing fatigue that lasts for more than a day or two, try to determine what is causing you to feel so tired and then test different solutions to see if they help.

Make lifestyle changes. If you suspect that lifestyle factors, such as poor sleep or eating habits, are causing your fatigue, work on improving your diet and focusing on following good sleep practices at night. (See "How to get a better night's sleep.")

Fatigue may also be brought on by a sedentary lifestyle, so it is important to make sure you are getting enough physical activity. While it can be a challenge to get moving if you are tired all the time, exercise can help you feel better if you give it a chance. "I think as with any type of behavioural change, recognize that it is going to be difficult," says Dr. Tung. Try to break things down into small, achievable goals. For example, you might start by doing two minutes of exercise a day, and then after a few days increase it to five minutes, and then 10 minutes, she says. Getting more physical activity into your day can also help you sleep more soundly at night.

Check your medications. Fatigue may be caused by certain medications, says Dr. Tung. If you are taking a new medication and suddenly experience fatigue, reach out to your doctor.

Promote calm. If anxiety or stress is triggering your symptoms, paying attention to your mental health should be a priority. Cognitive behavioural therapy, mindfulness meditation practice, and stress reduction strategies can help, says Dr. Tung.

How to get a better night's sleep

If you are experiencing sleep disturbances, improving your sleep habits may help. Strategies to try include the following:

Go to bed and wake up at the same time each day.

Avoid electronic devices at least two hours before bed, because the light from these devices may disturb your body's natural sleep clock.

Sleep in a quiet, dark, cool space.

Avoid caffeine late in the day.

Get regular exercise. (While some experts advise exercising in the morning, there's no clear evidence that the time of day you exercise matters when it comes to sleep quality.)

Avoid alcohol before bed. Alcohol may help you fall asleep faster, but it generally results in more fragmented sleep, and sleep quality in people who are alcohol users tends to be worse.

However, if these strategies do not help, and the sleep problems you are experiencing are frequent and affect your daily life, it is time to visit your health care professional.

Seeing your doctor

However, not all causes of fatigue are treatable on your own. You may need to pay a visit to your primary care provider. "Warning signs for fatigue include severe or persistent symptoms or when it interferes with your ability to function," says Dr. Tung. If this is the case, it may be time to make an appointment to get checked out.

Your clinician will want information about your diet, physical activity, sleep habits, stress level, and mood. He or she will do a physical exam and likely order blood tests to rule out anaemia or a thyroid disorder. If your fatigue is being caused by an underlying medical condition, treating it can often help you get your energy back.


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