Why Am I So Tired?

Your eyes are bloodshot, your energy is low, and your patience is beyond thin. If this perfect storm of imperfect physical, emotional, and psychological scenarios is brewing after a particularly solid night of sleep, you might be asking yourself, “why am I so tired?!” It’s a question that just about everyone has from time to time, and it can be frustratingly hard to answer when all of the basic needs — proper nutrition, rest, physical activity, etc. — have seemingly been met. So what gives? You have improved your sleep hygiene and cut out that evening glass of wine, what else could be going on? Here are some of the surprising reasons you might be dragging (and the concrete steps you can take to feel better fast).

Feeling tired isn’t just tied to physical causes — your mental health plays a major role in your energy levels as well. Experts have long known that feeling tired or having low energy can be a symptom of depression, along with trouble falling asleep or sleeping too much. In fact, a review in 2018 found that over 90% of people with major depressive disorder also experience fatigue.

When assessing your fatigue, your primary care provider may ask you questions about your mood in addition to assessing your sleep habits and other potential biological causes. If you feel that your mood is the primary driver of your fatigue, you can partner with your provider to come up with a strategy to address your mood, which may involve behavior changes, therapy, or medication (or a change in medication).

Feeling weak, tired, and having difficulty concentrating? While these symptoms are fairly nonspecific, one common culprit is iron deficiency. Iron is a critical component in the function of healthy red blood cells which deliver oxygen to our muscles and tissues. When your iron levels are low, the transport of oxygen is impeded and can even impact the production of red blood cells, resulting in iron deficiency anemia (anemia means there is low blood cell amount in the body). When there aren’t enough red blood cells to supply the organs with oxygen, it can lead to an array of symptoms including shortness of breath, heart palpitations, and yes, fatigue and weakness. However, you don’t need to be anemic to feel these effects, as low iron alone can also make you feel run down and tired too.

Iron deficiency and iron deficiency anemia are more common than you might think, and much more common in individuals who menstruate because of repeated blood loss during menstruation (The heavier the period, the greater the risk). Individuals with very restricted diets (e.g. vegetarians and vegans) are also at high risk if they are not getting adequate amounts of iron in their diet or supplements. Foods that help prevent iron deficiency are rich in iron, such as red meat, beans, dark leafy greens, iron-fortified grains, seafood, and peas. It’s also important to include plenty of vitamin C-rich foods, like broccoli, citrus fruits, strawberries, and peppers, in your diet since vitamin C aids in the absorption of iron. If menstruation is the primary cause of your iron deficiency, your primary care provider may recommend birth control to help regulate and lighten your period each month, and there are several oral birth control options that have an iron supplement (Fe) built into it.

If you are found to have iron deficiency or iron deficiency anemia, it’s important to partner with your primary care provider in addressing it, as they can guide you on different treatment options or recommend additional testing if it’s not improving after treatment.

Sleep apnea is a common condition that occurs when a person experiences breathing interruptions during sleep — about 22 million Americans have it. There are many different factors that influence your risk for the condition, including age, weight, alcohol use, smoking, and certain medical conditions. Symptoms can include loud snoring, gasping for air, and reduced breathing at night. As a result of the frequently disruptive sleep, people with sleep apnea often experience fatigue and sleepiness during the day in addition to other symptoms like dry mouth, irritability, headaches, and more. Sleep apnea isn’t just inconvenient — left untreated, it can lead to serious and even life threatening conditions like heart disease or a stroke.

Luckily, there are plenty of solutions and treatments for sleep apnea, including certain lifestyle modifications like smoking cessation, breathing devices (CPAP machines), and more. If your primary care provider thinks sleep apnea may be the cause of your fatigue, they may connect you with a sleep medicine specialist or order a sleep study to better assess your breathing at night.

Perhaps unsurprisingly, there is a long list of health issues that can contribute to chronic tiredness. Everything from diabetes to thyroid disorders can cause fatigue. Your primary care provider can often help you rule out any concerning causes of fatigue based on your story and physical exam, but they will let you know if they think some additional lab work or other testing is needed. All that said, it’s important to understand that tiredness alone does not indicate the presence of any serious health condition.

Struggling with fatigue or have more questions? Book an appointment to talk to a primary care provider.