March 4, 2012

Why I feel tired all the time? Why I Struggle to get out of bed every morning?

Do you struggle to get out of bed this morning and feel bad about it? The consolation is that you are not alone. Chronic tiredness is one of the most common reasons people visit their doctors. At any time, one in every five people feels unusually tired and one in ten has prolonged fatigue.

Of course, feeling exhausted or run down could be down to the breakneck pace of our 24/7 lifestyle, which can play havoc with sleeping patterns.

But, adds Professor Steve Field, a Birmingham GP: ‘Doctors must not exclude the possibility of serious illness.’

He explains: ‘Tiredness itself is not an illness, but rather will be the symptom of a condition — whether it’s physical, psychological or social.

'But if this doesn’t appear to be the case, it could be that being tired is due to an underlying medical problem.’

TIRED, WEAK AND BREATHLESS



OTHER SYMPTOMS: Swollen ankles, feet, legs, stomach and veins in the neck; chest pain after heavy meals or exercising.

POSSIBLE CAUSE: Cardiomyopathy, a disease of the heart muscle. This causes the heart walls to thicken, particularly in the left ventricle, which is the main pumping chamber — as a result, the heart stops pumping blood effectively round the body.

‘As the heart muscle isn’t working properly, there is less oxygen circulating around the body, which is why the condition causes such tiredness,’ says Robert Hall, a cardiac nurse and medical director of the charity Cardiomyopathy UK.

The condition can be inherited, or triggered by heart disease or even an infection. Around 125,000 Britons suffer from it and, untreated, it can be fatal.

TREATMENT: Drugs known as ace inhibitors improve the symptoms by relaxing the blood vessels, improving blood flow  from the heart. Beta-blockers can also reduce the heart’s workload and increase its efficiency.

FOGGY, DAZED, GROGGY FEELING

OTHER SYMPTOMS: Dry mouth, constipation or diarrhoea.

POSSIBLE CAUSE: Many people think allergies such as hay fever cause fatigue but, in fact, what makes sufferers tired is their anti-histamine medication, says Barry Kay, emeritus professor of allergy and clinical immunology at London’s Imperial College.

‘These drugs act on receptors in the brain that make you feel sleepy.

'That’s why it’s vital not to give children some of the so-called older generation antihistamine tablets for allergies at exam time.’

A 2007 study by the charity Education for Health found that nearly three-quarters of students taking hay fever medication could expect to drop a grade in their exams.

TREATMENT: Older forms of antihistamine, such as Piriton, though highly effective at treating allergies, are more likely to make you feel tired.

‘Newer drugs such as Zyrtec or Claritin have a less sedating effect,’ adds Prof Kay.

TIRED AND WEAK, WITH ACHING MUSCLES

OTHER SYMPTOMS: Loss of body hair, loss of bone mass (leading to fractures), loss of libido and difficulty concentrating.

POSSIBLE CAUSE: In men, the trigger could be low levels of the male hormone testosterone. When levels drop, it can cause a loss of muscle mass, so the sufferer would feel tired whenever they do any physical activity, says Dr Mark Vanderpump, consultant endocrinologist at the Royal Free Hospital in London.

Low testosterone, caused by a condition known as hypogonadism, affects about five in 1,000 men. The cause isn’t known, although it can be genetic.

TREATMENT: It’s rare to reverse the underlying cause, says Dr Vanderpump. But it is possible to have testosterone replacement therapy to revert the symptoms and restore muscle strength.

PHYSICAL EXERTION AN EFFORT; CREEPING FATIGUE 

OTHER SYMPTOMS: Increasingly tired over time; slight sight problems, thirst and passing more urine than usual; frequent infections, cuts that are slow to heal, numbness or tingling in hands or feet.

POSSIBLE CAUSE: Undiagnosed Type 2 diabetes, which affects around one million Britons. It can be triggered by obesity, which may explain why patients feel so tired.

‘If a person is unfit, everything they do requires more effort,’ says GP Professor Steve Field.

‘They may be eating fatty foods and not exercising, and that makes the body feel tired.’ Fluctuating blood sugar levels also lead to tiredness.

Type 2 diabetes is caused by the body’s inability to produce enough of the hormone insulin — or the insulin that is produced is not working properly.

The symptoms can take several weeks or longer to come on.

TREATMENT: The aim of treatment is to maintain blood glucose levels to avoid the risk of complications such as blindness, nerve damage, ulcers and amputation.

Treatment involves regular exercise, a healthy diet and sometimes medication to prevent high blood sugar.

CRASHING, DEBILITATING FATIGUE

OTHER SYMPTOMS: Physical activity is impossible; heavier periods; night sweats; breast tenderness; loss of libido and mood swings.

POSSIBLE CAUSE: The perimenopause, the stage spanning the five years leading up to the menopause (which generally strikes in the late 40s or early 50s).

