Fatigue — when does exhaustion pose a danger?

From time to time almost everyone reaches a point of exhaustion or burnout. These cases of temporary tiredness usually have an identifiable cause and an expected remedy. However, when the exhaustion is persistent, it lasts longer, is more profound and is not relieved by rest. It becomes an almost constant state of fatigue which, once established and become a constant companion, over time reduces energy, motivation and concentration. Such a level of fatigue affects emotional and psychological well-being and is therefore a clear source of danger. Fatigue is difficult to define medically because the sensation is subjective and everyone experiences it differently. In general, the most natural cause is lack of sleep. If fatigue becomes persistent and you feel you never really get rested, see a doctor as soon as possible!

Causes of fatigue

Fatigue most often traces back to one or more of your habits or routines, most notably lack of physical activity. It is also commonly associated with depression. In some cases, fatigue can be a symptom of other medical conditions that require treatment.

Lifestyle factors

An honest inventory of things that might be responsible for your tiredness is often the first step toward improvement. It may be related to, for example:

Alcohol or drug use

Unhealthy eating habits

For example, late-night "overeating," meaning consuming too large a quantity of food. Heavy dinners (e.g. meat with potatoes or bread-based dishes). Etc.

Lack of physical activity

Lack of exercise leads to a decrease in muscle strength and mass and thus reduces physical capacity.

Medications

For example antihistamines (commonly for allergies) and some cough medicines.

Jet lag

This is a temporary sleep disorder that occurs when you travel across multiple time zones by plane.

The body has its own internal clock (circadian rhythm) that signals when to be awake and when to sleep. Jet lag occurs because your body clock is still synchronized to the original departure time zone rather than the one you have traveled to. The more time zones you cross, the more likely you are to experience jet lag.

Time difference can cause daytime fatigue, malaise, difficulty staying alert and gastrointestinal problems. Its effect is temporary but can significantly reduce comfort during holidays or business trips. Fortunately, there are steps you can take to prevent or minimize its consequences.

Insufficient sleep

Excessive physical activity

Overtraining can also cause exhaustion. Remember that the effect of exercise is consolidated during recovery, so rest is extremely important.

Diseases

Persistent exhaustion can be a sign of disease, or an effect of drugs or therapies used in past or ongoing treatments, such as:

Concussion

A traumatic brain injury that affects how the brain works. Effects are usually temporary and may include headache and problems with concentration, memory, balance and coordination.

A blow to the head is the most common cause, though violent shaking of the head and upper body can also cause concussion.

It may sometimes involve a loss of consciousness, but most often this does not occur.

Concussions frequently happen in falls and are common in contact sports or rugby. Most people make a full recovery.

Acute liver failure

A rapid (days or weeks) decline in liver function, usually in someone without pre-existing liver disease. It is most often caused by hepatitis viruses or drugs such as paracetamol (acetaminophen). Acute liver failure is less common than chronic liver failure, which develops more slowly.

This condition, also known as fulminant liver failure, can cause severe complications including excessive bleeding and increased pressure in the brain. It is a medical emergency that requires hospital care.

Depending on the cause, acute liver failure may be reversible with treatment. In many cases, however, liver transplantation may be the only option.

Sleep apnea

A potentially serious sleep disorder where breathing repeatedly stops for long seconds and then restarts.

If you snore and regularly wake up feeling tired even after a full night’s sleep, you may have sleep apnea.

The main types are:

• Obstructive sleep apnea: the most common form, occurring when throat muscles relax.
• Central sleep apnea: occurring when your brain fails to send proper signals to the muscles that control breathing.
• Complex sleep apnea syndrome.

See a sleep clinic, because therapy can relieve symptoms. Most importantly, it can help prevent heart problems and other complications (for example progressive cognitive decline).

COPD exacerbation and emphysema

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that obstructs airflow into the lungs. Symptoms include breathing difficulty, cough, phlegm production and wheezing. It is usually caused by long-term exposure to irritating gases or particles, most often cigarette smoke. The risk of heart disease, lung cancer and many other conditions is increased.

Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. These two conditions often occur together and vary in severity.

Chronic bronchitis involves inflammation of the inner walls of the airways that carry air to the lung air sacs (alveoli). It is characterized by persistent cough and phlegm production.

Emphysema is a condition in which the air sacs at the ends of the smallest airways in the lungs are destroyed and merge together. As a result, the surface area available for oxygen exchange is reduced.

Although COPD is progressive, it is treatable. With appropriate therapy most people can achieve good symptom control and quality of life, and reduce the risk of associated diseases.

