Fatigue; Causes, Symptoms, Diagnosis, Treatment

Fatigue
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Fatigue can be described as a lack of energy and motivation (both physical and mental). It is a subjective feeling of tiredness which is distinct from weakness and has a gradual onset. Fatigue is a feeling of tiredness, exhaustion, or lack of energy. You may feel mildly fatigued because of overwork, poor sleep, worry, boredom, or lack of exercise.  Fatigue can have physical or mental causes. Physical fatigue is the transient inability of a muscle to maintain optimal physical performance and is made more severe by intense physical exercise. Mental fatigue is a transient decrease in maximal cognitive performance resulting from prolonged periods of cognitive activity. 

Fatigue is a subjective feeling of tiredness that has a gradual onset. Unlike weakness, fatigue can be alleviated by periods of rest. Fatigue can have physical or mental causes. Physical fatigue is the transient inability of a muscle to maintain optimal physical performance, and is made more severe by intense physical exercise. Mental fatigue is a transient decrease in maximal cognitive performance resulting from prolonged periods of cognitive activity. It can manifest as somnolence, lethargy, or directed attention fatigue.

Types of Fatigue

There are different types of fatigue.

  • Physical fatigue: A person finds it physically hard to do the things they normally do or used to do, for example, climbing stairs. It includes muscle weakness. Diagnosis may involve a strength test.
  • Mental fatigue It is harder to concentrate on things. The person may feel sleepy, have a decreased level of consciousness, and in some cases show signs similar to that of an intoxicated state.

According to the severity, there are two types 

  •  Acute fatigue
  • Chronic fatigue

Causes of Fatigue

  • Mental health issues

    It can result from stress, bereavement and grief, eating disorders, alcohol abuse, drug abuse, anxiety, moving home, boredom, and divorce. It can occur with clinical depression, either due to the depression itself, or because of associated problems, such as insomnia.

  • Endocrine and metabolic reasons

    Conditions such as Cushing’s disease, kidney disease, electrolyte problems, diabetes, hypothyroidism, anemia, kidney disease, and liver disease can all lead to fatigue.

  • Drugs and medications

    Some antidepressants, antihypertensives, statins, steroids, antihistamines, medication withdrawal, sedatives, and anti-anxiety drugs can cause drowsiness.

  • Heart and lung conditions

    Pneumonia, arrhythmias, asthma, chronic obstructive pulmonary disease (COPD), valvular heart disease, coronary heart disease, and congestive heart failure, among other heart and lung diseases, can cause fatigue.

  • Sleep problems

    Working late, shift work, jet lag, sleep apnea, narcolepsy, insomnia, and reflux esophagitis can lead to a lack of sleep and fatigue.

  • Chemicals and substances

    Vitamin deficiencies, mineral deficiencies, poisoning, and consuming too many caffeinated or alcoholic beverages may make it harder to get to sleep, or stay asleep, especially if these are consumed too close to bedtime.

  • Various diseases, conditions, states, and treatments

    Cancer, chemotherapy, radiation therapy, chronic fatigue syndrome (CFS), fibromyalgia, systemic lupus, rheumatoid arthritis, obesity, massive blood loss, and weakened immune systems can all cause fatigue.Fatigue can also be a sign of infection. Some infections that cause tiredness include malaria, tuberculosis (TB), infectious mononucleosis, also known as glandular fever, cytomegalovirus, HIV infection, flu, and hepatitis, among others.

  • Chronic pain

    Patients with chronic pain often wake up tired, even after sleeping for a long time, especially if pain disrupts their sleep.The combination of pain and lack of sleep can cause persistent tiredness.

  • Being overweight or underweight

    Being overweight increases the risk of fatigue, for various reasons.These include having to carry more weight, and being more likely to have a condition where fatigue is a common symptom, such as diabetes and sleep apnea.

  • Too much or too little activity

    A person who feels tired may not exercise, and lack of exercise can cause further fatigue. Lack of exercise may eventually make it harder and more tiring to perform a physical chore.

  • Problems with the thyroid gland

    A low thyroid level (hypothyroidism) can cause fatigue, weakness, lethargy, weight gain, depression, memory problems, constipation, dry skin, intolerance to cold, coarse and thinning hair, brittle nails, or a yellowish tint to the skin.A high thyroid level (hyperthyroidism) can cause fatigue, weight loss, increased heart rate, intolerance to heat, sweating, irritability, anxiety, muscle weakness, and thyroid enlargement.

  • Anxiety and stress 

A person who is chronically anxious or stressed keeps their body in overdrive. The constant flooding of adrenaline exhausts the body, and fatigue sets in.

This illness is characterised by severe and prolonged feelings of sadness, dejection and hopelessness. People who are depressed commonly experience chronic fatigue.

  • Grief 

Losing a loved one causes a wide range of emotions including shock, guilt, depression, despair and loneliness.

A rare, chronic disorder that causes weakness and rapid muscle fatigue.

