Introduction
We all feel tired from time to time. Usually, it's obvious why
we are tired. We take the time to rest and get over it quickly.
But tiredness can be a serious problem if:
- there is no obvious reason for it
- it goes on for a long time
- it is so bad that you can't do anything at all.
This sort of tiredness can stop us from enjoying and getting on
with our lives.
How common is tiredness?
At any given time, 1 in every 5 people feel unusually tired
and 1 in 10 have prolonged fatigue. Women tend to feel tired
more than men. It can be a problem at any age, but is less common
in the very young and old.
If you want to work out how you became tired in the first
place, it can be helpful to think about:
- parts of your life that might be particularly tiring
- any events that might have triggered your tiredness
- other things in your life that might be keeping you tired.
Reasons for being tired
These can be physical or psychological, or both.
Physical
Being overweight.
Your body has to work harder just to do everyday things.
Being too thin
Your muscles may not be strong enough to do everyday things without
becoming tired.
Physical illness
Any serious illness can make you tired, especially painful
ones. Even less serious illnesses, like glandular fever, can
leave you feeling worn out.
General:
- Anaemia
- Autoimmune disorders
- Chronic infections
- Cancer
- Liver, heart or long-term chest
problems
Glandular:
Sleep:
Muscular:
- Myositis
- Multiple sclerosis
Even if you have got over cancer or
heart problems, you can still have a problem with tiredness.
There is also evidence that some women with tiredness may have too
little iron, in spite of apparently normal red blood cells.
Treatments
The following treatments can exhaust you:
- serious operations on your abdomen or chest
- medications like beta-blockers and strong painkillers
- treatments for cancer, such as radiotherapy and
chemotherapy.
Doing too little - and getting unfit
If you don't get any exercise, you may find it hard to sleep
through the night.
Doing too much and tiring yourself out
If you carry on doing things - whether physical or mental -
even when you feel tired, you may find it harder to recover, and
get even more tired.
Pregnancy and breast feeding
Both of these can sap your energy.
Poor sleep
Disturbed sleep can leave tired and you will find it hard to
concentrate.
Psychological
Worries and stress
Worry makes you feel tired - especially when you cannot
see a way out of your problems.
Insomnia
If you don't sleep well for a long time, you can start to feel
tired, irritable and fed up.
Depression
Depression tends to make you feel tired all the time. It
can make you wake early which can make you feel even
more tired.
Everyday difficulties
Everybody gets stressed and exhausted when bad things happen to
them. It's worth remembering that even positive events, like moving
home or getting married, can also be exhausting. Being faced
with a difficult decision, especially 'no win' situations, can
exhaust you.
Emotional shock
Bad news,
bereavement or the break up of
a relationship can all make you feel drained.
Expecting too much of yourself
Everyone has standards - in work and in their personal
life. They are usually helpful - they give you a sense of
direction. But, if you expect too much of yourself, you
can find yourself repeatedly failing, making you feel frustrated
and tired.
Habits
If you are feeling tired, you may get into the habit of
sleeping in the day. This can make it more difficult to
'switch off' at night and get a good night's sleep.
Sleeping too much
It sounds odd, but this too can make you tired - perhaps because it
reduces your fitness.
Activity
A 'roller-coaster' of too much activity followed by too much rest;
if you do too much on a good day, you may overdo things and feel
even more tired the next day.
Work and family
Continuing difficulties
There are some things in life that you find hard, or impossible to
change. If you don't feel in control of your life, it is easy to
get frustrated and tired.
Looking after small children
No surprises here. If your child doesn't sleep through the night,
neither do you. It can be really hard work just to keep going with
your daily routine.
Night work
Night workers often find that they get tired easily. This is more
likely if the timing of their shift is constantly being
changed.
Work stress
- Too much work
- Not enough control over your work
- Not being recognised for the work you do
will all tend to make you feel tired.
Unemployment
Not working when you want to can tire you out through
frustration.
What we drink
Coffee and tea
Coffee, tea and some soft drinks contain caffeine. This
is a chemical which makes us feel more awake. Six cups of coffee a
day or ten cups of tea (or six mugs) are enough to upset sleep and
make you wound-up and tired.
