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Why Am I So Tired? 7 Causes of Fatigue
Getting plenty of sleep but still exhausted? Before you blame your multi-tasking, super-woman lifestyle, learn more about what might be at the root of your unexplained fatigue.
By Colette Bouchez
Reviewed by Louise Chang, MD
We are in the midst of a global energy crisis but it has nothing to do with oil. The problem is unexplained fatigue.
"I'm so tired; I just can't do what I used to do."
"I'd love to go but honestly, I just don't have the energy."
"Sex? You mean right now?"
If you're like most women, these phrases have become mantras, the echo of our collective yawn growing louder every day.
"The single biggest complaint I hear from my patients, day in and day out, is fatigue," says cardiologist Nieca Goldberg, MD, Director of the NYU Medical Center Women's Heart Program and associate professor at the NYU School of Medicine.
Of course, for some of us the problem is simply multi-tasking to the max and not getting enough sleep, or good quality sleep. "If you're continually logging in just 5 or 6 hours a night, it's going to catch up with you, no matter your age," says Rebecca Amaru, MD, clinical instructor of obstetrics and gynecology at the Mount Sinai Medical Center in New York City.
But if you are getting a healthy 7 to 8 hours a night and you're still tired, Goldberg says it's time for a check-up to uncover the causes for fatigue.
"If your fatigue goes on for more than a week and there is no explanation for feeling tired, then yes, see your doctor," says Goldberg.
While occasionally fatigue may be a sign of a serious illness, experts say most often it's caused by a minor problem, with a relatively easy fix.
To help you zero in on why you can't stop yawning, here are 7 hidden causes of fatigue -- potential health problems you should discuss with your doctor.
Fatigue Cause # 1: Anemia
"If you are in your reproductive years, and particularly if you experience heavy menstrual cycles, have fibroid tumors or uterine polyps, or if you've recently given birth, the blood loss may have caused you to develop anemia -- a leading cause of fatigue in women," says Amaru.
Problems occur, she says, when the bleeding leads to a deficiency of hemoglobin, the iron-rich protein in red blood cells that carries oxygen from the lungs to other parts of your body. When your tissues and organs don't get enough oxygen, she says, the result is fatigue.
Other causes of anemia include internal bleeding, or a deficiency of iron, folic acid, or vitamin B12. Anemia may also be caused by chronic diseases like kidney disease, for example. Symptoms can include dizziness, feeling cold, and irritability.
To confirm a diagnosis of anemia, your physician will give you a blood test. Treatment, she says, usually consists of iron supplements if iron deficiency is the cause, and adding iron-rich foods -- such as spinach, broccoli, and red meat -- to your diet.
Fatigue Cause # 2: Underactive thyroid (hypothyroidism)
If you are generally sluggish, run down, and even a little depressed, Goldberg says the problem may be a slow thyroid, also known as hypothyroidism. The thyroid is a small, butterfly shaped gland that sits at the base of your neck and controls your metabolism, the speed at which your body operates.
"I believe that undiagnosed thyroid disorder is one of the major female health problems in this country. I think it is even more widespread than anyone realizes," says Goldberg.
According to the American Thyroid Foundation, by age 60 approximately 17% of all women will have a thyroid disorder and most won't know it. The most common cause, they say, is an autoimmune disorder known as Hashimoto's thyroiditis. This condition causes the body to destroy the cells responsible for producing thyroxin and other hormones secreted by the thyroid gland. The result is hypothyroidism, or a slow metabolism.
Blood tests known as T3 and T4 will detect thyroid hormones. If these hormones are low, Goldberg says synthetic hormones can bring you up to speed and you should begin to feel better fairly rapidly.
Fatigue Cause # 3: Undiagnosed Urinary Tract Infection (UTI)
Although most women associate a urinary tract infection with symptoms such as burning or urgency, Goldberg says in some instances fatigue may be your only clue.
