Why am I always tired?
Tiredness is one of the most common reasons people see an internal medicine doctor. The cause is sometimes simple and sometimes a sign of illness. This article explains what may be behind it and when to have tests.
We all know tiredness. A busy week or a few nights of poor sleep is enough to leave anyone feeling low. But when weeks pass and rest does not help, it is time to look for the cause. Tiredness is not a disease in itself; it is a sign, and it has many possible causes.
Common, everyday causes
The NHS source lists several common causes: too little or poor sleep, an unhealthy lifestyle (diet and inactivity), stress and depression, hormonal changes such as pregnancy or the menopause, some infections, and some medicines that cause drowsiness. These are checked first, because they are the most common.
Which illnesses can be behind tiredness?
Internal medicine conditions in which tiredness is one of the main signs:
- Diabetes. The NHS source lists heavy tiredness together with thirst, passing a lot of urine and unexplained weight loss. Many patients have no clear symptoms.
- Underactive thyroid. Unusual tiredness, feeling cold, weight gain, constipation and feeling unwell. NIDDK says these symptoms are common and do not necessarily mean a thyroid problem.
- Anaemia. MedlinePlus says a blood cell count may show anaemia or iron deficiency.
- Heart disease. MedlinePlus says women, older people and patients with diabetes may have tiredness, weakness and shortness of breath during a heart attack instead of chest pain. Take sudden severe tiredness with shortness of breath or chest pressure seriously.
- Fatty liver. It sometimes comes with tiredness and a feeling of being unwell, but it often has no symptoms.
This list is not complete. There are other causes, such as sleep problems and depression. For this reason, do not diagnose yourself.
When should you see the doctor?
According to the NHS, see the doctor in these situations:
- You have been tired for several weeks and do not know why
- The tiredness is getting in the way of daily life
- The tiredness comes with other signs such as weight loss or a change in mood
- You have been told you snore or make choking sounds when you sleep
Call 115 (the emergency number in Iran) at once if sudden tiredness comes with chest pain or pressure, severe shortness of breath, cold sweat, weakness on one side of the body or confusion.
What happens at the visit?
The doctor asks about sleep, diet, stress, medicines and other symptoms. The doctor examines you and, depending on the findings, may ask for tests such as blood sugar, a blood cell count or a thyroid test. Often the cause is not found the first time, and follow-up is needed. This is normal and does not mean you are being ignored.
What helps: write down how long the tiredness has lasted, your sleep and wake times, any change in weight and the medicines you take, and bring them with your earlier test results.
What helps until the visit?
The NHS advises: healthy food and regular exercise, fixed sleep and wake times (about 6 to 9 hours of sleep), winding down for a few hours before bed, a quiet, dark bedroom, and avoiding smoking, a lot of alcohol, caffeine and heavy meals close to bedtime. Cut down on phone and screen use for an hour before bed.
Do not start supplements, iron tablets or vitamins yourself; the cause has to be found first.
Every patient’s treatment plan is different; ask the doctor about your own situation.