Alcohol
If you drink alcohol in the evening, it tends to wake you
up in the middle of the night. If you drink quite a lot regularly,
it can make you depressed and affect your sleep.
'The last straw'
It will often takes several things together to make you feel tired.
For example, if you feel stressed for a long time, you will
probably sleep badly and feel 'below par'. You might then catch a
cold. This can be the 'last straw' which finally exhausts you. You
feel that you have to rest to get over this, but then quickly
become unfit. You will now find that just doing everyday things can
make you even more tired. If you can't get back to your normal
routine, you will probably feel worried and frustrated. This gives
you more sleepless nights and makes you more tired ....... and so a
vicious circle is set up.
Beating tiredness
1. Improve your sleep
- Go to bed and get up in the morning at the same time every day,
no matter how you feel.
- Make sure your bedroom is comfortable: not too hot, not too
cold, and not too noisy.
- Don't eat or drink a lot late at night. Try to have your
evening meal early rather than late.
- Try to gradually reduce the time you spend 'napping' during the
day.
- If you can't sleep, don't lie there worrying about it: get up,
leave the bedroom and do something you find relaxing. When you feel
tired enough, go back to bed.
- Pick a way to relax before going to bed - such as reading,
listening to music or using a relaxation technique.
- Have a hot bath before bed. This should be as hot as you can
bear, without scalding you, and last a good twenty
minutes.
- If something is troubling you, and there is nothing you can do
about it there and then, try writing it down. Tell yourself you
will deal with it in the morning, and then go to bed.
- If none of this works, go and see your doctor.
2. Take some exercise
Many people feel too exhausted to start any exercise. However, in
the long run, regular exercise will make you feel less tired and
more energetic. So what can you do about this?
Try starting with a small amount of exercise: it doesn't
matter how little as long as it's easy and you can do it
regularly - every day, if possible. You then slowly increase the
amount you do over a period of weeks and months, adjusting it so
you don't get more tired. It can be as little as walking from one
room to another. Over time, you can increase the amount of
time you exercise (or distance you walk), aiming to eventually do
half an hour a day (you may need to divide this half hour into
several short periods of time).
Walking is the easiest exercise to try, but anything that
you enjoy will do. Many people like to swim or cycle regularly.
What you are trying to do is to gradually improve your fitness and
strength. You may be able to get advice from someone who knows how
to help unfit or ill people to get fit.
If you find that you are doing too much, and feeling worse,
don't give up! Carry on with some less demanding regular exercise,
perhaps for a shorter time each day. Don't do anything more
energetic until you have got used to the amount of exercise you are
doing at the moment.
Once you are managing half an hour a day, you should gradually
increase the intensity of your exercise so that you start to get a
bit out of breath.
3. Cut out caffeine
Gradually stop having all caffeine drinks over about a three week
period. Everyone knows that coffee and tea contain caffeine, but
watch out! There are many other drinks and products that have
caffeine in them, such as energy and cola drinks, some painkillers,
and energy-boosting pills. Some herbal remedies also contain a lot
of caffeine. If you are in any doubt, read the ingredients list on
the packaging.
Try to stay off caffeine completely for a month to see if you
feel better without it. You may find that stopping caffeine gives
you headaches. If this happens, just cut down more slowly the
amount of caffeine you are drinking.
Chocolate can also be a problem if you eat it every day
because it contains chemicals that make you feel more awake.
4. Weight
If you are overweight, you will feel a lot better if you lose
some weight gradually. A crash diet is not helpful and can make you
more tired. Apart from eating healthily, the best way to lose
weight is to gradually do more active and do more exercise.
If you are too thin, you will not recover your full energy
unless you start to get back to your normal weight. By doing this
you can start to re-build your muscles and your strength.
5. Plan your day/week
Try to plan your day and your week. Try to make sure that you
don't have any really hectic, tiring days. Organise it so that you
do a little every day. If you cram everything into one day, you may
be too exhausted to do anything for the rest of the week. Try to do
your chores when you think you will have the most energy.
6. Have realistic expectations
Be kind to yourself. If you have been tired for a long time, don't
expect to be back to your normal self overnight. Set realistic
goals for yourself and your recovery. Don't expect too much too
soon. All progress is good, however small or unimportant it may
seem at the time.
