Chronic tiredness

Chronic tiredness can be overcome

Chronic tiredness is one of the most common symptoms reported to doctors. It is psychologically very distressing and it can be misinterpreted by family, friends and co-workers. It can affect a person's life in a very negative way.  This leaflet is about ways of dealing with mild to moderate symptoms of chronic tiredness.  For more severe symptoms, see the leaflet `Chronic fatigue syndrome'.

What is tiredness?

Tiredness can be felt in different ways. For example:
•	feeling tired all the time
•	getting easily tired while performing everyday tasks
•	finding it difficult to recover from being tired, despite rest

There are times when everyone feels tired. However, feeling tired for most people is temporary and in most cases the cause can be identified quite easily.

Tiredness becomes a problem when:
•	it goes on for too long
•	you cannot work out the cause
•	it interferes with your day-to-day activities

Causes of tiredness
Many things can cause people to feel tired. A common cause of fatigue is not sleeping for long enough or not having a restful sleep. Physical illnesses like hypertension, diabetes and anemia or emotional disorders, eg feeling depressed, stressed or anxious are also common causes of tiredness. Finally, tiredness can be caused by a range of lifestyle factors, such as doing too little, doing too much, not having enough exercise and being overweight.

Effects of fatigue
If you have been feeling tired for some time it is likely that you are experiencing mental and physical problems as a result

Some of the effects of fatigue can include:

•	sleeping frequently
•	lack of energy
•	poor concentration
•	problems in making decisions
•	irritability	•	frustration
•	depression
•	anxiety
•	increased risk of accidents and injury

About medication
It is important to note that there is no specific medication that alone will cure fatigue. If the fatigue results from a physical or mental health problem, medication for these problems may reduce some of the underlying fatigue. Sometimes certain antidepressants have been found to be useful for some people.

Medications that claim to make you less tired can lead to addiction. That means, you have to use more and more of the drug for it to help you and when you stop using it your symptoms would be much worse. They are also harmful if taken during pregnancy or if used with alcohol and other drugs.

You must keep in mind that some of the medications people use to make them feel less tired:
•	can be addictive
•	can be harmful to your baby if you are pregnant
•	can interact in a fatal way with alcohol and other drugs

How to overcome chronic tiredness

Identify possible causes
It is important to try to identify the possible reasons why you feel tired. The following sections will help you to work out whether your feelings of tiredness are caused by:
•	poor sleep or sleep disorder
•	physical illness
•	emotional problems
•	lifestyle factors

Once the problem is identified it will usually be possible to work out a solution to help you overcome feelings of being tired.  Sometimes it is hard to find a cause but still possible to adopt strategies that help.

Poor sleep
Not getting enough sleep can make you feel tired. Have a look at the list below, and mark any item that is relevant to you. If there are others, write them in the space below.

I have problems going to sleep                           			
I do not feel refreshed when I wakeup 					                     
I frequently wake up during the night				
I wake up early in the morning and can't go back to sleep        		
Other comments on sleep				
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

To see how well you are sleeping, you could use the form to record your sleep over a seven day period. Filling out this form can help you work out how well you sleep. For the next seven days, write down the date, the time you go to bed (Bed time) and the time that you wake up (Wake time). Also mark from the scale how well you slept (0, very poor; 10, very well).

Sleep record form
	Week I 
Bed time	
Wake time	
Quality of sleep (0–10)	Week 2 
Bed time	
Wake time	
Quality of sleep (0–10)	Week 3 

Bed time	
Wake time	
Quality of sleep (0–10)	
Monday	_____	____	_____	_____	____	_____	_____	____	_____	
Tuesday	_____	____	_____	_____	____	_____	_____	____	_____	
Wednesday	_____	____	_____	_____	____	_____	_____	____	_____	
Thursday	_____	____	_____	_____	____	_____	_____	____	_____	
Friday	_____	____	_____	_____	____	_____	_____	____	_____	
Saturday	_____	____	_____	_____	____	_____	_____	____	_____	
Sunday	_____	____	_____	_____	____	_____	_____	____	_____	

Sleep disorders
It is important to determine whether you are suffering from a specific sleep disorder. Think about the following questions.
•	Has anyone told you that your snoring is loud or disruptive?
if so, you may be suffering from sleep apnea. This is a dangerous condition in which you stop breathing during sleep. There are effective medical treatments for this condition.

•	Have you ever experienced sudden attacks of sleepiness during the day in which you cannot stay awake?   If so, you may be suffering from narcolepsy in which people feel forced to sleep for a period ranging from a few seconds to half an hour. This can be dangerous, particularly when driving or operating machinery. However, the condition responds to medication.

•	Do you experience uncomfortable feelings in your legs or feet before falling asleep?
Does strong movement ease the discomfort? Has anyone told you that your muscles twitch or jerk? If the answer is yes to any of these questions you may have some form of a disorder in which there are numerous episodes of such twitching during the night. This condition can be corrected with vitamin E, iron, calcium or drugs.

Make sure that you contact your doctor if you have answered 'yes' to any of the above.

