13 medical reasons you’re tired all the time

You feel like you’re always going to bed early, but when your alarm goes off, it’s hard to open your eyes and you’re in a fog all day. You may feel like no matter how much sleep you’re getting, you’re still tired. But how do you know how much sleep you need?

How much sleep you need varies by age. While newborns under three-months-old may need up to 19 hours of sleep and adults over 65 may need as little as five hours, most adults need about seven to nine hours of sleep a night. While not getting enough sleep can hurt your health in these sneaky ways, oversleeping and constantly being tired can be a sign of a problem.

What’s best, according to Dr Jacob Teitelbaum, who specialises in sleep, fibromyalgia, and pain, is to sleep the amount of time that leaves you feeling the best. “If you are needing more than 10 hours of sleep to feel restored, however, then that suggests that your sleep quality is poor and needs to be addressed,” he says.

If you’re getting enough sleep on a good schedule or are even oversleeping and still feel tired, it could be a sign of health problems.

You may think skimping on sleep during the week and oversleeping during the weekends will help you feel well-rested, but it’s actually hurting your sleep. This habit is called “social jetlag” which is brought on by shifts in your sleeping schedule during the week versus on the weekends. “Your body prefers routine, but still appreciates you making up the sleep, so it’s best to find a steady balance you can stick to,” adds Dr Teitelbaum.

When you visit your doctor and complain of feeling tired all the time, the first things they’ll often check for is anaemia or thyroid disorder because you can detect those with a blood test, says Dr Amy Shah. “When a patient says ‘I’m tired,’ it’s such a broad term and could be so many things, but if someone says ‘I’m tired and feeling a little more short of breath,’ or, ‘I’m having trouble exercising,’ that tends to be anaemia.” Anaemia is when your blood doesn’t carry enough oxygen to the rest of your body and the most common cause of anaemia is iron deficiency. Anaemics may also experience feeling cold, dizzy, irritable, or have headaches in addition to feeling tired.

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People who suffer from conditions, such as fibromyalgia, rheumatoid arthritis, hypothyroidism, and anaemia, often require sleep. “For fibromyalgia, the person is not able to go into deep restorative sleep because the sleep center (the hypothalamus) is not working,” explains Dr Teitelbaum. “For rheumatoid arthritis, the pain often disrupts deep sleep, so it takes more sleep to get the same recharging of your battery.” In hypothyroidism and anaemia, extra sleep over nine hours doesn’t really help.

If you have a thyroid issue, like an underactive thyroid (hypothyroidism), in addition to feeling tired, you might also feel like your skin is really dry and you’re constipated a lot, along with the lack of energy, says Dr Shah. Hypothyroidism is a condition that occurs when your thyroid gland doesn’t produce enough of certain important hormones. While women are more likely to have hypothyroidism, thyroid function tests can diagnose hypothyroidism easily and if you have an issue, your doctor may prescribe a synthetic thyroid hormone.

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Most people who have high blood sugar due to type 2 diabetes have insulin resistance. “Insulin is the key that opens up our cellular energy furnaces called mitochondria and allows sugar to enter to be burned for fuel,” explains Dr Teitelbaum. “Because this key is not working, sugar cannot get into the furnaces to be turned into energy, leaving people tired.”

If you feel like you’re tired all the time, don’t want to get out of bed in the morning, and/or have trouble sleeping, you could be suffering from depression. Your primary care physician should do a depression screening during a regular visit, says Dr Shah. Your doctor can use a screening tool to determine if you’re experiencing an ongoing depressive disorder, or whether a life stressor or alcohol affects your emotional state. “Depression, alcohol abuse, and fatigue are very tightly knit,” says Dr Shah. Sometimes people will treat depression with alcohol and then be tired, she says.

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Your gut is supposed to be a very closed system of cells where nothing from inside of the gut gets into the outside—like a pathway where the body absorbs what it needs without having things enter the rest of the body, says Dr Shah. “If you’re eating poorly, especially a lot of processed foods, the gut cells can become a looser, net-like structure instead of a tight structure and proteins that aren’t supposed to be in our bloodstream leak into our bloodstream, which creates an inflammatory response,” says Dr Shah. The inflammatory response is thought to possibly manifest as bloating, fatigue, moodiness, headaches, or weight gain. Some people call this leaky gut, although this condition hasn’t been clinically proven. If you have food sensitivities (to foods like wheat and dairy) you can feel fatigued, get rashes, and experience bloating or brain fog. “There’s no real good test for food sensitivities,” says Dr Shah.  Following an elimination diet of possible food culprits and then slowly introducing them back in may help you identify what you’re sensitive to. If you remove all wheat from your diet and feel great, and then add it back and feel lethargic, that could be a tell-tale sign of a food sensitivity to wheat, Dr Shah says.

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“Adrenal fatigue isn’t a Western medicine term, it’s a functional medicine term, and a lot of Western doctors don’t recognise it as a medical [issue],” says Dr Shah. There’s a disconnect because it’s hard to show with lab testing, she says. These hormone imbalances could be brought on by a stressful situation in your life, like family problems, or it could be constant stress at work, lack of sleep, over-exercising, having a poor diet, or drug or alcohol abuse, says Dr Shah. Those circumstances can push your stress hormones high and then eventually leave you exhausted and depleted, like a bank account that you’re overdrawing on and not putting money back into.

Doctors will often check for chronic infection as a cause of fatigue due to such infections as the Epstein-Barr virus (mononucleosis) or Lyme disease. Both of these medical issues can present with extreme fatigue.

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