Learn from your tiredness:
- were you demanding too much of yourself before you got
tired?
- did you have a good balance between work, rest and
enjoying yourself?
- should you reconsider what you want from life?
What doesn't help
We'd all like a magic cure to take away our tiredness. There
isn't one. There are many products on the market that claim to do
this. There is no good evidence that any of them help for very
long. This goes for vitamins, minerals, stimulants, total rest and
sleeping, and exclusion diets that cut out particular foods.
Not getting better
There is always a reason and sometimes more than one. You may be
suffering from an undiagnosed illness. Ask your doctor to check out
whether you have any of these problems. Common treatable problems
include thyroid disease, anaemia,
sleep apnoea (temporarily stopping
breathing when asleep), restless legs (an uncomfortable restless
feeling in the legs that happens when you are trying to
rest), anxiety and depression.
M.E. and Chronic Fatigue Syndrome
A small number of people suffer from severe and disabling tiredness
that goes on for a long time and for which there is no clear
cause. This is called Myalgic Encephalomyelitis (ME) or
Chronic Fatigue Syndrome (CFS).
For a diagnosis of CFS, you have to have:
1. 6 months or more of medically unexplained tiredness that
is:
- new - you haven't always felt like this
- not associated with continuing effort
- reduces the amount you can do
- not relieved by rest.
2. 4 or more of the following symptoms:
- sore throat
- tender lymph nodes
- muscle pain
- joint pain
- headache
- unrefreshing sleep
- tiredness after exercise that last more than 24 hours.
3. No active physical disease or mental disorder that could be
responsible for these symptoms. So, before a diagnosis of CFS is
made, physical and psychological examinations (and physical
investigations) are requited. You will also need an assessment of
your mental state.
People with CFS/ME have often felt that doctors believed that
their problem was 'all in the mind' - even though they had physical
symptoms. Doctors now recognise that this is an illness, although
it is poorly-understood. Like many other 'physical' illnesses, such
as asthma and irritable bowel syndrome. some psychological
treatments seem to help. This does not necessarily mean that CFS is
a mainly physical disorder. So - what do we know?
Viral infection
Certain viral infections can trigger CFS/ME. We also know that
people with CFS/ME have no continuing infection with the
virus. So, there may be factors other than the virus which keep
CFS/ME going and delay your recovery. These are called 'maintaining
factors' and often the same ones as those that cause general
tiredness, as described earlier in the leaflet.
Maintaining factors
These include difficulty in sleeping, depression and anxiety.
If you can identify the factors that are keeping the CFS/ME
tiredness going (they are usually more than one), you have a chance
of improving. They are often that same factors that cause the
general tiredness as described above.
Trying too hard
Even trying to get better can sometimes make things worse. For
instance, if you rest too much, you will get weaker and more
unfit. So when you do try to do something, you feel even more
tired. It can also be easy to get into a 'boom and bust' pattern,
where you do too much one day and then 'collapse' the day
after.
What we believe about health
Most of us think that if we have a viral illness, we should go
to bed or rest at home for a few days. This works very well
for short illnesses. However, if you do carry on resting for longer
than a week or two, it tends to make you more tired.
Treatments for CFS
We now have treatments that we know can help CFS/ME. They
won't work for everybody and it is important to make sure that any
treatment suits the individual. They include:
- Supervised graded exercise therapy (GET). This is a way of
gradually increasing your amount of physical activity and stamina
without over-tiring yourself. It doesn't suit everybody, but does
seem to help about 2/3 of those who try it.
- Cognitive behaviour therapy (CBT).
This is a talking treatment which helps you to change any unhelpful
ways of thinking about your illness and to improve your coping
skills.
- Pacing. This is a common sense approach to adjusting one's
daily activity so that you avoid over-tiredness and a
possible relapse.
What if I don't do anything about it?
If you are tired for a few weeks after a viral infection, you
are likely to get over it without any trouble.
BUT
If you have had CFS for six months or more, you will probably
need help - only about 1 in 10 people with established
CFS/ME gets better without any treatment.
How well do the treatments work?
- About 6 out of 10 people feel better with either CBT or GET,
although quite a few people with CFS have reported that GET tends
to make them more tired, not less.
