Chronic tiredness seems to be a big medical syndrome of the 21st-century living and one of the most common reasons for a trip to the doctor’s office.
For every person who seeks help many more just put up with it. As symptoms go it seems more social than medical and has none of the dramatic appeal of crushing chest pain.
Researchers have largely ignored it on the grounds that it is normal, boring, and no-one dies from it. But studies in the past three years show that while chronic tiredness is common it is not trivial. People who visit their doctors complaining of exhaustion are likely to feel just as sick and tired six months later.
Chronic tiredness affects all social classes, although manual workers and mothers of small children seem to be more vulnerable. Definitions vary, although to qualify you are generally expected to have been tired all the time for at least two weeks.
There is considerable overlap between fatigue, psychological distress, and having problems with sleeping. Everyone feels tired at times, but chronic fatigue makes you feel relentlessly under par, dissatisfied, and unable to cope. It is the difference between dragging yourself out to meet friends, and collapsing on the sofa because going out is too much of an effort.
This condition is not to be confused with chronic fatigue syndrome, which affects only a tiny proportion of people but which stimulates exhaustive debate over what causes it.
Simon Wessely, a consultant in psychological medicine at the Institute of Psychiatry, London, says that tiredness is not exactly an illness but can impair people’s ability to earn a living and look after their families. He likens tiredness to blood pressure — everyone has it — but it does not necessarily make you sick. The impact of a number of factors tips the balance.
Obesity and smoking, for example, will raise blood pressure while a stressful job and frantic housework every day can make you tired. Most people blame social causes for their tiredness, but others prefer a medical diagnosis.
“We increasingly define ourselves as sick,” says Wessely. “Rather than accept they are tired some people diagnose themselves as having total allergy syndrome or believe they have a vitamin deficiency.”
Studies show that fewer than 1 in 10 people who visit their doctors have a physical cause for their tiredness. Medically acceptable causes of tiredness are anemia, pregnancy, an underactive thyroid gland, and infections such as glandular fever. They all can be diagnosed by simple tests. Fewer than one in 100 people who is chronically tired turns out to have cancer.
The most common medical diagnosis is depression, which is more likely to be the case if you have felt tired for a long time, have lost weight, and consistently wake up early in the mornings.
But while depression may need medical treatment, most of the other causes of tiredness can be controlled by making social adjustments. What is so great about the remedies for coping with chronic tiredness is that they are all about injecting a bit of fun into our lives.
“Our lives are all work and no play,” says Trudie Chalder, a lecturer in the department of psychological medicine at the Institute of Psychiatry, and author of Coping with Chronic Fatigue. “You should ask yourself what you have done in the past week that you have really enjoyed.”
Chalder maintains we should lower our expectations and learn to do things less well — let the house look a tip for a few weeks and go and take some exercise, or read a book.
People who are tired all the time often have problems sleeping but this is not necessarily the cause of their exhaustion. It is more likely that how we feel during the day determines how tired we are. Anger, emotional problems, and any old worries are all knackering.
Lying awake reliving these high points, however, is obviously not restorative, and improving sleep hygiene, as it’s called, can help.
“It is important to establish a routine of going to bed at the same time and getting up at the same time,” says Chalder. “Have a wind-down period for an hour or two before going to sleep.”
Alcohol just before bedtime, late-afternoon catnaps, and going to sleep after midnight all can make you feel tired the next day.
The most effective form of sleep disturbance, of course, are young children, which is the main reason why mothers are the most tired people on earth. Dr. Leone Ridsdale, a senior lecturer in general practice at Guy’s Hospital, London, believes that mothers are affected more than fathers, partly because they cannot compartmentalize their lives.
“Women still do the majority of domestic work even if they’ve got jobs,” she says. “There are no boundaries to their work.”
But as your doctor is unlikely to offer to take the kids off your hands for the weekend, is there any point in dragging yourself to the surgery?
Ridsdale generously suggests there is. First, because doctors can check there is no physical reason for the tiredness; second because they can sometimes offer counseling to help you control it.