What is fatigue and how does it differ from drowsiness. What are the common causes of fatigue. How can fatigue be managed effectively. When should you seek medical attention for fatigue. What tests may be conducted to diagnose the underlying cause of fatigue.

Defining Fatigue: More Than Just Tiredness

Fatigue is a complex physiological and psychological state that goes beyond mere tiredness. It’s characterized by a persistent feeling of weariness, lack of energy, and diminished motivation. Unlike drowsiness, which is simply the need for sleep, fatigue can persist even after adequate rest. This condition can significantly impact one’s quality of life, affecting both physical and mental performance.

To better understand fatigue, let’s break it down:

• Physical fatigue: Manifests as muscle weakness, reduced endurance, and slower reaction times
• Mental fatigue: Presents as difficulty concentrating, reduced cognitive function, and decreased motivation
• Emotional fatigue: Characterized by feelings of apathy, irritability, and emotional exhaustion

Common Causes of Fatigue: From Lifestyle to Medical Conditions

Fatigue can stem from a wide range of factors, both benign and potentially serious. Identifying the root cause is crucial for effective management. Here are some common culprits:

Lifestyle Factors

• Poor sleep habits or sleep disorders (e.g., insomnia, sleep apnea)
• Unhealthy diet and dehydration
• Lack of regular exercise
• High stress levels
• Overwork or an imbalanced work-life schedule

Medical Conditions

• Anemia (including iron deficiency anemia)
• Thyroid disorders (both underactive and overactive)
• Depression and other mental health issues
• Chronic pain conditions
• Autoimmune diseases (e.g., lupus, rheumatoid arthritis)
• Infections (acute or chronic)
• Heart conditions
• Diabetes
• Chronic fatigue syndrome (CFS)

Medications and Substances

• Certain prescription medications (e.g., antihistamines, blood pressure medications)
• Alcohol and recreational drug use
• Caffeine withdrawal

Recognizing the Signs: When Fatigue Becomes a Concern

While occasional fatigue is normal, persistent or severe fatigue warrants attention. How can you distinguish between normal tiredness and problematic fatigue? Consider these factors:

• Duration: Fatigue lasting more than two weeks without improvement
• Impact: Significant interference with daily activities and quality of life
• Associated symptoms: Unexplained weight loss, fever, or pain
• Lack of improvement: Fatigue that doesn’t respond to lifestyle changes or adequate rest

If you experience any of these signs, it’s advisable to consult a healthcare professional for a thorough evaluation.

Diagnostic Approaches: Unraveling the Mystery of Fatigue

When investigating fatigue, healthcare providers employ a multifaceted approach to pinpoint the underlying cause. This process typically involves:

Comprehensive Medical History

Your doctor will inquire about:

• The onset and duration of fatigue
• Associated symptoms
• Sleep patterns
• Diet and exercise habits
• Stress levels and recent life changes
• Current medications and supplements

Physical Examination

A thorough physical exam may include:

• Checking vital signs
• Assessing heart and lung function
• Examining lymph nodes
• Evaluating neurological responses

Laboratory Tests

Depending on the suspected cause, your doctor may order various tests:

• Complete blood count (CBC) to check for anemia
• Thyroid function tests
• Blood glucose levels for diabetes screening
• Liver and kidney function tests
• Inflammatory markers
• Vitamin D and B12 levels

Specialized Tests

In some cases, additional tests may be necessary:

• Sleep studies for suspected sleep disorders
• Cardiac stress tests for heart-related fatigue
• Imaging studies (e.g., CT scans, MRI) if structural issues are suspected

Effective Management Strategies: Combating Fatigue on Multiple Fronts

Addressing fatigue often requires a multifaceted approach, combining lifestyle modifications with targeted treatments for underlying conditions. Here are some strategies to consider:

Lifestyle Modifications

1. Optimize sleep hygiene:
   • Maintain a consistent sleep schedule
   • Create a relaxing bedtime routine
   • Ensure a comfortable sleep environment
2. Improve nutrition:
   • Eat a balanced diet rich in fruits, vegetables, and lean proteins
   • Stay hydrated throughout the day
   • Consider a multivitamin supplement (consult your healthcare provider first)
3. Incorporate regular exercise:
   • Aim for at least 150 minutes of moderate-intensity aerobic activity per week
   • Include strength training exercises twice a week
   • Start slowly and gradually increase intensity
4. Manage stress:
   • Practice relaxation techniques like meditation or deep breathing
   • Consider cognitive-behavioral therapy (CBT) for stress management
   • Engage in hobbies and activities you enjoy
5. Balance work and personal life:
   • Set realistic goals and priorities
   • Learn to delegate tasks when possible
   • Take regular breaks throughout the day

