Tired all the time

Feeling Tired all the time

Feeling tired all the time is such a common presentation to the GP(1) that doctors even have their own acronym for it, ‘TATT.’ Over the last 10 years of being a doctor I have learned that tiredness means different things to different people. It can mean waking unrefreshed, poor sleep, lack of motivation or the inability to take your dog for a short walk. 
 
These symptoms can have a huge impact on a person’s quality of life, for example they may not be able to do their job well, fatigue may be affecting their relationship or lead to anxiety and  low mood so it is crucial that GPs spend time exploring this.
 
Sometimes there is an obvious trigger for tiredness such as a marriage breakdown, a new baby in the family or a bereavement but often the cause is less clear, it links to multiple factors or an underlying medical problem. I enjoy these consultations as you have to be a real detective, using multiple techniques to get to the root of the problem. A GP will ask about your lifestyle, sleep, mental health and biological symptoms. They may examine you to look for physical signs that could explain tiredness. Other medical conditions you have and drugs that you take are important too. 
 
Doctors often have an idea about what the underlying diagnosis may be but we nearly always do blood tests in order to rule in or rule out certain conditions. It is very rewarding to find an underactive thyroid or anaemia that can be easily treated with tablets and a patient will feel better after a few weeks. Sometimes the bloods pick up new diagnoses such as diabetes and in these cases it is good to diagnose such conditions early so we can start appropriate treatment. 
 
When blood tests are normal it helps reassure a patient that there is nothing physically wrong and can empower them to make lifestyle changes. I have seen numerous patients overcome fatigue by making small lifestyle modifications such as improved sleep hygiene, doing regular exercise and changing how and when they use caffeine and alcohol. There are some practical and simple suggestions made by sleep expert Matther Walker that you can follow online or in his book below (2). Diet can be important and there is evidence that low b12 levels  for example can affect the quality of sleep (3) so checking vitamin levels is sometimes helpful too. 
 
Doctors tend not to prescribe sleeping tablets as they are addictive and are not effective in the long-term. Instead, for many, CBT techniques are effective (4) and as well as psychotherapy there are also apps for this which can be accessed via the NHS Apps Library. Certainly during the covid-19 pandemic I have spoken to many who are struggling with anxiety and poor sleep and these resources have been really useful.
 
Occasionally tiredness is due to longer-term conditions such as depression or chronic fatigue syndrome and your GP can support you with this. Rarely it can also indicate a serious medical problem such as heart failure or cancer so if you have felt tired for over 3 months, particularly if you have any other symptoms it is very important that you speak to a doctor.
 
References
1.     https://cks.nice.org.uk/tirednessfatigue-in-adults
2.     Why We Sleep: The New Science of Sleep and Dreams – 2017 by Matthew Walker
3.     Vitamins and Sleep: An Exploratory Study. K Lichstein, K Payne, J Soeffing, H Durrence, D Taylor, B Riedel, and A Bush. Sleep Med. 2008 Jan; 9(1): 27–32
4.     Cognitive Behavioral Treatment of Insomnia. J Williams, A Roth, K Vatthauer and C McCrae. Chest. 2013 Feb; 143(2): 554–565.
5.     https://patient.info/doctor/fatigue-and-tatt