Take Stock, Set Priorities, Take Care of Yourself
By Jeanie Lerche Davis
Reviewed By Charlotte Grayson
Feeling tired, zapped of energy? You're not the Lone Ranger.
Doctors see it all the time: "Women with four kids, a full-time job, and they get up at 5 to get everybody ready for the day. Their lives are very hectic, they only get four hours of sleep. They expect their bodies to do more than is realistic for one person," says Sharon Horesh, MD, primary care specialist with the Emory Clinic in Atlanta.
Fatigue has many origins. For women, anemia brought on by heavy menstrual cycles may cause fatigue. An underactive thyroid also causes fatigue. A cold, sinus infection, or virus can drag you out -- even for three or four weeks.
But all too often, you're not taking care of yourself. It's as simple, and as difficult, as that.
"The first thing I ask is, 'What time do you go to bed? When do you wake up? What's your day like?'" Horesh tells WebMD. As trite as it may sound, you need to sleep more, eat healthy, take care of yourself -- "commonsense things," she says. "It's not a medical problem, it's a lifestyle issue."
Look at Your Options
First step, take stock of your life. If you can't juggle it all, get some perspective. "Decide whether you're putting yourself under unnecessary stress," says Inyanga Mack, MD, professor of primary and community medicine at Temple University School of Medicine in Phiadelphia.
"Some people can successfully carve out a year or two to achieve a goal. But others push themselves to meet unrealistic demands that are not really necessary," Mack tells WebMD.
Assess your priorities, rank their importance, then make some decisions. "Maybe a therapist can help," she says. "Maybe you need to look for help with childcare or financial problems. Maybe you need to make better spending decisions so you're not stressed financially. Some people buy a truck first, then figure out how pay for it."
You do have options, Mack says. "If you're a young woman with young children, trying to finish school, trying to work, you don't have somebody to take care of the kids, can't afford to stop working, and are working a low-pay job -- you're not actually trying to do something extravagant. They are wonderful goals, but you may need more time to do it. You may need to take fewer classes during the semester."
For many people -- especially women in their 30s and 40s -- severe anxiety and depression are leading causes of fatigue, says Horesh. "Anxiety puts your body into overdrive and wears down the immune system. Some people even have medical symptoms like chest pain, racing heart, heart palpitations because their bodies are in overdrive. They're getting shots of adrenaline all the time."
Depression sets up a vicious cycle. "A lot of people don't see a doctor until they're really, really sick, because they don't want to take care of themselves, can't concentrate, can't get pleasure. They become completely withdrawn, sometimes suicidal, unable to help themselves," she says.
An imbalance of hormone levels could be causing these mood disturbances, she tells WebMD. Antidepressants, psychotherapy, meditation, or yoga can help reduce stress and restore emotional balance. "Different things work for different people," she says.
Exercise -- It's Soul-Satisfying
Exercise is a great stress-relief aide -- even if you're too tired for it, says Mack. "If you're feeling overwhelmed, tired for whatever reason, exercise might be the last thing you feel like doing. But moderate amounts of exercise can actually help your mood. You will have more energy and require less sleep. Exercise will make you more tired at night, and you will fall into a deeper sleep, get better rest."
Despite your busy life, push yourself to do this one extra thing, Mack says. "You just have to get yourself going. It does make a difference. It's worthwhile adding on that one extra thing. It can make a big difference -- not just in fatigue, but in your overall outlook, and can act as a very good stress reliever."
Get Plenty of Protein
Even if you're trying to eat right, you may be doing it wrong. "Diet is important," says Horesh. Fruits and vegetables fill you up with fewer calories. But they won't give you the long-lasting energy that you get from proteins and complex, starchy carbohydrates like whole-grain breads, pasta, rice, and beans.
"A diet that is very heavy in sugars -- too many sweets, junk food, cookies -- is going to give you surges in energy," she says. "But you're also going to have a sudden drop in energy.
"For energy, you need a diet that is better balanced -- higher in protein, higher in complex carbohydrates, but low in sugars and, of course, fats," she tells WebMD.
Log Those Zzzs
Yawn, it's the old saw: "If you're not getting enough sleep, nothing else will work," says Mack. "You can't ask your body to work on three to four hours a night and not have some physical complaint. Your body can just take so much."
You absolutely need those seven to eight hours of Z's every night, she tells WebMD. "And it needs to be good rest. You need to feel better when you wake up," she says.
Many people suffer from sleep apnea and don't realize it, says Horesh. "If you snore, if you have ever woken up gasping for air, if you wake up feeling not well rested, if you're so tired you fall asleep behind the steering wheel -- those are all signs that your airway is getting blocked during sleep. You're not getting full REM sleep that you need to feel rested. Unfortunately, people take it as normal. They say, 'I'm a bad sleeper.'"
For the rest of us, caffeine can be a big problem. It's easy to sip eight or nine cups of coffee through the day -- just to get the buzz you once got on two or three cups. If there's also Mountain Dew or tea at night, you're likely to have trouble sleeping, says Mack.
"Drinking two or three cups a day is OK," she tells WebMD. "But very large amounts from multiple sources -- tea, iced tea, soft drinks -- all that counts as caffeine. Drink too much, and you get into trouble."
Good "sleep hygiene" is essential: That means going to bed and waking up at the same time, not drinking a lot of caffeine or alcohol (it also disturbs sleep). Also, don't use the bed for much more than sleep. No eating, watching TV, or reading in bed.
When Should You Worry?
If fatigue has lasted more than a month -- and your lifestyle is in fairly good shape -- then see a primary care doctor, advise both Mack and Horesh.
- If blood sugars are chronically high, a sign of diabetes, you will feel chronically tired.
- Cancer will also make you feel rundown. That's good reason to get routine screening mammograms and other screening tests.
- Fibromyalgia, lupus, and other autoimmune diseases also have fatigue as a symptom.
- Chronic fatigue syndrome is more than it may sound. "The term is really misused. Many people think that if they're always tired, they have chronic fatigue. People who truly have it are completely debilitated, they are up and functioning only about two hours a day, just can't move otherwise -- severely fatigued."
Originally published Jan. 31. 2003.
Medically updated May 17, 2005.
SOURCES: Sharon Horesh, MD, primary care specialist, Emory Clinic, Atlanta • Inyanga Mack, MD, professor of primary and community medicine, Temple University School of Medicine, Philadelphia.
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