Health & Wellness

Why am I tired all the time?

Getting a perfect night’s sleep every night is impossible. But if you’re sleeping pretty well and still wake up finding yourself out of sorts and tired most days of the week, there may be underlying problems.

There is a difference between typical sleepiness and the bone-weariness that is fatigue.

“Everyone can feel simply exhausted on occasion from too much work and too little downtime, but true fatigue is pretty much constant,” explains sleep expert Dr. Ilene Rosen, president-elect of the American Academy of Sleep Medicine (AASM.) “With fatigue, people don’t have energy and sleep doesn’t make them feel better.” On the other hand, sleepiness is usually resolved after a good snooze.

The good news is that “. . . doctors have gotten very savvy about sleep health can get to the bottom of conditions that may be causing sleep problems,” she says. Even better: treating an underlying condition can generally result in feeling more refreshed after sleep.

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There is a difference between typical sleepiness and the bone-weariness that is fatigue.

There are many potential medical issues that could be causing fatigue and can include diseases like cancer or undiagnosed heart disease. The bottom line: see your doctor if you have concerns.

Here are just a few of the problems that could be causing you to feel so darn exhausted.

1. Anemia

This disorder makes it tough for blood to move oxygen throughout your body. The most common type is iron-deficiency anemia. Iron helps transport oxygen. Some people who have iron-deficiency anemia develop restless legs syndrome (RLS), a disorder that causes a strong and uncomfortable urge to move the legs while at rest. That inability to get comfortable results in fractured, disrupted sleep.

2. Diabetes

Fatigue is a common symptom of diabetes, but the reasons behind the fatigue may be due to numerous issues related to the disease. Although those with diabetes are more prone to infections and anemia, both of which can cause fatigue, fluctuating blood sugar levels are also to blame.

“Obesity and lack of exercise can make people tired, but obesity and lack of exercise can also lead to diabetes and fatigue,” says Rosen, who also serves as program director of the University of Pennsylvania Sleep Fellowship program. “That fatigue is one of the reasons people may first see a doctor and get tested.”

3. Thyroid problems

The thyroid gland, which is located in your neck, helps your body control its energy use. If the gland is underactive (hypothyroidism), you feel sluggish and exhausted, says Dr. Raj Dasgupta, a specialist in pulmonary and sleep medicine at the University of Southern California and AASM fellow.

“The risk for hypothyroidism increases with age, so some women, for example, might think their exhaustion might be due to the menopause when in fact it’s a thyroid issue,” says Dasgupta.

4. Sleep apnea

Many people snore. But when snoring is linked to breaks in breathing, sleep apnea is the most likely cause. The most common symptom is chronic fatigue. Obesity is a risk factor, as is smoking, heredity, and excessive alcohol use, among others. Left untreated, sleep apnea can cause some serious issues including heart disease, premature death, and accidents. “It’s such a common problem and it’s so important for people to be evaluated,’ says Dasgupta. “Treatment can improve symptoms.”

5. Chronic pain

Although it seems like a no-brainer that pain reduces your chances of a good night’s sleep, researchers are still trying to better understand the link. One of the big culprits is arthritis. About half of people with osteoarthritis have problems falling or staying asleep, according to the Arthritis Foundation. Fibromyalgia is another sleep zapper, and of its most common symptoms is chronic fatigue, along with body aches.

“People with fibromyalgia simply don’t get deep, restorative sleep, and it seems that without that kind of sleep pain tolerance is worse” says Dasgupta. In fact, in one study researchers deprived a group of healthy women of deep or slow-wave sleep, for three days. The results: poor pain tolerance and higher levels of discomfort and fatigue, according to the National Sleep Foundation.

6. Depression

Here’s the rub. Depression — a persistent feeling of sadness, anxiety and disinterest — may cause sleep problems. But sleep problems also contribute to depression. Some folks may first develop sleep issues before an onset of depression. For others, depression occurs first.

In any scenario, lack of sleep just adds to the problems. For those with depression, insomnia, unrefreshing sleep, and daytime sleepiness are common. But, some studies show that the risk of developing depression is highest among those with insomnia and difficulties staying asleep, according to the National Sleep Foundation.

RELATED: 'Pink noise' may boost slow wave sleep and improve memory

7. Breathing problems

“Essentially anything that affects your breathing and oxygen can affect your sleep,” says Rosen. For example, people with asthma can cough and wheeze at night and have fractured sleep. Those with chronic obstructive pulmonary disease are more likely to develop insomnia, nightmares and daytime sleepiness, according to the Lung Institute.

Even a simple cold, the flu, or sinus problems can affect the quality of your sleep, leaving you exhausted.

8. Check your medicine cabinet

Certain classes of medications can also disrupt sleep.

“Some can cause daytime drowsiness others can keep a person up at night, but in many cases alternatives can be prescribed or people can take certain drugs at a different time,” says Dr. Kingman Strohl, program director of the Sleep Medicine Center at University Hospitals Cleveland Medical Center.

The list of drugs that can cause sleep problems is long, but some of the most notable offenders include:

  • Certain selective serotonin reuptake inhibitors used to treat depression and anxiety
  • Anti-arrhythmics used to treat heart rhythm problems
  • Beta-blockers used to treat high blood pressure
  • Cough and cold medications containing alcohol
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Medicines and prescriptions you should have (and when to throw them out)

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Medicines and prescriptions you should have (and when to throw them out)

Play Video - 3:35

9. But maybe you just need more sleep

Let’s get real. If you feel just so sleepy all the time, there’s a good chance “. . . you’re just not getting enough sleep,” says Strohl, professor of medicine at Case Western Reserve University School of Medicine. “People don’t place a big priority or enough value on sleep and then they wonder why they are tired.” Adults are supposed to get about seven to nine hours every night, but more than one-third of people say they barely get seven, according to the National Sleep Foundation.

RELATED: Here's how much sleep you really need each night

If you don’t place a priority on sleep, you can run into some big trouble like obesity, dementia, or poor job performance, among others.

So try to keep regular sleep hours (even on weekends), toss your tech from your bedroom, skip the late night dinners and alcoholic drinks right before bedtime, and get your exercise during the day. Those lifestyle changes alone may be enough to help you get a better night’s sleep.

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