Why Am I So Tired? The Many Causes of Fatigue
Medical Author:
Charles Patrick Davis, MD, PhD
Charles Patrick Davis, MD, PhDDr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications. Medical Editor:
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACRDr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology. One of the most common complaints that I hear when taking a history from a patient of a current illness is that the patient says, almost as an afterthought "... and I don't know why I am so tired." In most instances, this complaint is not the main reason that the patient is seeing me. In some instances, "being tired" is mentioned to physicians during a routine checkup after the patient said they have no current health concerns. So, should I as a physician treat the comment like an afterthought and concentrate on the "real reason" the patient is being seen? I could focus on the "real reason" for the visit, but if I skip asking questions about "being tired," I may miss finding out information or clues about the patient's illness and completely overlook a potential diagnosis and treatment for the patient. Therefore, the first thing to understand about "tired" is what the patient means by the word. Does the patient mean they feel sleepy or fatigued -- they are not the same. Fatigued (tired) describes a lack of energy and motivation, not feeling sleepy (although both can occur together). If the answer is fatigue, the next step is to determine if the fatigue is mental, physical, or both. Now we are beginning to narrow down some clues to the cause of the fatigue, but we (the patient and the doctor) still have a long way to go together. Fatigue is mainly a symptom and not a disease in itself. The key is for the doctor, with the patient's help, to discover the underlying cause of fatigue. The patient's input is important because accurate answers to the doctor's questions may lead the doctor toward a diagnosis or, at least, may suggest what medical tests may help provide a diagnosis. For example:
However, there are reasons that are "normal" for a person to be tired. Normal people who have intense physical or mental challenges can become fatigued. If the intense activity is halted (for example, "Whew! The exam is over"... or... "I had to really run to catch Fluffy after her leash broke"), the fatigue gradually dissipates over hours or a day. When patients describe longer-lasting fatigue or fatigue with otherwise normal activity, then it may be telling the patient and their doctor there is an underlying cause of their tiredness. So what are some common questions you may hear your doctor ask that gives clues to the underlying causes of fatigue? The first set of questions may lead to some frequently seen causes of fatigue:
The answers can give the patient and their doctor some insight into three major categories of problems that can have fatigue as a symptom:
In addition, such questions can provide insight about short-term normal fatigue such as bereavement, exercise, or changes in normal activity. The other types of questions are a bit harder for both the patient and the doctor to use as clues because if the patient responds positively, often the physician will be need some additional testing done (possibly by other doctors or tests with results that will not be immediately available to your physician) to uncover or clarify an answer. If you have a primary physician, that doctor should already have most of these questions partly or fully answered. However, the primary care doctor may not have these answers if you see multiple physicians, have not seen you doctor "...in quite a while..." or you are seeing a physician for the first appointment. Examples of such questions include:
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