Why am I so tired all the time?

It’s a modern-day mantra: “Why am I so tired all the time?” In our hyperconnected, turbulent world, everyone feels worn out now and then.

But sometimes tiredness becomes something more: a deep, unshakeable fatigue that interferes with your life for weeks, months or even years.

Our first urge, when this happens, is often to shrug it off. Push through. Fatigue is more than just tiredness, though. It’s a message the body sends to alert us that something needs attention.

How is fatigue different from tiredness?

“To me, tired is something you feel for a day or two — after a stressful period at work or even after running a marathon,” said Dr. Chan Badger, president of Novant Health primary care services. “But the term ‘fatigue’ refers to a more chronic condition.”

Fatigue is surprisingly common and slightly more prevalent among women than men. In primary care settings, Badger said, as many as one-third of all patients seeking care describe fatigue as a worrisome symptom.

Dr. Chan Badger

“When a patient comes in and says, ‘You’ve got to help me — I’m just so fatigued all the time,’ we need to sort out what they're talking about,” he said. “The only way to do that is to ask a lot of questions and listen carefully to the answers."

What does fatigue feel like? Is it the same for everyone?

The word fatigue can mean very different things to different people, including:

• Feeling constantly “worn out” or depleted. Feeling sluggish and unrefreshed after sleeping, having trouble getting up in the morning, or finding it difficult to take part in normal daily activities like cleaning the house or going to work.
• Having low stamina or easy fatiguability. Feeling motivated to take part in an activity, but needing to sit down and rest after a short while. “This is that feeling you get when you’re recovering from the flu or COVID-19,” Badger said.
• Being mentally or emotionally fatigued. Experiencing a lack of motivation, less interest in favorite activities or having an ongoing case of “the blahs.”
• Having an uncontrollable need to sleep. Nodding off during meetings or experiencing sleepiness that interferes with relationships and responsibilities.

What are the different types of fatigue?

When assessing fatigue, clinicians often categorize it into one of three types — acute, subacute and chronic — based on how long the patient has experienced it. This can be helpful in determining potential causes.

Acute fatigue — lasting up to one month: Acute fatigue is almost always related to a specific illness. “Influenza, mononucleosis or COVID-19 can really zap you,” Badger said. This type of fatigue can also result from:

• Major stress or emotional turmoil.
• Sleep — too much, too little or unusual sleep patterns (like shift work).
• Alcohol or drug use.
• Jet lag.
• Prescription or over-the-counter medications.

Subacute fatigue — lasting one to six months: “When someone feels fatigued on a more chronic basis, we’d be looking at a more long-term cause,” Badger said. Possible areas to explore include:

• Heart and lung diseases like emphysema, chronic obstructive pulmonary disorder or congestive heart failure.
• Endocrine system disorders, including potential issues with the thyroid or adrenal glands.
• Clinical depression (even in those undergoing treatment) or seasonal affective disorder.
• Cancer treatments like chemotherapy or an undetected cancer.
• Lifestyle-related health concerns like under- or over-exercising, working too many hours or poor eating habits.
• Anemia (having too few healthy red blood cells to deliver oxygen to your body).
• Allergic reactions, including seasonal allergies.

Chronic fatigue — lasting more than six months

Potential causes of long-term debilitating fatigue include:

• Autoimmune conditions including diabetes, multiple sclerosis and rheumatoid arthritis.
• Traumatic brain injury or concussion.
• Sleep apnea.
• Chronic kidney disease.

There’s also chronic fatigue syndrome (also known as myalgic encephalomyelitis, or ME/CFS) — patients suffering from chronic fatigue don’t necessarily meet the diagnostic criteria for ME/CFS.