Fatigue, also known as tiredness, exhaustion, lethargy, and apathy, describes a physical and / or mental state of being tired and weak . Although physical and mental fatigue are different – and chronic fatigue is another topic that occupies a separate section – the two often exist together, if a person is physically exhausted long enough, they will also be mentally tired.

When someone experiences physical fatigue, it means that they cannot continue to function at their normal levels of physical ability. Mental fatigue, however, is more inclined towards feeling sleepy and being unable to concentrate properly.

The fatigue is a symptom rather than a sign. A symptom is something the patient feels and describes, such as a headache or dizziness, while a sign is something the doctor can detect without talking to the patient, such as a rash. It is a non-specific symptom, that is, it can have several possible causes.

Mental and physical fatigue

Physical fatigue

The person’s muscles cannot do things as easily as before. Climbing stairs or carrying grocery bags can be much more difficult than before. Physical fatigue is also known as muscle weakness or lack of strength. Doctors generally perform a resistance test as they progress through the diagnosis and try to find out the causes of individual cases.

Psychological (mental) fatigue

Focusing on things has become more difficult. When symptoms are severe, the patient may not want to get out of bed in the morning, or go about their daily activities. Mental fatigue often appears alongside physical fatigue in patients, but not always. People may feel sleepy, have a decreased level of consciousness, and in some cases show signs similar to that of a state of intoxication. Mental fatigue can be fatal, especially when the patient has to perform certain tasks, such as driving a vehicle or operating heavy machinery . The fatigue of trained physicians is a serious public health problem; both for the health of the resident doctor and the patients under his responsibility.

Why am I so tired?

The possible causes of fatigue are practically endless. Most of the illnesses listed in the medical literature include malaise or fatigue as one of the possible symptoms.
The causes are sometimes classified under various lifestyle problems and / or a few broad disease entities.

Here are some (not all) of the possible causes:

Mental health (psychiatric)

Pain, eating disorders, alcohol abuse, drug abuse, anxiety, moving, boredom, and divorce.

A certain amount of stress can energize us, in fact, most of us need some kind of mental pressure to get going. However, when high levels of stress – hence high levels of cortisol – become excessive, they can easily cause fatigue. Stress and worry are two emotions that commonly cause tiredness. Stress can reach a point where those who suffer from it become “unable to see the light at the end of the tunnel”, leading to despair. Desperation is draining, and it eventually causes fatigue if it’s around long enough . Not being in control over a situation can be frustrating, annoying, and very exhausting.

Having a baby in the house, especially if he / she wakes up a lot during the night, can interfere with the parents’ sleep.

Clinical depression can cause tiredness for a number of reasons. Fatigue can be caused by depression itself, or one of the problems associated with depression, such as insomnia.

Endocrine / metabolic causes

Cushing’s disease, kidney disease, electrolyte problems, diabetes, hypothyroidism, anemia, and liver disease.

Drugs / Medications

some antidepressants, antihypertensives, antihistamines, steroids, withdrawal medications, sedatives, and anti-anxiety medications.

Statin drugs are among the best-selling prescription drugs in the world. Researchers at the University of California, San Diego, published a report showing that statins can cause fatigue.

Heart and lung conditions

Pneumonia, arrhythmias, asthma, COPD (chronic obstructive pulmonary disease), heart valve disease, coronary heart disease, and congestive heart failure.

Sleep problems

Working late at night, sleep apnea , narcolepsy, insomnia, and reflux esophagitis.

Some jobs are more closely linked to a risk of fatigue than others. Examples include police, doctors, nurses, firefighters, shift workers in general whose sleep pattern is “unnatural” for humans. The problem of fatigue is compounded if shift-routines are changed regularly.

Infectious diseases, infections

Malaria, various tropical diseases, TB (tuberculosis), infectious monocucleosis (glandular fever), Cytomegalovirues, HIV infection, influenza and hepatitis.

Chemicals and substances

The vitamin deficiency , mineral deficiency, intoxication.