Covid-19 (coronavirus infection)

Coronaviruses can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The new coronavirus identified in 2019 is known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease it causes is called coronavirus disease 2019 (COVID-19). The World Health Organization (WHO) declared COVID-19 a pandemic in March 2020.

Fatigue or exhaustion can be a symptom of COVID-19 infection (as with many other viral infections).

Diabetes

A disease that affects how the body uses blood sugar (glucose). Glucose is vital for health and is a basic energy source for every cell and tissue. It is also the brain’s main fuel.

In diabetes, the level of sugar in your blood rises and cannot enter cells to be converted into energy. High blood sugar over time leads to health problems, including chronic fatigue.

Depression

A mood disorder that causes persistent sadness and loss of interest. It affects feelings, thinking and behavior, and can lead to many emotional and physical problems. It can make routine daily activities difficult and sometimes make life feel not worth living.

It is more than simple sadness: it is not just a temporary weakness and cannot be overcome by will alone. Depression may require long-term treatment.

Most people feel better in a reasonable time with medication, psychotherapy or a combination of both.

Obesity

A complex disease characterized by excessive accumulation of body fat. It is far from being "just" a cosmetic problem. It increases the risk of other diseases and health problems such as heart disease, diabetes, high blood pressure and certain cancers. Carrying excess weight puts additional strain on the body. Even when sitting or lying down you are carrying extra "load," which can lead to fatigue.

There are many reasons why losing weight can be difficult. Obesity is usually the result of inherited, physiological and environmental factors. These predispositions combine with your choices about eating and exercise, producing a complex effect on your life that is often hard to change.

The good news is that even modest weight loss can improve or prevent many obesity-related health problems. A healthier diet, more exercise and gradual changes in bad habits can help with weight loss.

Fibromyalgia

Characterized by musculoskeletal pain accompanied by fatigue, sleep, memory and mood problems. Researchers believe fibromyalgia amplifies pain sensations by affecting how the brain and spinal cord process pain and non-pain signals.

Symptoms often begin after a triggering event such as physical trauma, surgery, infection or significant psychological stress. Sometimes symptoms develop gradually without a single triggering event.

Fibromyalgia is more common in women than men. Many people with fibromyalgia also have tension-type headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.

Although there is no cure, various medications can help control symptoms. Exercise, relaxation and stress-reduction techniques are also very helpful.

Grief

Medications and treatments

Fatigue can be caused by chemotherapy, radiation therapy, certain painkillers, heart medications and some antidepressants.

Hyperthyroidism (overactive thyroid)

Occurs when the thyroid gland produces too much of the hormone thyroxine. It speeds up the body’s metabolism, which can cause unintentional weight loss, a fast or irregular heartbeat and persistent fatigue.

Various treatments are available: antithyroid medications and radioactive iodine are used to slow hormone production. Sometimes treatment includes surgery to remove part or all of the thyroid gland.

Although it can be a serious condition (especially if ignored), most people respond well when the disorder is diagnosed and treated in time.

Hypothyroidism (underactive thyroid)

Occurs when the thyroid gland does not produce enough of certain vital hormones. In early stages, hypothyroidism may not cause noticeable symptoms. Without treatment it can lead to many health problems over time such as weight gain, joint pain, fatigue, infertility and heart disease.

Diagnosis is made with thyroid function tests. Treatment with synthetic thyroid hormone is generally simple, safe and effective. The required dose is individual and it may take time to find the right amount with your doctor.

Chronic fatigue syndrome (CFS)

A complex condition characterized by extreme fatigue lasting at least six months that cannot be fully explained by another condition. The fatigue worsens with physical or mental activity and does not improve with rest.

Other typical symptoms include:

• Sleep that is not refreshing.
• Problems with memory, cognition and concentration.
• Dizziness that worsens when moving from lying to sitting or standing.

This condition is also known as myalgic encephalomyelitis (ME). A newer recommended term is systemic exertion intolerance disease (SEID).

Its cause is unknown, although many theories try to explain its development, ranging from viral infection to psychological stress. Some experts believe chronic fatigue syndrome may be triggered by a combination of several factors.

There is currently no diagnostic test that confirms it. Various medical analyses may be needed to exclude other health problems with similar symptoms. Treatment focuses on improving symptoms.

Chronic infection or inflammation

Chronic kidney disease

A condition involving a gradual loss of kidney function. The kidneys filter waste and excess fluid from the blood, which then leave the body in urine. One of the kidneys’ important roles is cleansing the blood of excess fluid, chemicals and waste. If the kidneys cannot perform this task and treatment is not provided, serious health problems may develop, and in the worst case can be life-threatening. Advanced chronic kidney disease can lead to dangerous accumulation of fluid, electrolytes and waste products.

