Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 6, 2015

Tiredness is a common complaint, and everyone struggles with it at times. In most cases, it simply means that rest or lifestyle changes are required. However, experiencing tiredness can be a cause for concern if it's frequent or persistent.


Definition & Facts

Tiredness is a state of feeling low in energy, weak and fatigued. When being tired becomes a consistent issue, it can impact personal safety and the safety of others.

For instance, driving while fatigued is the biggest cause of traffic accidents in the United States and Europe. People who are tired are also more likely to experience serious accidents when operating machinery. Aside from safety issues, frequent tiredness impacts quality of life and the ability to function and be productive.


There are numerous causes of tiredness, several of which are of significant medical concern. Anemia, which can come from deficiencies in iron (iron anemia) or vitamin B12 (pernicious anemia), causes intractable fatigue in most of its victims.

Menopause common causes women to experience low energy from a lack of key sex hormones. Sleep apnea, which is estimated to affect roughly one in 15 Americans, disturbs sleep due to repeated nighttime breathing cessation, thereby causing daytime tiredness. Depression, restless legs syndrome, chronic fatigue syndrome, fibromyalgia, anxiety, hypothyroidism, food intolerances and certain digestive disorders are also well-known causes of frequent tiredness.

More pressing causes of tiredness can include cancer, viral infections, kidney failure, emphysema, asthma and diabetes. Failure to consume adequate calories to support baseline metabolic requirements, which is most commonly seen in dieters, anorexics, vegans and vegetarians, can also lead to chronic tiredness.

In addition, poorly managed stress due to work, family or personal issues often results in tiredness because of emotional and psychological exertion. Other possible causes can involve alcohol or drug abuse, which is frequently used as a coping mechanism by people who experience depression or significant levels of stress.

When to see a doctor

Individuals who suspect that they suffer from sleep apnea are urged to see a doctor, since it increases the risk of heart disease, heart attack, stroke and sudden death if left untreated. Substance abuse should also be addressed by a healthcare professional as it normally cannot be successfully treated alone.

In cases where hypothyroidism, anemia, viral infections, diabetes, or depression are believed to be the cause, medications are typically required for these conditions, so a doctor must be consulted. Suspected cancer, kidney failure or emphysema should be addressed as soon as possible, since early detection and treatment allow for better outcomes and survival rates. With fibromyalgia, digestive disorders and chronic fatigue syndrome, having these conditions properly diagnosed is the first step in regaining energy levels and getting other symptoms under control.

There are also instances where tiredness may represent a medical emergency. If tiredness is sudden or unusual and presents with difficulty breathing, numbness or tingling in the face, tightness or pain in the chest, dizziness, muscle laxity on one side of the face, nausea, ]]vomiting||, bloody stools or rectal bleeding, sharp abdominal pain, severe headache, slurred speech, blurry vision or pain in the left arm, call an ambulance immediately.

Treatment & Therapy

Treatments and therapies for tiredness depend heavily on the underlying cause. For iron or pernicious anemia, a doctor will prescribe high-dose iron supplements or give an intramuscular injection of vitamin B12, respectively.

Depression, chronic stress, anxiety, fibromyalgia, chronic fatigue syndrome and certain digestive disorders (IBS, IBD, Crohn's or ulcerative colitis) are normally treated with a combination of sedatives, muscle relaxers, antidepressants or antipsychotics. In some cases, opioid painkillers may be prescribed depending on the severity of the patient's discomfort and whether it could be worsening their tiredness. Sleep apnea is normally addressed through the use of a continuous positive airway pressure (CPAP) machine, and if the patient is obese or overweight, weight loss is strongly recommended.

For tiredness caused by unmanaged diabetes, blood sugar and insulin levels are brought under control using insulin injections or anti-diabetic drugs as well as dietary overhauls and close monitoring of blood glucose. Antiviral drugs may be used in certain cases where a viral infection is causing tiredness, such as HIV, malaria or hepatitis. In patients who are consuming insufficient calories due to poor dietary habits or chronic dieting, a doctor may refer them to a dietitian for counseling on obtaining adequate calories while also maintaining proper nutrition.

When these individuals are affected by an eating disorder, antidepressants and psychotherapy may be used alongside dietary counseling. In instances of emphysema and asthma, corticosteroid inhalers are the most common treatment. For women struggling with tiredness caused by menopause, hormone replacement therapy is still common, but it is falling out of favor due to increased risks of breast cancer, ovarian cancer, uterine cancer and blood clots.

Instead, a doctor may recommend certain supplements, regular intake of soy products or a diet and lifestyle overhaul for these women. If a doctor finds that a person is struggling with tiredness caused by hypothyroidism, they will prescribe artificial thyroid hormones, which must be taken for life.

Prevention & Prophylaxis

In the absence of chronic underlying health problems, which must be managed medically, there are many ways to prevent tiredness. Many people today struggle with poor sleep habits, difficulty falling asleep or waking up feeling un-refreshed. To address this, a growing number of experts are suggesting that people avoid sources of blue-wave or "white" light at least two hours before bed.

This is based on research showing that light in this spectrum prevents formation of melatonin, the sleepiness hormone, in the brain. It's also recommended to keep the bedroom as dark as possible since even small light sources can disturb the sleep cycle. Avoiding stimulating activities prior to sleep, like video games, television, movies and arguing, can also result in better sleep and less daytime tiredness.

Furthermore, controlling sources of stress and striking a healthy work-life balance is valuable for improving energy levels and can help improve sleep quality and duration. Many people have found that certain herbal or nutritional supplements help them sleep better or prevent tiredness, such as vitamin B12, iron, guarana, folic acid, 5-HTP, magnesium or melatonin.

Finally, since a poor diet and sedentary lifestyle can cause or contribute to tiredness, it's strongly recommended to consume a balanced variety of nutritious whole foods and get at least 20 minutes of exercise each day.