Consuming too many caffeinated or alcoholic beverages can make it harder to get to sleep or stay asleep, especially if you drink them close to bedtime.

Various diseases, conditions, states, and treatments

Cancer, chemotherapy, radiation therapy, chronic fatigue syndrome , fibromyalgia , systemic lupus, rheumatoid arthritis , obesity, massive blood loss, and weakened immune systems. Chemotherapy for breast cancer is more likely to be the cause of long years of fatigue after your treatment.

Chronic pain

Chronic pain patients generally wake up tired, even after sleeping for a long time. For many, pain disturbs their sleep, which also leaves them tired. The combination of sleep disturbances and having to endure persistent pain can be very exhausting, leaving the patient exhausted for much of the time . Some diseases and conditions in which pain is the main symptom, such as fibromyalgia, are also linked to other conditions, such as sleep apnea and restless legs syndrome , which make symptoms even worse.

Changes in the structure of neural interactions

A Swiss scientist shows that there is an association between muscle fatigue and changes in the interaction between neural structures.

Fatigue can be self-perpetuating. A person who feels tired will not be able to exercise; lack of exercise can cause fatigue. Also, lack of exercise can make it harder and more exhausting to perform a physical task.

Being overweight and underweight

Being overweight / obese is a growing problem in many parts of the world today. Obese people are much more likely to experience fatigue for a number of reasons – having to carry a lot of weight makes obese people burn out quickly. They are at higher risk of developing diseases and conditions in which fatigue is a common symptom, such as diabetes and sleep apnea. Low weight can mean there is less muscle strength; a very thin person can tire more easily.

How common is fatigue?

It can affect people of any age. Experts say that 10% of people in the world at any given time are suffering from persistent fatigue. Persistent tiredness affects women more than men . Primary care physicians (family doctors, general practitioners) in the US and UK say they frequently see patients who come in to complain of extreme tiredness or fatigue.

The US National Institutes of Health reports that approximately one in five Americans report having fatigue that is severe enough to interfere with normal daily life.

It can also affect healthy individuals after intense mental and / or physical activity.

What is the difference between fatigue and drowsiness?

Fatigue is usually a more chronic (long-term) condition than drowsiness (sleep). Drowsiness is generally caused by poor sleep, or a lack of stimulation. Drowsiness can be a symptom of a medical condition. Fatigue, especially chronic fatigue, is often linked to a larger medical problem.

People who suffer from fatigue feel that they lack motivation and energy. Although fatigue and drowsiness are not the same, drowsiness, or the desire to sleep, is a common symptom that accompanies fatigue. Apathy can also accompany fatigue.

Signs and symptoms of fatigue

The main symptom of fatigue is tiredness (severe fatigue) after physical or mental activity. The patient does not feel rested after resting or sleeping. Severe fatigue can undermine a person’s ability to carry out normal activities.

Patients describe tiredness, especially chronic fatigue (chronic fatigue syndrome) as overwhelming, and describe tiredness as completely different from what they have experienced before – it is not a consequence of overdoing things, but simply a loss of motivation. Fatigue is a common symptom among people with clinical depression.

Some people find that symptoms worsen after exercise – known as post-exertional discomfort, or payback. Sometimes post-exertional discomfort may not emerge until several hours after exercise; sometimes even a day later.

Signs of fatigue and its symptoms can be physical, mental, or emotional in nature. Below is a list of some possible signs and symptoms of fatigue:

Bloating, abdominal pain, constipation, diarrhea, nausea, and possibly problems similar to IBS ( irritable bowel syndrome )
Muscle
pain Painful lymph nodes
Apathy, lack of motivation
Chronic (long-term) fatigue
Difficulty concentrating
Dizziness
Hallucinations
Body coordination – eye may be affected
Headache
Impaired judgment
Indecision
Irritability
Loss of appetite
Bad mood
Poor immune system function
Short-term memory impairment – there may be trouble organizing thoughts and finding the right words to say (brain fog)
Drowsiness
Slow responses to stimuli
Reflexes slower than normal
Some vision problems, such as blurred vision

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses.He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

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