Emotional causes
It is common to feel tired when feeling stressed, depressed, anxious and angry. Think about your situation, read through the list and mark those items that apply. If you have other emotional problems that are not listed, write them in the space provided.

Possible emotional causes:
Feeling stressed                      			
Worrying a lot                        		
Feeling sad or depressed              		
Anger           		                
Other	
						
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
	
Lifestyle causes

You have already examined how you are sleeping and whether poor sleep could be causing your fatigue. There are other common lifestyle causes of fatigue. Read the list and mark the items that apply to you. If there are other possible lifestyle causes write them in the space below.

Possible lifestyle causes:
Not enough to do during the day/night			
Getting bored with what you are doing			
Too much to do during the day/night			
Drinking alcohol every day				
No regular exercise routine				
No regular meals					              
Eating too much					              
Overweight						
Other lifestyle causes		
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Overcoming fatigue

After reading through the list you may have become aware of a possible cause of your fatigue. If you are still not sure, you should consult your doctor.   Once you have identified a cause you can start to plan ways to overcome fatigue.

If you are not sleeping well then you thou should discuss this with your doctor.  Ask for the leaflet: How to get a better night's sleep. 

If you have identified a physical cause then you should discuss ways of managing the problem with your doctor. Although there might be no immediate cure for a chronic illness, there might be better ways to manage the symptoms so it is less likely to make you tired.

If you have identified en emotional cause for feeling tired then you should discuss it with your doctor or counsellor. You might also want to try the 'slow breathing relaxation' and the `identifying pleasant activities' exercises, which are described below.

If you have identified a lifestyle cause then you should consider some of the following strategies.

Dealing with lifestyle causes
It is important to change lifestyle causes of your tiredness. Here are some examples of what you can do. Read the strategies below and mark those that might be useful to you.
	If practical,  take a period of short holiday, where you can relax and also work out some of the changes that you will make to your lifestyle.  Even a weekend break may be helpful.
	Carry out the slow breathing for relaxation exercise, described below
•	If you are doing too much, you can look at ways of reducing your workload,
e.g. asking others to help around the house, asking your employer for an assistant, reducing the times you socialize, etc.
•	If you are doing too little, you can look for activities that you enjoy and that will keep you busy, e.g.,join a social club, look for volunteer work, adopt new hobbies, etc.
•	If you are overweight, we recommend that you reduce the amount of food that you eat and limit your fat and sugar intake. It would be useful to discuss a diet plan with your doctor.
•	If you are bored, it would be important to find and build into your day some activities that you enjoy and find stimulating
•	If you do not exercise, we recommend that you slowly build up to a regular exercise routine
(if you are over 65 and/or have a medical condition discuss this with your doctor)

Slow breathing for relaxation (a special technique)
Feeling physically or mentally tense can interfere with sleep. Learning ways to relax can help sleep problems. There are many types of relaxation techniques. This is one of them.

•	breathe in to a count of 3 seconds.
•	when you get to 3, slowly breathe out to a count of 3
•	repeat this exercise for 5 minutes
•	when you are doing it last time say the word 'relax' to yourself as you breathe out
•	breathe in using your abdomen (not your chest) and through your nose
•	practise 10-15 minutes, at night in a comfortable chair
•	keep in mind that benefits of relaxation will not occur unless you practise

Identify pleasant activities
Think about those activities that you enjoy and those that you would like to have done (but never have). Write them below and carry out at least one of these activities each day

Pleasant activity			Activity I have always wanted to do
………………………	………………………………………………….
………………………	………………………………………………….
………………………	………………………………………………….

Establish a regular exercise routine
Look at the list below.
A little activity: taking leisurely walks, once or twice a week
Some activity: daily activities of regular housework, shopping, taking frequent walks
Active: routine exercise, aerobics, playing tennis, etc.

If you are not in the active group try to increase your level of activity by establishing a regular exercise routine. This can help you to overcome fatigue. Remember:
•	start slowly
•	gradually increase your level of activity
•	choose activities that you enjoy
•	choose convenient activities (those that fit into your daily routine)

Remember: if you are older than 65 years or have a chronic health condition or other physical problem, consult your doctor first before starting an exercise programme

Keep a record of progress 
Filling out the following form will help you keep track of your progress. Each day write down the date, and what you did during the day. Then mark how tired you were, using the scale as a guide. Then give yourself an overall rating (from 1–10) of how fatigued you were over the week.  You can compare your weekly scores and see how they change over time.

Week 	Level of  fatigue		
			Not at all	Mild	Moderate	Severe
Monday			_________	________	_________     _________
Tuesday		_________	________	_________     _________
Wednesday	_________	________	_________     ________
Thursday	_________	________	_________     _________
Friday		_________	________	_________     _________
Saturday		__________	________	_________      ________
Sunday		_________	________	_________      ________

Further information 
Coping with Chronic Fatigue by Trudi Chalder, 1995, for mild to moderate symptoms
Chronic Fatigue Syndrome: the Facts by Mike Sharp and Frankie Campling, Oxford University Press, 2000, for more severe symptoms.