Fatigue Part I: Why am I so Tired? by Dr. Sharon Orrange/Primary Care Physician: at DailyStrength Doctors and Advisors

Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…

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LOCATION: Santa Monica, CA, USA

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Assistant Professor of Clinical Medicine, Division of Geriatric, Hospital and General Internal Medicine, Keck School of Medicine, University of Southern California

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Fatigue Part I: Why am I so Tired?

Posted in Chronic Fatigue... by Dr. Sharon Orrange on Feb 14, 2010

If I had a dollar for every time I hear this from a patient I could save our economy. This is a serious and disabling complaint we hear from 22-33% of patients in our primary care offices. In this blog I want to address the potential causes of fatigue, and what workup your doctor should pursue. In a follow-up blog we will talk about approaches to the treatment of fatigue.

First, make the distinction in your mind of fatigue from somnolence, feeling winded, and muscle weakness, although these symptoms may also be associated with fatigue. People with fatigue report a lack of energy, mental exhaustion, poor muscle endurance, delayed recovery after physical exertion, and nonrestorative sleep.

There are many potential causes of fatigue including lifestyle issues, physical conditions, mental disorders, and medication side effects. Here are your initial steps toward figuring out the cause:

1) Ask yourself about the quality and quantity of your sleep. If your sleep is disrupted by getting up to use the restroom, a partners snoring, or allergic rhinitis (stuffy nose) that wakes you up chances are you are NOT getting a good restorative sleep.

2) Get a good physical exam. Physical examination findings that could suggest a worrisome cause of fatigue include enlarged lymph nodes, a heart murmur, an enlarged thyroid, lower extremity swelling (heart failure, liver disease), poor muscle tone and other neurologic abnormalities.

3) If the physical exam is unrevealing consider talking to your doctor about some basic blood tests. Laboratory studies should be considered although their results affect management in only 5 percent of cases. Many physicians will order a complete blood count, erythrocyte sedimentation rate, chemistry panel, thyroid-stimulating hormone, and urinalysis. Women of childbearing age should receive a pregnancy test.

What is chronic fatigue? Chronic Fatigue is defined as fatigue that lasts longer than six months. Chronic fatigue is not the same thing as Chronic Fatigue Syndrome which includes fatigue as well as 4-5 other associated symptoms and won't be specifically discussed in this blog. Medical or psychiatric diagnoses can explain fatigue in at least two-thirds of patients with complaints of chronic fatigue. In one study, for example, a psychiatric diagnosis was found in 74 percent of over 400 patients who presented to a chronic fatigue clinic with at least one month of fatigue. The three major psychiatric illnesses were major depression (58 percent), panic disorder (14 percent), and somatization disorder (10 percent). There is debate, however, whether depression in individual patients is the cause or consequence of symptoms of chronic fatigue.

Medical causes for chronic fatigue that deserve to be investigated if no psychiatric cause is found include:

Heart causes: heart failure, chronic obstructive lung disease

Disturbed sleep: sleep apnea, GERD, allergic rhinitis

Endocrine causes: diabetes, hypothyroidism, adrenal insufficiency

Infectious: mono, hepatitis, HIV

Inflammatory: Rheumatoid arthritis, lupus

Medications: antihypertensives (beta blockers, etc), muscle relaxants, sedatives, pain medicines

Fatigue is frustrating and often there are no easy answers. In the next blog I will talk about steps you can take toward the treatment of fatigue.

"Fatigue is the best pillow"

Benjamin Franklin

Dr O.

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Displaying comments 32-13 of 32

When I discovered I was so tired all the time,,,i started with a check up and I was physically fine....I then started watching the food I was eating,,,and eliminating some things. when I eat a large amount of carbohydrates it makes me so tired and sluggish.
I now eat mostly fruits and veggies with some form of protein.....and I have so much more energy....t
Learning about our bodies and how things affect them,,is one of the best ways of caring for yourself.....

By Jayjay1938 May 09, 2012

I'll tell you why I am fatigued all the time. No money and male between 18 and 65 in the United States. This means your diet is expired junk food and noodles from food pantries. No decent medical attention. ER prescriptions not filled because of no money to make a co-payment. Due to no way to walk anywhere on poor health and neglecte3d injuries it just makes things worse. About the only thing I can do is know those who dont care will see a waste in their tax dollars as another ER visit is planned tonight due to dizzyness not solved on Friday.

By pinkfloyd1979 Sep 26, 2010

I'll tell you why I am always fatigued. No money to buy what I need for health and no one cares. That simple. I have been asking for help on nutritional and medical needs since I was 19 and gotten nothing but turned away 100% of the time. 6 feet tall and 135 pounds and a long list of neglected injuries. Zero friends and a family that hates me in a superficial and materialistic nation that lives on stereotypes. So for tonight instead of dinner and then bed a few hours later, it will be aq trip to the ER by ambulance since the dizzyness I been living with the past week just gets worse and I never found a magical way to get a dollar for the co-pay on a prescription as well as money for nutritious foods and gadorade and so on that the doctor told me to eat and drink after Fridays visit.

By pinkfloyd1979 Sep 26, 2010

Hello,
There seems to be very little on DS regarding Insulin resistance or X syndrome.
Do you have any information on this condition.
I am working on the basis that I might be insulin resistant, as most of my symptoms come on after eating and even though I had a negative diabetic result I understand that its still possible that I am resistant. I have a high family incidence of diabetes with 5 members of my family confirmed diabetic. Do you have any help or advise as to how I can get a diagnosis? I am based in the UK. thanks David

By ponder44 Jul 30, 2010

Can't wait for the next blog. I have been thro test after test and nothing, just premenopause and joint pain. Maybe Meniere's and was told the head aches were connected to migraines, he said hormomes in later life can cause head aches, if you had migraines when you were younger!
Thanks

By janiecf Jul 27, 2010

in your column you did not mention that fatigue can and often comes along with the polysystic kidney disease....as the body cannot process the proteins from meat products so it gets tired all the time.....and can and often does affect daily life. fatigue is a factor in a lot of medical and non medical issues not just mental.....

