Why Am I So Tired?

{Rancho Cucamonga, California}

As I struggled to get up this morning and hit the snooze button multiple times then proceeded to turn off my alarm clock on accident (thus waking up several hours later), I contemplated reasons why I’m feeling so tired today.  I’m sure several of us try to diagnose ourselves, and sometimes jump to the worst conclusions as to the causes of our tiredness.  But before you start self-diagnosing, here are a few potential causes that I generally explore with my patients before resorting to lab tests and referring back to their primary care doctors:

1.  Are you getting enough sleep?  Lack of sleep is an obvious cause, but you’d have no idea how many people actually believe they’re inhuman and should be able to get by on less sleep without crashing.

2.  Is your schedule constantly changing?  Our circadian rhythm acts as an internal clock that guides our sleep-wake cycle.  Any disruption as a result of a change in schedule or activity (ie, I have several patients whose job schedules constantly change, such as firemen, dispatchers, etc; or college students studying late night for exams; or recent travel to a different time zone) can disrupt your cycle, thus causing you to feel more tired than normal during the day.

3.  What type of food do you eat?  If you start your day with a meal chock full of refined carbs (bagel, doughnuts, croissants, etc), your insulin levels skyrocket, thus feeling sluggish.  Also, not eating enough food is an obvious reason for low energy levels.

4.  Do you rarely exercise?  Just turning up your current level of activity up a notch (ie, if you’re sedentary, start walking, etc) has been shown to increase your energy levels.

5.  Do your workouts involve exercises that your body’s not quite yet conditioned to?  I, myself have tried various types of workouts programs and generally struggled to adjust when I first started, which is to be expected.  In the past, I’ve done boot camps and Crossfit, which I truly enjoyed, yet my recovery times were quite long (in addition, I also had to change my nutrition to adequately fuel my body).  Thus, I had several days where I’d want to nap or veg on the couch all day (leg days tend to be the worst!).  I have several patients who feel abnormal because they’re making great efforts to drastically increase their physical activity, yet don’t realize that feeling tired during the recovery phase is normal.

6.  Did you forget to take your medication?  Thyroid medications (such as levothyroxine), stimulant medications (such as those used to treat ADHD), antidepressants (such as buproprion) can drop your energy levels if not taken regularly.

7.  Is it a medication side effect?  If you were recently started on new medications and notice that you’re feeling more tired lately, then check with your doc (or search online as most people do) to check if lethargy is a possible side effect.

8.  Did you cut back on your regular caffeine intake?  Somnolence is a common symptom of caffeine withdrawal (in addition to headache, irritability, decreased concentration, etc).

9.  Did you overexert yourself with activity recently?  Work, running errands, planning a big upcoming event, etc — it’s normal to feel exhausted and need time to regroup after a busy day (or days) of activity.  Know your limits as to how much activity you can handle, or go easy on yourself if you’re not as productive on subsequent days.

10.  Are you working on some difficult material in psychotherapy?  Since I am a psychiatrist, I usually explore this possibility.  Processing difficult emotions can be draining.  I’ve experienced this firsthand and used to take naps after my Saturday sessions with my therapist.

11.  Is tiredness a sign of depression?  If tiredness is also accompanied with symptoms such as loss of interest in activities you normally enjoy, isolation, sadness, etc, then lack of energy might be a sign of depression.  Reach out to your doctor, especially if symptoms don’t improve and start impacting your ability to carry out your daily activities.

If the cause of tiredness is not apparent, then make sure to contact your medical doctor to discuss your symptoms.  However, more often the cause of tiredness is not a major medical issue.  In my practice, I find that the most common cause of lethargy is related to schedule and unrealistic expectations that we place on ourselves to be superhuman (I’m definitely guilty of this) and accomplish so much in one day without allowing adequate time to rest and refuel, thus leading to excessive stress, insomnia, poor eating habits, subsequent depression, etc.  Listen to your body — if rest is needed, allow yourself enough time to reset, relax, and gain your energy back.

Photo by Marlon Santos