"Not every woman has obvious symptoms of a UTI. Some have no symptoms or mild symptoms that go unnoticed, except for the fatigue," she says.
In most instances, a UTI is caused by bacteria in the urinary tract, often the result of improper bathroom hygiene (wiping back to front, for example). Sexual intercourse can increase the risk because it can push bacteria from the vagina into the urethra.
If your physician suspects that you have a UTI, your urine will be tested. Treatment is quick and easy, and usually involves an oral antibiotic medication. Goldberg says the fatigue will lift within a week or less.
If your symptoms return, get tested again, she says, because in some women, UTI's are chronic. If this is the case, talk to your doctor about preventive care, including low dose antibiotics.
Fatigue Cause # 4: Caffeine Overload
Many of us grab a coffee or cola for a quick burst of energy, but for some women, caffeine can have the opposite effect.
In an article published in the journal US Pharmacist, author W. Stephen Pray, PhD, RPh, reports that caffeine is a stimulant, but if you take too much, the tables can turn.
"In some patients, continued abuse results in fatigue," according to Pray. And if you think this means you simply require more caffeine to get the kick, this isn't the case. "Any attempts to solve the problem by increasing caffeine intake causes the fatigue to worsen," he says.
The solution: Eliminate as much caffeine from your diet as possible. This means not only cutting out coffee. Chocolate, tea, soda and even some medications also contain caffeine and could be causing unexplained fatigue.
Fatigue Cause # 5: Food Intolerances
While food is supposed to give us energy, some doctors believe hidden food intolerances can do the opposite. According to Rudy Rivera, MD, author of Your Hidden Food Allergies Are Making You Fat, even mild food intolerance can leave you feeling sleepy. Eat the offending food long enough and you could find yourself feeling continually exhausted.
"Evidence indicates food intolerance as a cause of fatigue, and even suggests that fatigue may be an early warning sign of food intolerance," he says.
If you suspect that food may be behind all that yawning, Rivera says to start with an elimination diet, cutting out foods that cause you to feel sleepy within 10 to 30 minutes of eating them.
Fatigue Cause # 6: Sleep Apnea
If you're not getting enough sleep, it stands to reason you'll be tired. But what if you don't know that you aren't getting sufficient sleep? This is often the case with a condition called sleep apnea -- a sleep disorder that causes you to momentarily stop breathing, often many times during the night. Each time you stop breathing, you awaken just long enough to disrupt your sleep cycle, usually without being aware of it. Your only clue, says Goldberg, is that you experience constant fatigue no matter how many hours you sleep each night.
According to Goldberg, sleep apnea, which is caused by an upper airway obstruction, often occurs in women who are overweight or obese. Snoring is often a sign of sleep apnea. Diagnosis requires a visit to a sleep lab, or to a doctor specializing in sleep apnea.
If you have sleep apnea, your physician will recommend lifestyle changes, including losing weight and quitting smoking. Medical treatment includes devices that keep airway passages open while you sleep. In extreme cases, surgery may be necessary to ensure proper airway flow. Left untreated, sleep apnea can increase your risk of stroke or heart attack.
Fatigue Cause # 7: Undiagnosed Heart Disease
If you find yourself becoming exhausted after activity that used to be easy, it may be time to talk to your doctor about the possibility of heart disease.
According to Goldberg, when overwhelming fatigue sets in after ordinary tasks -- such as vacuuming the house, doing yard work, or commuting from work each day -- your heart may be sending out an SOS that it needs medical attention.
"This doesn't mean that you should panic every time you yawn," says Goldberg. "Most of the time, fatigue is not the first sign of heart disease, and it's usually linked to something far less serious."
At the same time, Goldberg points out that heart disease is the leading cause of death in women. "If fatigue following activity is significant, and no other possible reason comes to mind, see your doctor for a check-up," she advises. If your fatigue is related to your heart, medication or treatment procedures can usually help correct the problem, reduce the fatigue, and restore your energy.