Medical Interventions

Depending on the underlying cause, your healthcare provider may recommend:

• Treating specific medical conditions (e.g., thyroid disorders, anemia)
• Adjusting medications that may be contributing to fatigue
• Cognitive-behavioral therapy for depression or anxiety
• Sleep disorder treatments (e.g., CPAP for sleep apnea)
• Pain management strategies for chronic pain conditions

When to Seek Immediate Medical Attention

While most cases of fatigue are not emergencies, certain symptoms warrant immediate medical evaluation. Seek immediate care if fatigue is accompanied by:

• Chest pain or shortness of breath
• Severe abdominal pain
• High fever (above 103°F or 39.4°C)
• Confusion or altered mental status
• Sudden, severe headache
• Thoughts of self-harm or suicide

Long-term Management: Living Well with Chronic Fatigue

For individuals dealing with chronic fatigue, whether due to a specific condition like Chronic Fatigue Syndrome (CFS) or as a symptom of another ongoing health issue, long-term management strategies are crucial. Here are some approaches to consider:

Energy Conservation Techniques

• Pacing: Balance activity with rest periods to avoid overexertion
• Prioritization: Focus on essential tasks and learn to say no to non-essential commitments
• Energy mapping: Identify peak energy times and schedule important activities accordingly

Adaptive Strategies

• Use assistive devices to reduce physical strain
• Modify your home or workspace to conserve energy
• Consider flexible work arrangements if possible

Psychological Support

• Join support groups to connect with others facing similar challenges
• Consider cognitive-behavioral therapy to develop coping strategies
• Practice mindfulness and acceptance techniques

Regular Monitoring

• Keep a symptom diary to track patterns and potential triggers
• Maintain regular check-ups with your healthcare provider
• Be open to adjusting your management plan as needed

Remember, living with chronic fatigue is a journey that requires patience and persistence. By implementing these strategies and working closely with your healthcare team, you can improve your quality of life and better manage your symptoms over time.

The Role of Research and Future Directions in Fatigue Management

As our understanding of fatigue continues to evolve, ongoing research is paving the way for new and improved management strategies. Here are some areas of focus in current fatigue research:

Biomarker Identification

Scientists are working to identify specific biological markers that can help diagnose and monitor fatigue more objectively. This could lead to more precise treatments tailored to individual patients.

Neuroimaging Studies

Advanced brain imaging techniques are being used to better understand how fatigue affects brain function and structure. This research may reveal new targets for therapeutic interventions.

Microbiome Research

Emerging evidence suggests a potential link between gut health and fatigue. Studies are exploring how the gut microbiome may influence energy levels and overall well-being.

Personalized Medicine Approaches

Researchers are investigating how genetic factors and individual differences may influence fatigue susceptibility and treatment responses. This could lead to more personalized and effective management strategies.

Novel Therapeutic Agents

Pharmaceutical companies are developing new drugs targeting specific pathways involved in fatigue. These may offer more targeted relief with fewer side effects compared to current options.

Integrative Medicine

Studies are exploring the potential benefits of combining conventional medical approaches with complementary therapies like acupuncture, herbal medicine, and mind-body practices for fatigue management.

As research progresses, it’s likely that our approach to fatigue management will become increasingly sophisticated and tailored to individual needs. Staying informed about these developments can help both patients and healthcare providers make more informed decisions about fatigue treatment and management strategies.

Fatigue: MedlinePlus Medical Encyclopedia

Fatigue is a feeling of weariness, tiredness, or lack of energy.

Fatigue is different from drowsiness. Drowsiness is feeling the need to sleep. Fatigue is a lack of energy and motivation. Drowsiness and apathy (a feeling of not caring about what happens) can be symptoms that go along with fatigue.

