Why do I feel so tired, Doc?

Fatigue is not an uncommon complaint that a doctor hears at his clinic. This term however could mean many things to many people. While there are many normal causes for fatigue and tiredness, I would like to write about the abnormal (pathological, disease related) causes for tiredness that the reader needs to be aware of.

Fatigue could happen normally from doing unaccustomed severe exertion or exercise or due to inadequate rest and recovery after exertion, sleep deprivation, travel thorough different time zones (Jet lag) or due to obesity, under nutrition and severe emotional stress. You could recover from fatigue from the above causes by taking adequate rest. So why should fatigue persist even after taking enough rest and what could the reasons be for it?

Pathological fatigue has many causes. Broadly they may be grouped into the following categories.

Significant Fatigue is when fatigue persists for at least 2 weeks and can affect upto 25% of the population at some time. Chronic sleep deprivation (sleep apnoea) can also be a cause for severe fatigue.

Chronic Fatigue is when fatigue affects the person for more than 6 months.

Alarm signs in Chronic fatigue:

1. Anorexia and weight loss (>10% per 6 months)

2. Enlarged Lymph nodes.

3. Memory and concentration impairment

4. Inability to function due to myalgias, arthralgias, headaches etc.

5. Deep depression

Evaluation of complaints of Fatigue:

Treatment of Fatigue

Identification and treatment of the cause for fatigue will cure the problem most of the times`.

Interventions that may be of benefit for people with problematic fatigue are:

1. To fix lifestyle abnormalities – to regulate lifestyle, to eat, sleep on time.To exercise regularly – resistance as well as aerobic training reduce fatigue. (Graded exercise programme)

2. Use of nocturnal cPAP for those with Obstructive Sleep Apnoea

3. Medications – Melatonin or nocturnal sedatives

– Modafinil or Armodafinil

– Testosterone replacement therapy for those with deficiency

– Steroid replacement therapy for those with adrenaline insufficiency

– Correction of Vit D and other vitamin deficiencies.

4. Cognitive Behaviour therapy provided by an experienced psychologist.

A note of Long Covid Syndrome:

Covid 19 infection has been the most common cause for prolonged fatigue over the past 2 years. Long covid syndrome refers to the persistence of symptoms many weeks after the acute infection. Fatigue is a persisting symptom irrespective of the severity of the infection. In one study 92% of covid patients had fatigue 79 days after the onset of Covid infection.

Common symptoms of long covid include:

Fatigue,breathlessness, chest pain,mental fudge and cognitive abnormalities, sleeplessness, smell and taste abnormalities, headache and feverishness etc. Treatment is essentially symptomatic only.

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