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.
This webpage provides information, not advice. You should read our full disclaimer before reading further.
This information reflects the best available evidence at the time of writing. We aim to review our mental health information every three years, and update critical changes more regularly.
- 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
These can be physical or psychological, or both.
- 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.
Any serious illness can make you tired, especially painful ones. Even less serious illnesses, like glandular fever, can leave you feeling worn out.
- Autoimmune disorders
- Chronic infections
- Liver, heart or long-term chest problems
- Sleep apnoea
- 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.
TreatmentsThe 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 having a young baby: both of these can sap your energy.
Poor sleep: disturbed sleep can leave tired and you will find it hard to concentrate.
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.
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.
- 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
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.
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.
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.
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.
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.
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.
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.
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
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.
4 or more of the following symptoms
- sore throat
- tender lymph nodes
- muscle pain
- joint pain
- unrefreshing sleep
- tiredness after exercise that last more than 24 hours.
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 required. 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?
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.
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.
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.
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.
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- CFS/ME Working Group. Report of the CFS/ME working group: Report to the Chief Medical Officer of an Independent Working Group. 2002.
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