The ovaries begin to produce less of the hormone oestrogen, explains consultant gynaecologist Jenni Byrom of the Birmingham Women’s Hospital.

Oestrogen controls levels of stress hormones such as cortisol and adrenaline in the blood, and when these are not regulated it can cause fatigue, as they contribute to anxiety and tension.

‘Women in perimenopause may also have heavier periods. This would cause a drop in red blood count, which can lead to anaemia — a common cause of fatigue,’ adds  Ms Byrom.

‘Night sweats, another symptom of the perimenopause, can also disrupt sleep, causing fatigue during the day.’

TREATMENT: Regular exercise and cutting back on alcohol may help. Go to sleep and wake at the same time each day. This resets the body clock and means you are more likely to get a good night’s sleep, and so offset the tiredness associated with  the perimenopause.

TIRED, WEAK  AND THIRSTY

OTHER SYMPTOMS: Dry mouth, lips and eyes; urine is dark; passing only small amounts, infrequently; headaches.

POSSIBLE CAUSE: Dehydration — more than 70 per cent of our body is made up of water, so if we become dehydrated we lose water from our cells, making it harder  to function properly, says Dr Adam Carey, director of Core Performance, a nutrition and fitness clinic.

He adds that as we become dehydrated, blood volume is reduced so the heart has to work harder to pump the same volume. ‘When you’re dehydrated, weakness and tiredness is an early sign. By the time you feel really thirsty, you are severely dehydrated.’

TREATMENT: We need three litres of fluid a day — this doesn’t have to be water, but can include any form of liquid such as juice, soup, tea and food — fruit, particularly grapes and melon, and vegetables are full of water, and even cheese is made up of a third water.

GENERAL LETHARGY, LOW MOOD

OTHER SYMPTOMS: Tired, although are able to work and exercise; feeling the cold, dry and/or pale skin, coarse, thinning hair, brittle nails and a hoarse or croaky voice.

POSSIBLE CAUSE: An underactive thyroid gland — this sits in front of the windpipe and produces the hormones thyroxine and triiodothyronine.

Together these regulate the body’s growth and metabolism (the speed at which the body burns energy).

‘When you have little or no thyroid hormone, your metabolic processes slow down, so you feel tired,’ says Dr Vanderpump.

Thyroid illnesses affect at least a fifth of people in the UK — mainly women. Doctors believe it becomes especially common around the time of the menopause.

TREATMENT: Diagnosis is made on the basis of a blood test to check hormone levels. A thyroxine replacement medicine, called levothyroxine, is taken in tablet form to restore hormone levels.

FALLING ASLEEP READING OR WATCHING TV, IRRITABLE MOOD

OTHER SYMPTOMS: Feeling exhausted and unable to concentrate on tasks during the day; falling asleep whenever physically inactive, even when eating; snoring; waking up with a sore or dry throat; lapses in memory or concentration; headaches (particularly in the morning).

POSSIBLE CAUSE: Sleep apnoea, a condition where the muscles and soft tissues in the throat relax and collapse during sleep. This leads to the airways becoming blocked, for up to ten seconds or more. The patient then starts breathing again, often with a ‘snort’ or gasp — this can happen hundreds of times a night, though they won’t usually remember what has happened.

Around four in 100 middle-aged men and two in 100 middle-aged women have the condition — around 800,000 Britons.

‘The condition can leave you exhausted as it interrupts deep, slow wave sleep and REM sleep, which is a time of healing and growth in the body,’ explains Russell Foster, professor of neuroscience at Oxford University.

Untreated, long term the risks include high blood pressure and even depression.

TREATMENT: Losing weight and quitting smoking will help keep airway passages open. Sleeping on your side, rather than your back, may also help. Moderate to severe cases of sleep apnoea may need a treatment called continuous positive airway pressure — a breathing mask worn while you sleep which delivers a continuous supply of compressed air to prevent the airways closing.

LETHARGY AT THE  END OF THE DAY

OTHER SYMPTOMS: Finding it difficult to muster energy for anything after a day’s work; diarrhoea or constipation; nausea and vomiting; a bloated tummy; excessive wind pain and abdominal cramps.

POSSIBLE CAUSE: Up to half a million people have undiagnosed coeliac disease. The disease, which tends to run in families, is caused by an intolerance to gluten, a protein found in particular grains such as wheat, barley and rye, and therefore foods such as bread and pasta, breakfast cereal, pastry, pizza.

This triggers the immune system to attack the gut tissues, so nutrients aren’t absorbed, triggering conditions such as osteoporosis and anaemia which causes tiredness, says consultant gastroenterologist Dr Steven Mann, of the Spire Hospital in Bushey, Herts.


TREATMENT: Your GP should refer you to a dietitian to give you individual advice and a step by step plan on removing gluten from your diet without losing out on essential nutrients.