- About a quarter of treated patients rate themselves as
completely recovered from their CFS/ME after CBT - and the same
number still consider themselves recovered five years after the
treatment finished.
Which treatment to choose
Both CBT and GET (see above) are helpful for many people - but
they clearly do not help everybody. Pacing makes good common sense,
but does not yet have much evidence to support it, although it is
currently being investigated.
If you need help of this sort, you may need to see a
specialist or therapist trained in rehabilitation.
Further reading
Coping with chronic fatigue by Trudie Chalder. Sheldon Press,
London, 1995.
Chronic Fatigue Syndrome: The facts by Michael Sharpe and
Frankie Campling. Oxford University Press, Oxford, 2000.
Self-help for Chronic Fatigue Syndrome: A Guide for Young
People. Trudie Chalder, Kanees Hussain. Blue Stallion Publications,
Witney, Oxon, 2002.
Overcoming Chronic Fatigue: A self-help guide using Cognitive
Behavioural Techniques. Mary Burgess with Trudie Chalder. Robinson,
London, 2005.
References
NHS
Centre for Reviews and Dissemination. Interventions for the
management of CFS/ME. Effective Health Care 2002;7:
1-12.
CFS/ME Working Group. Report of the CFS/ME
working group: Report to the Chief Medical Officer of an
Independent Working Group. 2002. (Search via http://www.dh.gov.uk/)
Royal College of Physicians. Chronic
Fatigue Syndrome. London: RCP, 1996. (Report of a joint
working group of the Royal Colleges of Physicians, Psychiatrists
and General Practitioners).
McGregor RS. Chronic complaints in
adolescence: chest pain, chronic fatigue, headaches, abdominal
pain. Adolescent Medicine State of the Art Reviews 1997;8:
15-31.
Calverton MD (2002) Health behaviour
in school-aged children, 1997-1998. World Health Organisation.
Macro International.
The association of obesity, cytokine levels,
and depressive symptoms with diverse measures of fatigue in healthy
subjects (2005) Weonjeong Lim, et al Arch Intern
Med. 2005;165:910-915.
Iron supplementation for unexplained fatigue
in non-anaemic women: double blind randomised placebo controlled
trial (2003) Verdon F et al. BMJ, 326: 1124-1128.
Watt T et al (2000) Fatiguein the
Danish general population. Influence of sociodemographic factors
and disease. J. Epidemiol. Community Health, 54(11): 827 -
833.
Janssen N et al (2003) Fatigueas a predictor of sickness
absence: results from the Maastricht cohort study on fatigue at
work. Occup. Environ. Med., 60(90001): 71 - 76.
Andrea H et al (2003) Associations between
fatigue attributions and fatigue, health, and psychosocial work
characteristics: a study among employees visiting a physician with
fatigue. Occup. Environ. Med., 60(90001): 99 - 104.
Sharpe M & Wilks D (2002) Fatigue. BMJ,
325, 480-483.
Viner R. & Christie D. (2005) Fatigue
and somatic symptoms. BMJ 330, 1012-1015.
This leaflet was produced by the Royal College of
Psychiatrists' Public Education Editorial Board.
Series Editor: Dr Philip Timms.
With grateful thanks to Professor Peter White and Professor Matthew
Hotopf.
© 2008 Royal College
of Psychiatrists. This leaflet may be downloaded, printed out,
photocopied and distributed free of charge as long as the Royal
College of Psychiatrists is properly credited and no profit is
gained from its use. Permission to reproduce it in any other way
must be obtained from the
Head
of Publications. The College does not allow reposting of
its leaflets on other sites, but allows them to be linked to
directly.
For a catalogue of public education materials, or copies of
our leaflets contact:
Leaflets Department, The
Royal College of Psychiatrists, 17 Belgrave
Square, London SW1X 8PG, Telephone: 020 7235 2351
x259.
Charity registration number (England and Wales) 228636 and in
Scotland SC038369.
Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.
Please answer the following questions and press 'submit' to send your answers OR
E-mail your responses to dhart@rcpsych.ac.uk
On each line, click on the mark which most closely reflects how you feel about
the statement in the left hand column.
Your answers will help us to make this leaflet more useful - please try to rate
every item.
Did you look at this leaflet because you are a (maximum of 2 categories
please):
Age group (please tick correct box)