Fatigue can be a normal and important response to physical activity, emotional stress, boredom, or lack of sleep. Fatigue is a common symptom, and it is usually not due to a serious disease. But it can be a sign of a more serious mental or physical condition. When fatigue is not relieved by enough sleep, good nutrition, or a low-stress environment, it should be evaluated by your health care provider.

There are many possible causes of fatigue, including:

• Anemia (including iron deficiency anemia)
• Depression or grief
• Iron deficiency (without anemia)
• Medicines, such as sedatives or antidepressants
• Persistent pain
• Sleep disorders such as insomnia, obstructive sleep apnea, or narcolepsy
• Thyroid gland that is underactive or overactive
• Use of alcohol or drugs, such as cocaine or narcotics, especially with regular use

Fatigue can also occur with the following illnesses:

• Addison disease (a disorder that occurs when the adrenal glands don’t produce enough hormones)
• Anorexia or other eating disorders
• Arthritis, mainly adult or juvenile rheumatoid arthritis
• Autoimmune diseases such as systemic lupus erythematosus
• Cancer
• COVID-19
• Diabetes
• Fibromyalgia
• Heart failure
• Infection, especially one that takes a long time to recover from or treat, such as bacterial endocarditis (infection of the heart muscle or valves), parasitic infections, hepatitis, HIV/AIDS, tuberculosis, and mononucleosis
• Kidney disease
• Liver disease
• Malnutrition

Certain medicines may also cause drowsiness or fatigue, including antihistamines for allergies, blood pressure medicines, sleeping pills, steroids, and diuretics (water pills).

Chronic fatigue syndrome (CFS) is a condition in which symptoms of fatigue persist for at least 6 months and do not resolve with rest. The fatigue may be worsened with physical activity or mental stress. It is diagnosed based on the presence of a specific group of symptoms and after all other possible causes of fatigue are ruled out.

Here are some tips for reducing fatigue:

• Get enough sleep each night.
• Make sure your diet is healthy and well-balanced, and drink plenty of water throughout the day.
• Exercise regularly.
• Learn better ways to relax. Try yoga or meditation.
• Maintain a reasonable work and personal schedule.
• Change or reduce your stressors, if possible. For example, take a vacation or resolve relationship problems.
• Take a multivitamin. Talk to your provider about what is best for you.
• Avoid alcohol, nicotine, and drug use.

If you have long-term (chronic) pain or depression, treating it often helps the fatigue. Be aware that some antidepressant drugs may cause or worsen fatigue. If your drug is one of these, your provider may have to adjust the dosage or switch you to another drug. DO NOT stop or change any medicines without first talking to your provider.

Stimulants (including caffeine) are not effective treatments for fatigue. They can make the problem worse when they are stopped. Sedatives also tend to worsen fatigue.

Contact your provider right away if you have any of the following:

• Confusion or dizziness
• Blurred vision
• Little or no urine, or recent swelling and weight gain
• Thoughts of harming yourself or of committing suicide

Call your provider for an appointment if you have any of the following:

• Unexplained weakness or fatigue, especially if you also have a fever or unintentional weight loss
• Constipation, dry skin, weight gain, or you cannot tolerate cold
• Wake up and fall back to sleep many times during the night
• Headaches often
• Are taking medicines, prescribed or non-prescribed, or using drugs that may cause fatigue or drowsiness
• Feel sad or depressed
• Insomnia

Your provider will perform a complete physical examination, paying special attention to your heart, lymph nodes, thyroid, abdomen, and nervous system. You will be asked about your medical history, fatigue symptoms, and your lifestyle, habits, and feelings.

Tests that may be ordered include the following:

• Blood tests to check for anemia, diabetes, inflammatory diseases, and possible infection
• Kidney function tests
• Liver function tests
• Thyroid function tests
• Urinalysis

Treatment depends on the cause of your fatigue symptoms.

Tiredness; Weariness; Exhaustion; Lethargy

Clauw DJ. Fibromyalgia, chronic fatigue syndrome, and myofascial pain. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 258.

Lindemann JC. Fatigue. In: Kellerman RD, Rakel DP, eds. Conn’s Current Therapy 2021. Philadelphia, PA: Elsevier 2021:14-15.

Seller RH, Symons AB. Fatigue. In: Seller RH, Symons AB, eds. Differential Diagnosis of Common Complaints. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 14.

