By Dr. Victor Sierpina 

"I’m just so tired all the time. What can I do, doc?” Fatigue is one of the most common and challenging problems faced by those of us in clinical medicine.

Not only is it a vague symptom, but the number of possible causes listed in medical textbooks runs literally into the hundreds, some quite serious. With a differential diagnosis list that long, I know that as a doctor, I almost instantly start to feel fatigued myself when I hear the complaint of fatigue. It is exhausting to consider and to address comprehensively.

Still, it is my and other health care professionals’ responsibility to help to sort this out for our patients. Because this problem is so prevalent and complex, I will devote a couple of issues to it. The numerous medical causes will be discussed in the next column and should be approached in consultation with your physician.

Perhaps the most obvious, but often overlooked, cause of chronic fatigue, is poor quality of sleep. We often suffer from a darkness deficiency, overstimulation mentally, or from the effects of drugs, caffeine, tobacco or alcohol on our sleep pattern.

The quieting ancient rhythms of light and dark are now overwhelmed by bright lights, big screen TVs, late hour shows, not to mention our overfilled and stressful lives. All of these interfere with soothing bedtime rituals, the need to still our minds as well as our bodies and achieve true restful sleep. Remember how you trained your kids to go to bed with certain comforting rituals? Adults need something similar.

The wonderful tradition of siestas or daytime naps is practically extinct in our culture except for the very young and the very old. I think this is a loss for health, sanity and restoration.

Let’s bring back the daytime nap as a normal part of modern life. The Europeans are better at this than we are in America. Employers will likely find their people are more productive later in the day after a little shut-eye after lunch. Too many naps during the day, on the other hand, can leave you too rested to get a good night’s sleep.

Another somewhat paradoxical cause of fatigue is lack of exercise. In fact, my idea to write on this topic was occasioned by a chance comment in the Alumni Field House men’s locker room. A robust friend of mine who is around 70 but looks 50 bemoaned how tired he was all the time.

He works out regularly and has a very active lifestyle so lack of exercise isn’t his problem. However, most people who complain of chronic fatigue need to do more exercise rather than less. Exercise is a physical stimulus to improved circulation, energy and feelings of well-being. If you don’t feel enough energy to exercise, do it anyway and notice how it improves you attitude and vitality.

Another extremely common cause of so-called fatigue is depression. You might not feel blue, tearful or suicidal but undiagnosed or subclinical depression can creep up on anyone. It can take the zest out of living and make you feel like you are just “tired out” all the time.

There are online depression screens like the PHQ9 that your can take in the privacy of your home or you can talk to your doctor about this aspect of your mental health. Stress, poor family or work relationships, unresolved grief, anxiety or anger can all contribute to depression and accompanying fatigue. Get ahold of these issues if they are gong on for you and seek professional help and perhaps medication if needed.

Not living up to your own dreams or expectations for yourself can be another source of fatigue. Think of your highest aspirations, the things you wanted to accomplish and achieve when you were younger.

Have you given up on those dreams, those possibilities? Have you replaced possibility thinking with impossibility thinking? Have you abandoned the quest for excellence and your personal best with a ho-hum, just make it through until Friday concession to a life of mediocrity?

If so, you might just feel tired all the time. With nothing to look forward to, no animating and exciting goals to drive you, life starts to look pretty bleak, hopeless, and tiring.

In my years of practice, these four areas contribute to more cases of fatigue than medical issues such as anemia, low thyroid or organ failure. More on these medical causes of fatigue next week.
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Dealing with fatigue
Here are some ways to get a handle on your fatigue:
1) Make sure your sleep quality is good. Re-establish your sleep biorhythms by excluding outside light and noise, and by trying make your bedtime and wake-up times regular. Use the bedroom for sleep and sex, avoiding distracting stimuli such as television. Avoid hypnotics and sleep aids if possible as these alter brain wave patterns necessary for deep, restful sleep.
2) Get some daily exercise to give you a need to actually be sleepy but avoid exercising within a couple hours of bedtime as this can keep you up.
3) Consider if you might be depressed or suffering from other exhausting chronic psychological stressors. Get help if you need it.
4) Live your dream.

Dr. Sierpina is the W.D. and Laura Nell Nicholson Family Professor of Integrative Medicine at the University of Texas Medical Branch.