By need2talk123 Jul 25, 2010

youdontlooksick: I dont have control over that part...:)

By DrOrrange May 07, 2010

I am going through Andopause (male menopause). I am always tired, and when I say always, I mean it. I heard of Bioidentical hormone therapy. Will that work?

http://testosterone-for-men.com/Bio...

By raiundazan Apr 09, 2010

I was just curious Dr. Orange why you posted this in the Chronic Fatigue Syndrome Support Group since your article has nothing to do with that disease?

By youdontlooksick Mar 22, 2010

I am a newly 60 year old female. I have gone through menopause. I have been told I have Rheumatoid arthritis. It seems that I have been tired for so long. After menopause I had trouble sleeping. I tried the PM meds for night sleeping and have found Ambein to work but I don;t like taking them. With them or without I still wake up so tired. My knees espically the right one hurts all the time. I have pain in my upper shoulders upper arms neck. You can poke them and they hurt. I have been having excessive sweating of the head. I just have the water drip off the hair down the sides of the face. The back of my neck is soaked from sweat running off the hair. I am so hot and I don't sweat, but by the time I get home I have to change my shirt. Now I also noticing my face. It seems to have puffed up I am overweight. Anyway I am a wreck.

By maryil Apr 29, 2009

For those who are up to date with medical research there is NO debate, however, whether depression in individual patients is the cause of symptoms of chronic fatigue. Depression is a consequence of severe CFS. If it were a cause then SSRI, MAOI's or TriCyclics would work. They have all proved to be unbeneficial just read Prosac Backlash or talk to Cheney, Myhill, Nicholson or any number of the major 35 researchers into CFS. This is a very poor article Dr Orrange. Its the sort of trash that CFS sufferers can do with out. Its not helpfull. Its time you got up to speed with Mitacondrial Dysfunction. When you do I have every confidance that you will write an amendment, and contact all those who responded to your post. Now is not the time for you to crawl into a protective defensive shell, now is the time to learn and get the facts right for the sake of those who suffer.
Al

By Ali5tair Apr 21, 2009

I think http://personalmoneystore.com/money...">SAT scores can also cause fatigue

By SamuelX Apr 13, 2009

I have been experiencing some unexplained symptoms--not the least of which is fatigue. To be frank, I am fed up with doctors who suggest psychiatric problems when they have not found a medical cause. To think that you would start with psychiatric causes for chronic fatigue and then consider medical diagnoses is quite troubling to me.

By bethnich Apr 07, 2009

I was so damned fatigued for no reason that the doctor could find at first. In addition, I had muscle and joint pain and fatigue and night sweats. After almost giving it up, my doc did one last long shot test for hepatitis, thinking it was unlikely. Guess what? I had Hepatitis C. Please consider that HEP C, which is a silent disease in many people, can be the cause of fatigue and rule it out as a possible cause!

By HEPCinRVA Apr 04, 2009

Well, crap. I have a heart cause, disturbed sleep, an endocrine cause, an inflammatory cause, and a medication cause (or three). No wonder I'm fatigued. I'm going to have to take a nap now.

By kaydi8 Apr 01, 2009

Yikes! No wonder I'm tired!! I have major depression, panic disorder, somatization disorder, GERD, allergic rhinitis, hypothyroidism (Hashimoto's Thyroiditis - which is an autoimmune disorder), and have to take Seroquel (atypical antipsychotic) and Vistiril (antihistimine for anxiety) and Remeron for the depression. Yet when my doctor prescribed Provigil (stimulant) to help me function to care for my children, Medicare sent me a letter saying it wasn't medically necessary!!

How frustrating! What would make Provigil medically necessary? Catatonia?!?

Of course I could pay for it myself, but since I'm on Social Security and get no child support for my twins who were conceived by rape that is financially impossible. The price tag ($252/month) is 25% of my monthly income. But, because of my fatigue, Children's Services is threatening to take my children!

Any ideas for help? Could I be eligible for respite care with my diagnoses?

Thank you so much for this article. At least I now know WHY I'm constantly fatigued!!

By katiescarlett Mar 31, 2009

the less you do the more tierd you get , i find exersise helps me get my energy levels up , takes a month or two before youll feel the benifits as your body will feel worse for the first 6 to 8 weeks , but it helps for sure
try buying a walk counter and try an do 10,000 steps a day walking , the step counter helps keep your goal

By mark0102 Mar 24, 2009

My severe pain has lead to increased fatigue; pain wears you out like nothing else.

By mianutzy Mar 24, 2009

Foung the information about Vitamin D, B12 and Stored Iron informative. I will be going to an Endocronologist shortly. I have Fibromyalgia, Epstein Barr, Psorasis, and Chronic Fatigue. I also am going through menopause. Which blood tests would be helpful to check for my Fibromyalgia as I feel very achy lately, especially around the neck and shoulders? I lost my livlihood since I also have chronic tennis elbow, treated with extracorpeal shock wave. Anything repetive makes my life miserable, and I have not had much quality of life since all my ailments hit at once. Any advice would be helpful. Tried the popular meds for FMS, to many side affects. I have not yet tried acupunture so that is my next treatment. I am concerned there is some type of deficiency not yet picked up by my Rheumatologist.

By NJGirl07 Mar 17, 2009

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