fatigue

and Sabine Schrör, medical journalist

Ingrid Müller is a chemist and medical journalist. She was editor-in-chief of for twelve years. Since March 2014 she has been working as a freelance journalist and author for, among others, Focus Gesundheit, the health portal ellviva.de, the publishing house living crossmedia and the health channel of rtv.de.

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Sabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.

More about the experts All content is checked by medical journalists.

Are you tired during the day? Most of the time, that's just a sign that your body needs a break. You should only take a closer look when tiredness permanently affects your performance. The main causes of persistent fatigue are lack of sleep, physical and mental exertion, and overwork. But diseases such as an underactive thyroid can also make you chronically tired. Read here about the causes of fatigue and what you can do about it.

Brief overview

What is fatigue? Basically normal body condition, signaling the need for rest. Persistent tiredness can also be a sign of a health disorder or illness. Frequent side effects are listlessness, reluctance and declining physical / mental performance.
Causes: chronic lack of sleep, lack of exercise, fatty, high-calorie food, obesity, malnutrition, lack of fluids, stress / burnout, boredom (boreout), poorly ventilated living or work rooms, toxins and pollutants in the environment, various diseases (such as infections, sleep apnea, hypothyroidism , Diabetes mellitus, anemia, chronic fatigue syndrome, cancer, depression, anxiety disorders, cardiac arrhythmias, low blood pressure, migraines), medication, alcohol.
When to the doctor In the case of inexplicable or prolonged tiredness. For fatigue-related impairment of physical / mental performance at work or in everyday life. With additional symptoms such as night sweats, dry mucous membranes, blood in the stool, swollen lymph nodes, severe thirst. In addition, if the tiredness cannot be relieved with sleep, relaxation and exercise in the fresh air.
Examinations: physical examination, blood tests, possibly examination in the sleep laboratory with electroencephalography (EEG), electrocardiography (EKG), gastroenterological examinations, etc.
Treatment: depending on the cause, e.g. B. diet change, medication for underlying diseases (such as iron supplements for iron deficiency, hormone preparations for hypothyroidism), behavior therapy and regular exercise for mental illnesses, breathing mask, bite splint or surgical corrections for sleep apnea.
What you can do yourself: live according to your own internal clock, if possible, take short naps during the day (power napping), a balanced, vitamin-rich, low-fat diet, drink enough (water, tea, etc.), if possible no alcohol or nicotine, regular exercise and sport, cold showers / alternate showers, stress relief, relaxation exercises.

Fatigue: description

Fatigue in itself is not a disease. Rather, it is a natural signal from the body when it needs rest and a break (e.g. due to acute lack of sleep) or when certain nutrients are lacking.

It is different when someone is constantly tired and exhausted and perhaps even tends to doze off during the day. In addition, there are often listlessness, reluctance and reduced physical and / or mental performance. These are all signs that something is wrong.

Who is affected?

According to the German General Practitioner Society (DEGAM), in surveys around 31 percent of people over the age of 16 state that they sometimes or often suffer from symptoms of fatigue - women more often than men. People from higher social classes and those who live in partnerships are less tired.

Fatigue & sleep

A lack of sleep is very often the cause of fatigue. But how much sleep does a person actually need? It varies greatly from person to person - some people are born to sleep a lot, others generally get by with less sleep.

We need that much sleep

In the course of life, the need for sleep decreases steadily

Age also plays a role: In the first three months of life, babies sleep an average of 17 hours out of 24. This average sleep duration drops to around 14 hours by the end of the first year of life. Two-year-olds need about 13 hours of sleep on average, four-year-olds about 12 hours. At the age of six, children usually get by with 11 hours of sleep.

Adults don't have to sleep as long to be fit the next day: 40-year-olds usually sleep around seven hours at night. The need for sleep generally decreases with age. For healthy 80-year-olds, around six hours of night sleep is usually enough. But as mentioned - these are all only guidelines. Everyone has their own personal need for sleep.

Fatigue: causes

Fatigue can have various causes. It does not necessarily have to be a sign of illness, but can also be caused by an unhealthy lifestyle, for example. Below is a list of the most important causes of fatigue.