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Fatigue | The BMJ

Clinical Review

ABC of psychological medicine

BMJ
2002;
325
doi: https://doi.org/10.1136/bmj.325.7362.480
(Published 31 August 2002)

Cite this as: BMJ 2002;325:480

• Article
• Related content
• Metrics
• Responses
• Peer review

1. Michael Sharpe,
2. David Wilks

Fatigue can refer to a subjective symptom of malaise and aversion to activity or to objectively impaired performance. It has both physical and mental aspects. The symptom of fatigue is a poorly defined feeling, and careful inquiry is needed to clarify complaints of “fatigue,” “tiredness,” or “exhaustion” and to distinguish lack of energy from loss of motivation or sleepiness, which may be pointers to specific diagnoses (see below).

Weary 1887 by Edward Radford (1831-1920)

Prevalence—Like blood pressure, subjective fatigue is normally distributed in the population. The prevalence of clinically significant fatigue depends on the threshold chosen for severity (usually defined in terms of associated disability) and persistence. Surveys report that 5-20% of the general population suffer from such persistent and troublesome fatigue. Fatigue is twice as common in women as in men but is not strongly associated with age or occupation. It is one of the commonest presenting symptoms in primary care, being the main complaint of 5-10% of patients and an important subsidiary symptom in a further 5-10%.

Fatigue as a symptom—Patients generally regard fatigue as important (because it is disabling), whereas doctors do not (because it is diagnostically non-specific). This discrepancy is a potent source of potential difficulty in the doctor-patient relationship. Fatigue may present in association with established medical and psychiatric conditions or be idiopathic. Irrespective of cause, it has a major impact on day to day functioning and quality of life. Without treatment, the prognosis of patients with idiopathic fatigue is surprisingly poor; half those seen in general practice with fatigue are still fatigued six months later.

Distribution of the complaint of fatigue in the population

Causes of fatigue

The physiological and psychological mechanisms underlying subjective fatigue are poorly understood. Fatigue may rather be usefully regarded as a final common pathway for a variety of causal factors. …

View Full Text

Log in

Log in using your username and password

Log in through your institution

Subscribe from £173 *

Subscribe and get access to all BMJ articles, and much more.

Subscribe

* For online subscription

Access this article for 1 day for:
£38 / $45 / €42 (excludes VAT)

You can download a PDF version for your personal record.

symptoms, diagnosis, treatment of chronic fatigue – Department of Neurology NCC No. 2 (Central Clinical Hospital RAS)

Chronic Fatigue Syndrome (CFS) is a disease that is characterized by an endless feeling of fatigue, loss of strength, overwork, which does not go away even after sound sleep and long rest. Psycho-emotional stress on the human nervous system is the main cause of this disease. Residents of megacities aged 25 to 45 years are most susceptible to chronic fatigue syndrome, and women suffer more from this disease. Until recently, it was believed that only adults were susceptible to the disease, but now the diagnosis of “chronic fatigue syndrome” has begun to haunt children, especially of school age.

Causes of chronic fatigue.

Until now, the exact causes leading to chronic fatigue syndrome have not yet been established. However, risk factors that can provoke the onset of this disease exist:

• Wrong lifestyle (frequent lack of sleep, lack of sunlight and fresh air, nicotine and alcohol use, etc. )
• Chronic diseases (lead to emaciation)
• Psychological disorders (constant stress, frequent depression, anxiety)
• Unbalanced diet (poor quality food, excess or lack of food, lack of vitamins)
• Unfavorable environment (ecological situation in cities is much worse than in rural areas)
• Infections and viruses (the constant struggle of the body with viruses leads to general fatigue)

Symptoms of the disease.

A distinctive feature of chronic fatigue is constant overwork, which does not disappear after a sound sleep and a long rest. This painful condition can last for more than six months.

Other symptoms of chronic fatigue:

• Insomnia
• Migraine
• Fatigue
• Decreased immunity
• Spinal and muscular pain
• Mental impairment
• Constant exhaustion
• Enlarged lymph nodes (armpits and neck)

This disease must be treated, so that in the future it does not lead to the development of serious neuropsychiatric diseases.

Diagnosis of chronic fatigue.

