Fatigue

About fatigue

Fatigue is a feeling of constant exhaustion, burnout or lack of energy. It can be physical, mental or a combination of both. Fatigue can affect anyone – most adults experience it at some time in their life.

Each year, many Australians see their doctor about fatigue. Fatigue is a symptom, not a condition.

For many people, fatigue is caused by a combination of lifestyle, social, psychological and general wellbeing issues rather than an underlying medical condition.

Although fatigue is sometimes described as tiredness, it is more severe than being tired at the end of a long day or from hard physical exercise. Everyone can feel tired at times, but this is usually resolved with a nap or a few nights of good sleep.

If you are getting enough sleep, eating healthily and exercising regularly but struggle with motivation, concentration and going about your daily activities, you may be experiencing fatigue that needs further investigation.

Sometimes fatigue can be more serious – it may indicate an underlying medical condition or it can put people at risk of a workplace or motor vehicle accident.

If fatigue is having a negative effect on how you live your life, or causing you distress, it is important to speak with your general practitioner (GP).

Symptoms of fatigue

Fatigue symptoms can be physical, mental and emotional and may include:

• chronic tiredness, sleepiness or lack of energy
• headache
• dizziness
• sore or aching muscles
• muscle weakness
• slowed reflexes and responses
• impaired decision-making and judgement
• moodiness (such as irritability)
• impaired hand-to-eye coordination
• appetite loss
• reduced immune system function
• blurry vision
• short-term memory problems
• poor concentration
• hallucinations
• low motivation.

Causes of fatigue

The wide range of causes that can trigger fatigue include:

• Medical causes– unrelenting exhaustion may be a sign of an underlying illness or condition (such as flu, glandular fever, chronic fatigue syndrome, thyroid disorders, heart disease or diabetes).
• Lifestyle-related causes – alcohol or drugs or lack of regular exercise can lead to feelings of fatigue.
• Workplace-related causes – workplace stress can lead to feelings of fatigue.
• Psychological causes – fatigue is a common symptom of mental health problems (such as depression and grief), and may be accompanied by other signs and symptoms (including irritability and lack of motivation).

Fatigue can also be caused by a number of factors working in combination.

Medical causes of fatigue

It is often hard to work out the exact cause of fatigue because can be a symptom of many medical conditions (such as anaemia, multiple sclerosis and cancer).

See your doctor if you experience prolonged bouts of fatigue. They will look at both medical and non-medical areas of your life to determine the cause and may ask how fatigue is impacting your life.

Difference between chronic fatigue and chronic fatigue syndrome (CFS)

Ongoing unexplained fatigue (or chronic fatigue) is distinct from myalgic encephalomyelitis (known as chronic fatigue syndrome or ME/CFS) in the following way:

• post-exertional malaise (PEM) – symptoms get worse after exercise or general exertion
• there may be a delay between the exertion and increase in symptoms, often by 24 hours or more.

If you’ve have ongoing, unexplained fatigue for more than 6 months and feel worse after activity, you might have ME/CFS. See your doctor for advice.

Lifestyle-related causes of fatigue

Common lifestyle factors that can cause fatigue include:

• Sleep problems – too little sleep, poor quality sleep or too much sleep can all cause fatigue. Disturbed sleep may occur for a number of reasons (for example, noisy neighbours, young children who wake in the night, a snoring partner, or an uncomfortable sleeping environment such as a stuffy bedroom). There are also medical causes of poor sleep such as sleep apnoea.
• Alcohol and drugs – alcohol is a depressant drug that slows the nervous system and disturbs normal sleep patterns. Other drugs (such as cigarettes and caffeine), stimulate the nervous system and can cause insomnia.
• Lack of regular exercise and sedentary behaviour – physical activity is known to improve fitness, health and wellbeing, reduce stress, and boost energy levels for most people. It also helps you sleep. However, too much or the wrong sort of exercise for your body may also lead to fatigue.
• Poor diet – low kilojoule diets, low carbohydrate diets or high energy foods that are nutritionally poor don’t provide the body with enough fuel or nutrients to function at its best. Quick fix foods (such as chocolate bars or drinks with caffeine or a lot of sugar), only give a short-term energy boost that quickly wears off and may contribute or cause fatigue.
• Individual factors – personal illness or injury, illnesses or injuries in the family, too many commitments (for example, working two jobs) or financial problems.

Workplace-related causes of fatigue

Common workplace issues that may contribute to fatigue include:

• Shift work – the human body is designed to sleep during the night. This pattern is set by a small part of the brain known as the circadian clock. Shift work confuses your circadian clock by working when your body expects to be asleep.
• Poor workplace practices – long work hours, hard physical labour, irregular working hours (such as rotating shifts), a stressful work environment (such as excessive noise or temperature extremes), boredom, working alone with little or no interaction with others, or fixed concentration on a repetitive task.
• Workplace stress – job dissatisfaction, heavy workload, conflicts with bosses or colleagues, bullying, constant change, or threats to job security.
• Burnout – is usually related to problems with the workplace and is a state of being exhausted, overwhelmed, and struggling to cope and has many causes. It can be described as striving too hard in one area of life while neglecting everything else. Fatigue is often one component of burnout.
• Unemployment – financial pressures, feelings of failure or guilt, and the emotional exhaustion of prolonged job hunting can lead to stress, anxiety, depression and fatigue.

Psychological causes of fatigue

Psychological factors are a common cause of fatigue. These may include:

• Depression – prolonged feelings of sadness, dejection and hopelessness may mean you are experiencing depression.
• Anxiety – feelings of worry, stress or being scared or tense can be a normal response to a situation (such as speaking in public). However, if these feelings happen a lot of the time or don’t have a clear cause, you may be experiencing anxiety.
• Grief – losing a loved one causes a range of emotions including shock, guilt, depression, despair and loneliness.

Diagnosing fatigue

Your doctor may:

• Take your medical history – including childbirth, medication, surgery, weight loss or gain.
• Do a physical examination to check for signs of illness or disease. They may also ask detailed questions about diet, lifestyle and significant life events (such as loss of a job or loved one).
• Order tests to check if your fatigue may be due to an undiagnosed medical issue (for example, anaemia or thyroid dysfunction).

Treating fatigue

Your healthcare provider will work with you to make changes to reduce your fatigue. These might include lifestyle changes or medical interventions such as:

• appropriate exercise for you
• changing drinking, drug or smoking habits
• dietary changes
• psychological support (such as seeing a psychologist or psychiatrist)
• medications (if required).

Fortunately for most people, fatigue will get better over time on its own or with some simple and practical lifestyle changes.

Where to get help

• Your GP (doctor)
• A psychologist or mental health practitioner
• Allied health practitioner (such as a physiotherapist or occupational therapist)