Common Causes of Fatigue
Metabolic/
Endocrine
anemia; hypothyroidism; diabetes; electrolyte abnormalities; kidney disease; liver disease; Cushing’s disease
Infectious infectious mononucleosis; hepatitis; tuberculosis; cytomegalovirus; HIV infection; influenza(flu); malaria and many other infectious diseases
Cardiac (heart) and Pulmonary (lungs) congestive heart failure; coronary artery disease; valvular heart disease; COPD; asthma; arrythmias; pneumonia
Medications antidepressants; anti-anxiety medications; sedative medications; medication and drug withdrawal; antihistamines; steroids; some blood pressure medications; some antidepressants
Psychiatric (Mental Health) depression; anxiety; drug abuse; alcohol abuse; Eating disorders (for example; bulimia; anorexia); grief and bereavement
Sleep Problems sleep apnea; reflux esophagitis; insomnia; narcolepsy; shift work or work shift changes; pregnancy; Extra night hours at “work”
Vitamin Deficiencies vitamin B12 deficiency, vitamin D deficiency, folic acid deficiency, iron deficiency
Other cancer; rheumatology illnesses such as rheumatoid arthritis and systemic lupus; fibromyalgia; chronic fatigue syndrome; normal muscle exertion; obesity; chemotherapyand radiation therapy

Chronic fatigue 

Chronic fatigue is a self-reported fatigue lasting at least six consecutive months. Chronic fatigue may be either persistent or relapsing.Chronic fatigue is a symptom of many diseases and conditions. Some major categories of diseases that feature fatigue include:

Symptoms of Fatigue

Diagnosis of Fatigue

The doctor may order some of the following tests depending on the suspected underlying cause of the fatigue.

  • Blood tests provides information about an infection, anemia, or other blood abnormalities or problems with nutrition.
  • Urinalysis provides information that might point to diabetes, liver disease, or infection.
  • Chem-7 looks at 7 common substances circulating in the blood. It consists of electrolytes (sodium, potassium, chloride, and bicarbonate), waste products of metabolism cleared by normally functioning kidneys (BUN and creatinine) and the source of energy for the body’s cells (glucose).
  • Thyroid function tests examine the function of thyroid gland (thyroid levels too high or too low).
  • Pregnancy test
  • Sedimentation rate test checks for chronic diseases or inflammatory conditions.
  • HIV test
  • Chest X-ray explores the possiblity infections or tumors.
  • Electrocardiogram (ECG, EKG) is an electrical recording that looks at the function of the heart.
  • CT scan of head is a A 3-dimensional X-ray of the brain to look for stroke, tumors, or other abnormalities.

Treatment of Fatigue

To treat fatigue successfully, it is necessary first to find the underlying cause.

Appropriate treatment for the condition can help alleviate fatigue.

Yoga, CBT, and mindfulness for fatigue

Researchers have found, for example, that cognitive behavioral therapy (CBT) combined with graded exercise therapy (GET) can be an effective treatment for myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS).

Another study found that symptoms of fatigue and depression fell in patients with multiple sclerosis(MS) who underwent mindfulness meditation training.

Yoga has been found to improve symptoms of fatigue and sleep quality in cancer survivors. The 4-week program included postures, meditation, breathing, and some other techniques.

It is important not to drive while sleepy. A survey carried out by the CDC found that around 1 in 25 drivers aged 18 years and above had fallen asleep while driving in the previous 30 days.

Lifestyle-related causes of fatigue

Common lifestyle factors that can cause fatigue include

  • Lack of sleep – typically adults need about eight hours of sleep each night. Some people try to get by on fewer hours of sleep.
  • Too much sleep – adults sleeping more than 11 hours per night can lead to excessive daytime sleepiness.
  • 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.
  • Sleep disturbances – disturbed sleep may occur for a number of reasons, for example, noisy neighbors, young children who wake in the night, a snoring partner, or an uncomfortable sleeping environment such as a stuffy bedroom.
  • Lack of regular exercise and sedentary behavior – physical activity is known to improve fitness, health, and wellbeing, reduce stress, and boost energy levels. It also helps you sleep.
  • 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 caffeinated drinks, only offer a temporary energy boost that quickly wears off and worsens fatigue.
  • Individual factors – personal illness or injury, illnesses or injuries in the family, too many commitments (for example, working two jobs) or financial problems can cause fatigue.
  • 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. A shift worker confuses their circadian clock by working when their body is programmed to be asleep.
  • Poor workplace practices – can add to a person’s level of fatigue. These may include 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 – can be caused by a wide range of factors including job dissatisfaction, heavy workload, conflicts with bosses or colleagues, bullying, constant change, or threats to job security.
  • Burnout – can be described as striving too hard in one area of life while neglecting everything else. ‘Workaholics’, for example, put all their energies into their career, which puts their family life, social life and personal interests out of balance.
  • Unemployment – financial pressures, feelings of failure or guilt, and the emotional exhaustion of prolonged job hunting can lead to stress, anxiety, depression, and fatigue.

References

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