In early stages, there may be few signs or symptoms; it may only be noticed when advanced.

Treatment aims to slow the progression of kidney damage, usually by eliminating or controlling the underlying causes. Even controlling the causes may not always prevent progression. Chronic kidney disease can progress to end-stage renal failure, which is fatal without dialysis or kidney transplantation.

Malignant tumor (cancer)

Conditions characterized by abnormal cells that multiply uncontrollably, invade and destroy normal body tissues. They can often spread throughout the body.

Cancer is the second leading cause of death worldwide. Survival rates have improved for many types of cancer thanks to screening, therapies and prevention.

Chronic pain

Multiple sclerosis

A disease of the brain and spinal cord (central nervous system) that can cause disability.

The immune system attacks the protective covering (myelin) of nerve fibers, causing communication problems between the brain and the rest of the body. The disease can eventually cause permanent nerve damage or destruction. Depending on where nerve damage occurs, MS can affect vision, sensation, coordination, movement and bladder and bowel function.

Signs and symptoms vary widely and depend on the extent of nerve damage and which nerves are affected. Some people with severe MS may lose the ability to walk independently or at all, while others may experience long periods of remission without new symptoms.

There is currently no cure. Treatments can, however, help speed recovery from attacks, modify the disease course and manage symptoms.

Heart disease

Refers to a range of conditions that affect the heart and can cause chronic fatigue and reduced physical and mental performance among other symptoms.

Heart diseases include:

• Vascular diseases such as coronary artery disease.
• Heart rhythm problems (arrhythmias).
• Congenital heart defects.
• Valve disease.
• Diseases of the heart muscle.
• Infections affecting the heart muscle or valves.

Many forms can be prevented or treated with a healthy lifestyle.

Anxiety disorders

Occasional anxiety is a normal part of life. However, people with anxiety disorders often worry intensely, excessively and persistently about everyday situations. They may experience recurrent episodes of sudden intense anxiety, fear or terror that peak within minutes (panic attacks). Some experience shortness of breath-like sensations and chest pain.

These feelings of anxiety and panic interfere with daily activities, are hard to control, disproportionate to actual dangers and can last a long time.

People may even consciously avoid certain places or situations to prevent panic feelings. Symptoms can start in childhood or adolescence and continue into adulthood.

Anxiety disorders include social phobia, specific phobias and separation anxiety disorder. More than one anxiety disorder may occur. Sometimes anxiety is a consequence of another condition that requires treatment.

Whatever form anxiety takes, treatment can help.

Stress

Anemia

There are not enough healthy red blood cells to carry adequate oxygen to your tissues. Because of low hemoglobin, you may feel tired and weak.

There are many forms and causes. It can be temporary or long-term, and symptoms range from mild to severe. Most cases of anemia have more than one cause. See your doctor if you suspect anemia. It can sometimes be a warning sign of a serious disease.

The diseases and conditions listed above are often associated with fatigue. In fact, fatigue can be a symptom of many other illnesses as well.

For an accurate diagnosis, always consult a doctor!

When to see a doctor?

Seek immediate emergency care for fatigue if you also experience any of the following symptoms.

• Thoughts urging you to harm yourself (including suicidal thoughts).
• Concern that you might harm someone else.
• Chest tightness or chest pain.
• Shortness of breath.
• An irregular or very rapid heartbeat.
• The feeling that you could faint at any moment.
• Severe abdominal, pelvic or back pain.
• Abnormal bleeding, including rectal bleeding or vomiting blood.
• Severe headache.

Make an appointment for medical evaluation

If fatigue persists for two weeks or more despite trying to rest, reduce stress, eat healthily and drink plenty of fluids, see a doctor.

Most people know that uninterrupted sleep is the remedy for tiredness.

But knowing and doing are two different things!

Sleep needs decrease with age and vary between individuals. Young children need a lot of sleep; school-age children require about 10–12 hours a day to be able to concentrate at school. Most adults feel refreshed after 6–8 hours of sleep a night. Older people often sleep even less than that.

Fatigue is usually manageable with lifestyle or routine changes. The effect is not immediate — it may take days or weeks to see results.

If fatigue does not improve despite lifestyle changes, this may indicate an underlying medical condition. The disease should be treated as soon as possible.

If you have persistent fatigue or exhaustion, see a doctor as soon as possible so that any serious underlying causes can be identified and treatment started immediately!