General causes

Chronic lack of sleep: going to bed too late, getting up early, living against the natural sleep-wake cycle
Lack of exercise: If you do not move enough, you get tired more quickly.
Fatty, high-calorie food: after an opulent meal, increased blood flows into the digestive organs. Other regions like the brain are then less affected
Blood and with it oxygen supplied - you get tired.
Obesity
Diets or underweight: If too few nutrients, minerals and vitamins are supplied to the body, deficiency symptoms can occur, which in turn can trigger fatigue.
Lack of fluids: If you drink too little, the blood becomes thick and can only circulate slowly. In this way, the brain is also supplied with oxygen after a delay. Therefore, drink enough. For adults, two liters of fluids per day (at moderate temperatures) are recommended.
Stress at work or in everyday life, burnout and persistent underload (boredom, boreout) make you tired.
poorly ventilated rooms and dry air
Toxins and pollutants in the air (work, living rooms)

Illnesses as a cause of fatigue

In addition, various diseases can be accompanied by fatigue. The most important examples are:

Infections with viruses or bacteria: The immune system runs at full speed to fight off the pathogens. Persistent fatigue is often the result. This happens, for example, with the flu, cold, pneumonia and glandular fever. Under certain circumstances, tiredness can persist for a long time after the infection has subsided (for example after the flu).

Sleep apnea: The nocturnal respiratory arrests interrupt sleep again and again and thus prevent a restful night's sleep.That is why those affected are often extremely tired during the day.

Anemia: tiredness, reduced performance, dizziness and headaches are common symptoms of anemia and the associated lack of oxygen in the body. Possible causes of anemia are e.g. lack of iron, vitamin B12 or folic acid, bleeding, infections, autoimmune or genetic diseases.
Cardiac arrhythmias
Metabolic disorders such as underactive thyroid (hypothyroidism) or diabetes (diabetes mellitus)
Cancer: For example, fatigue is an early symptom of blood cancer (leukemia) and lymph gland cancer (lymphoma). Cancer therapies (e.g. chemotherapy, radiation) also cause fatigue as a side effect. Overall, one speaks here of tumor-related fatigue, from which almost all cancer patients suffer at least temporarily.
Other chronic physical illnesses such as heart failure (heart failure), multiple sclerosis, rheumatoid arthritis, sarcoidosis, or chronic kidney failure (chronic kidney failure)

Mental illnesses such as depression and anxiety disorders can also be associated with fatigue. If symptoms such as tiredness and dejection always occur in the winter months, you may have winter depression (seasonal dependent depression, SAD).
Low blood pressure (hypotension)
migraine

Fatigue from medication or addictive substances

Certain medications can make you tired. These include antidepressants, neuroleptics, as well as agents for high blood pressure and allergies (antihistamines).

All addictive substances can also lead to fatigue. This is especially true for alcohol, but also for other addictive substances such as tobacco or illegal drugs.

Chronic fatigue syndrome

Chronic fatigue syndrome (CFS) must be distinguished from tiredness due to lack of sleep, stress, anemia, cancer and the like. It is also called chronic fatigue syndrome. This is a complex and elusive clinical picture that is associated with persistent exhaustion for no apparent reason. Other complaints such as insomnia, sore throat and muscle pain also occur. The exact cause of CFS is unknown.

Fatigue: when do you need to see a doctor?

Everyone knows fatigue as a natural sign that the body needs a break. However, if you are constantly tired over a long period of time, you should consult a doctor to rule out any illnesses as the cause.

Frequent fatigue can indicate a serious illness. This is especially true if symptoms such as night sweats, dry mucous membranes, blood in the stool, swollen lymph nodes or unusually strong thirst occur. Then you should definitely consult a doctor.

A doctor's visit is also recommended if:

tiredness cannot be combated with sleep, relaxation and exercise in the fresh air
the tiredness lasts longer than you are used to
Seizures of fatigue have a major impact on your physical and mental performance at work and / or in everyday life
You get tired without doing exceptional effort
the tiredness remains without being replaced by lively, awake phases

Fatigue: what does the doctor do?

