Causes of Exhaustion: Fatigue, Insomnia, Sleep Problems, etc.
Chronic fatigue is a really tough thing for anyone to manage. Not feeling well-rested or being unable to sleep not only saps your energy, it can make aches and pains worse, contribute to depression and anxiety, and even cause other chronic illnesses to flare up.
Doctors are often frustrated when patients come in with a complaint of fatigue. The reason is that the range of possibilities is really wide, and it takes a lot of careful history-taking to figure things out and decide on next steps. At Nexus, I don’t really get annoyed, though. I have lots of time to figure things out, and if it takes more than one visit to sort things, that’s okay.
There are a lot of possibilities for things that can cause chronic fatigue. Here are a few of the common ones I see:
Common possibilities for symptoms of chronic fatigue
Sleep disorders, like Obstructive Sleep Apnea (OSA)
This is very common, and even though we think of this as a common problem for middle-aged men, it happens to people of any gender and any age. The problem with OSA is that the jaw relaxes while sleeping and makes it hard to breathe. The body senses this and nudges the body awake a bit. Not enough to wake up completely, but enough to stop sleep from being restful. This is diagnosed with a simple sleep study test that can be done at home.
Thyroid disorders
Another really common cause of fatigue is low thyroid function. I think of the thyroid gland as our body’s “idle regulator.” When we are sitting still and the body is using energy at rest, it’s the thyroid that helps us know how “fast” to go. Low thyroid levels can cause temperature imbalances (you’ll feel cold all the time), fatigue, changes in skin and hair, and constipation. Thyroid problems are simple to diagnose and easy to treat.
Perimenopause
Obviously this only affects a segment of the population, but it’s something that nearly half of all people go through sooner or later. The symptoms associated with perimenopause are vast! Fatigue is one that’s very common. Lab tests are not too reliable for diagnosing perimenopause. Instead, we have to take a careful history and ask lots of questions about other symptoms that are going on. Perimenopause is often treated with hormone replacement, and is individualized to each patient.
Chronic Fatigue Syndrome (aka myalgic encephalomyelitis)
CFS is what we call a “syndromic illness,” meaning there is no single cause or lab test that diagnoses it. If we suspect CFS, we have to take a careful history and rule out many other causes to help us figure it out. There are lots of things that can help treat CFS, but it takes patience and a good relationship between the doctor and patient to manage it best. (By the way, this is something that’s perfectly well suited to a Direct Primary Care practice!)
And more!
This list is just a start. Anemia, depression, irritable bowel syndrome, fibromyalgia, long COVID, and a ton of other things can be going on when someone comes in and says “I’m just tired all the time.”
So where do we start in these instances?
It always begins with a careful history. I want to know how long the fatigue has been going on, what makes it better or worse, what the time course is like, and how often it seems to get really bad. We want to know how you are sleeping, and your mood, and the medicines you are on, and the surgeries you’ve ever had. Family history can help a lot, too. It takes a lot of time to get through all of this, and a lot of doctors just don’t have the time (or energy) to do it.
At Nexus, we excel in this sort of workup! We have time to spend with you, and the patience to let you tell us your story. And together, we can figure out what might be going on and figure out next steps.