Often, chronic fatigue syndrome is difficult to diagnose due to the fact that most of the symptoms occur in other diseases. At the same time, the symptoms of this disease are manifested in a complex, and not one at a time. Only a specialist can make an accurate diagnosis after a detailed examination and a detailed medical history. Sometimes, in order to exclude other pathologies, the doctor may refer the patient to a blood or urine test. The main diagnostic sign of the disease is the occurrence of a persistent feeling of fatigue, which does not disappear after a good rest, and bad mood, loss of appetite, apathy, general weakness are concomitant factors. This condition can be supplemented by frequent colds, exacerbation of chronic diseases, which significantly reduces efficiency and exacerbates the feeling of constant fatigue.

Depending on the manifestation of the symptoms that provoked this disease, the patient can visit the following specialists:

• Therapist
• Psychologist
• Neurologist
• Endocrinologist
• Immunologist

You can make an appointment with the specialists you are interested in in Moscow at the NCC Clinic No. 2 (Central Clinical Hospital of the Russian Academy of Sciences).

Treatment of chronic fatigue.

• Medication (vitamins, immunomodulators, homeopathic, anti-inflammatory drugs, antidepressants, antivirals)
• Physiotherapy (physiotherapy, acupuncture, soothing massage, hydrotherapy, etc.)
• Recommended good sleep, diet, planned daily routine.

Disease prevention.

• Proper nutrition
• Rational daily routine planning
• Sports activities
• Healthy sleep
• Refusal of bad habits.

If a situation arises in which a professional consultation of a neurologist becomes necessary, contact the specialists of the NCC No. 2 (CCH RAS). The best doctors of the capital will help you restore your health. Registration is available 24 hours a day on the website. You can also make an appointment with a neurologist by phone during working hours of the Central Clinical Hospital.

symptoms and treatment – Harmony of health

Chronic fatigue syndrome is a disease in which the human body experiences constant mental and physical weakness. Weakness occurs for unexplained reasons and may last for six months or more. People faced a similar ailment back in the 30s of the last century, but in fact, the diagnosis of chronic fatigue syndrome was first made only in 1988 year. Until that time, chronic fatigue was considered to be an accompanying symptom of various diseases, including infectious ones.

The feeling of extreme fatigue due to physical or mental overexertion has been experienced by many. As a rule, such a feeling arises after a responsible event or difficult work and disappears due to relaxation. In the case of ordinary overwork, a person is able to easily determine the cause of his fatigue and overcome it. With chronic fatigue syndrome, everything is different: the patient finds it difficult to remember when, why and under what circumstances he felt tired. This condition can deeply disturb and oppress the patient.

Modern medicine associates the appearance of chronic fatigue syndrome with a continuous acceleration of the pace of life and an increase in the flow of information. Any infectious disease can serve as an impetus for the onset of the disease. At the end of the acute period of infection, the patient may experience some weakness, fatigue and depression. Normally, this condition should pass in three weeks. With chronic fatigue syndrome, symptoms persist even after six months, and the patient has to turn to a medical center for professional help sooner or later.

Chronic fatigue syndrome: symptoms

The main symptom is endless fatigue that does not leave a person even after prolonged sleep and rest. Most patients develop a concomitant ailment – constant insomnia. Its appearance can be triggered by any factor – a change in the time zone, a change in work schedule, or banal stress.

Very often, chronic fatigue is accompanied by a significant deterioration in performance and attention, a sharp deterioration in the psycho-emotional state. Apathy, depression, hypochondria may develop. In some cases, against the background of chronic fatigue, phobias occur. There are cases of violation of thermoregulation and a sharp decrease in body weight.

With chronic fatigue syndrome, the patient often complains of dizziness, headaches, photophobia, dry eyes. Possible pharyngitis, tachycardia, soreness of the lymph nodes. Women may experience increased premenstrual syndrome.

Chronic fatigue syndrome: prevention

A healthy lifestyle is the surest way to avoid the development of the syndrome. Eat right, control the level of mental stress, do not forget about the benefits of adequate physical training. A person who adheres to the correct daily routine and knows how to avoid stressful situations is less susceptible to any diseases. Even if stress still overtakes you, allow yourself to relax and unwind.

Take at least short breaks while you work. If your work is associated with mental stress, do not be lazy to interrupt for simple physical exercises.