At the beginning, the doctor will collect your medical history (anamnesis) in an initial consultation in order to find clues as to the cause of the tiredness. You should speak openly and honestly about your life situation and possible problems, otherwise the doctor may not be able to help you. Possible questions in the anamnesis interview are, for example:

How severe is the tiredness? How long does it last? How is the fatigue course during the day?
Are there any other complaints associated with it?
Is tiredness new and unfamiliar to you?
Do you fall asleep at the wheel?
Does tiredness affect you in everyday life?
Are You Suffering From Symptoms Of Depression Or Anxiety?
How well and how long do you sleep at night?
Do you snore?
What is your social, professional and family situation like (worries, stress, overworking / underworking, etc.)?
Have you put on or lost a lot of weight recently?
Have you had an infection recently?
Do you suffer from a chronic illness?
Do you regularly take medication?
Do you use drugs?
Are you regularly exposed to harmful environmental influences (e.g. working with poisonous substances and pollutants, noise pollution)?

The medical history is followed by a physical exam. The focus is on the lymphatic regions, the heart, the respiratory tract, the gastrointestinal and urogenital tract as well as the function of the nervous system and muscles. The doctor can do a blood test, a blood glucose test, an examination in a sleep laboratory with recording of the brain waves (EEG) and an electrocardiography (EKG).

treatment

If the doctor has found an underlying disease to be the cause of your tiredness, he will recommend the appropriate therapy. Some examples:

Infections such as flu or cold - and with them tiredness - usually go away on their own after a few days, when the body has fought the pathogens. It may be possible to use antipyretic agents, expectorants, inhalations, etc. to alleviate the symptoms and support the healing process.

In the case of anemia due to iron deficiency, foods containing iron usually help. The trace element is found in plant-based foods such as whole grains, green leafy vegetables (broccoli, spinach), beetroot and nuts. Iron from animal products (e.g. meat) can, however, be better utilized by the body. If the iron deficiency is severe, the doctor will also prescribe an iron supplement.

If the anemia is triggered by a lack of folic acid or a vitamin B12 deficiency, appropriate dietary supplements can also help.

An underactive thyroid can be treated well with medication. Those affected usually have to take artificial thyroid hormones for life.

In the case of mental illness, behavior therapy in combination with regular exercise can help.

Sleep apnea is mostly due to obesity. Those affected should therefore lose weight as much as possible. Usually a few pounds less are enough to breathe more regularly and sleep better at night. If you also do without alcohol and sleep on your side, you can get the nightly breathing pauses even better under control. If all of that is not enough, breathing masks, bite splints or surgical corrections can be considered.

Fatigue: What You Can Do By Yourself

You can do a lot yourself to keep yourself fit and productive and to prevent attacks of fatigue. Before doing this, however, make sure that the tiredness is not caused by a serious illness.

Live according to your own internal clock as far as possible: Some people tend to be fit and productive in the morning hours, while others only reach their maximum performance level in the evening. Try to align your daily activities and your night sleep as best you can with your internal clock.
A short sleep in between (power napping) helps to recharge the batteries and protects against drowsiness.
Eat a balanced diet rich in vitamins and low in fat and avoid being overweight.
Drink enough, around two liters per day. We recommend water, unsweetened tea or fruit juice spritzer.
Consume alcohol in moderation and do not smoke.
Exercise regularly to stimulate the circulation. But don't overdo it, because too much exercise can also exhaust you.
A cold shower or alternating showers get your circulation going in the morning and drive away tiredness.
Try to reduce stress (work, family) and it is best to learn a relaxation technique such as yoga, autogenic training or progressive muscle relaxation.
Some medications make you tired. Ask your doctor about an alternative.

Overall, the following applies: tiredness can be treated - but mostly only through changes in lifestyle and daily routine. The successes do not show up overnight, but step by step. Give yourself the time you need.

Additional information

Guidelines:

Guideline "Fatigue" of the German Society for General Medicine and Family Medicine
Patient guideline "Fatigue" of the German Society for General Medicine and Family Medicine