Tired, low and aching? TATT – or as we know it in the business, “tiredness all the time” – is an incredibly common symptom, though perhaps not seen as often as you’d expect. In fact, it’s estimated that only seven per cent of persistent episodes of tiredness or fatigue results in a GP consultation.
I’m a GP at a practice in Bristol, and in a typical clinical day, I’d estimate that at least one or two consultations are specifically about persistent tiredness. That’s hardly surprising, since it can be a symptom of nearly every condition I can think of – whether physical or mental.
And yet, we’re only attending to the tip of the iceberg. Availability of appointments and accessibility are, of course, partly to blame. But so too is the context in which patients experience these symptoms. The reflex response of many is to soldier on. For some, it feels like there is no other option: work, home life, caring responsibilities and other demands of daily living all need to be attended to.
It’s easy to normalise tiredness, or self-diagnose it as the inevitable result of poor sleep, or the stress of a hectic lifestyle but it could point towards a more serious diagnosis. Here’s what you should know.
Seeing a GP
At the first consultation, a GP needs context. Tell them when you first noticed feeling tired, and how it has progressed since then. Does it last all day, and does it impact sleep? Are there any other symptoms you’ve noted, and has your mood been affected? Perhaps most importantly, tell them what you think is going on – in a short consultation this can be incredibly valuable, and help guide what happens next.
A GP will perform an examination, and then consider ordering blood tests to see if there is a condition that cannot easily be seen from an examination alone. These typically include a blood count to see if you’re anaemic (low in red blood cells), glucose levels for diabetes, thyroid function tests, and tests of liver and kidney function, to name but a few.
It’s surprising how many blood tests come back as perfectly normal – which can prove reassuring and frustrating at the same time. This doesn’t mean it’s the end of the road. Sometimes bloods don’t turn up trumps, because the underlying cause is psychological – as a result of stress, depression or anxiety – for which other forms of support and treatment can be effective. Chronic fatigue syndrome and fibromyalgia, two poorly understood conditions, may also be considered – for which there are also options in treatment.
But there are certain symptoms which should warrant closer scrutiny. It’s therefore a wise idea to report to a GP if you note tiredness combined with any of the following:
Have you been intentionally trying to lose weight through diet and exercise, or is there no clear reason as to why you’re shedding pounds? The latter is more suspicious, and unexplained weight loss should prompt urgent follow-up.
Multiple conditions can cause weight loss and tiredness together – including cancer, and I recognise the anxiety this can create from my own practice. Some patients delay speaking to a doctor because they fear the worst, only to discover the cause is something readily treatable – like diabetes, an overactive thyroid gland, or even coeliac disease.
That said, cancer is something we do need to consider, so please do seek medical advice if this applies to you. The sooner you are checked, the sooner a cause can be established and treated.
Inflammatory symptoms
Inflammation is the process by which the body defends itself from harm, and then begins to heal. Some inflammation is useful and necessary, but it can also be a feature of many other disorders where it continues beyond the point of being helpful – and instead generates ongoing symptoms.
It can affect practically every tissue of the body – but the cardinal signs include redness, swelling, heat and pain. In arthritis, for instance, these can be noted within the joints. In ulcerative colitis, a type of inflammatory bowel disease, gut inflammation generates symptoms including abdominal pain and diarrhoea.
Thinking outside the box can sometimes be the ticket here – many patients I’ve seen have understandably not made the connections between inflammation and the scattered, sometimes subtle symptoms it can cause across the body – like stiffness, rashes, even mouth ulcers. All variable clinical pictures with a deep, consuming tiredness at the heart of them.
Inflammation is a core underlying feature of many presentations of tiredness, contributing to both physical and psychological conditions – including depression. And many inflammatory conditions have specific treatments that can drastically improve symptoms.
Heart and Lungs
Disorders of both the heart and lungs can cause tiredness. Heart failure, for example, means that the heart isn’t working as an effective pump, so blood flow around the body may be compromised. Asthma, meanwhile, narrows airways – limiting oxygen levels.
Both of these are common examples of chest conditions that can cause tiredness, but the list is much longer. Any symptoms like shortness of breath, persistent cough, swelling in the feet and ankles, wheezing and a fluttering heartbeat, should be shared with your doctor.
Snoring
Sleep apnoea is a disorder where the airways repeatedly become obstructed during sleep, triggering episodes of paused breathing (or apnoea), and a fall in blood oxygen levels. That is until the body rouses you just enough to restart normal breathing.
Being awakened repeatedly from deeper stages of sleep limits the amount of time for recuperation, leading to significant daytime tiredness. And this is far more than just a snoring problem – over time it can put strain on the heart, contribute to high blood pressure, and increase the risk of stroke.
Sometimes the concern is not raised by the patient themselves, but by their sleeping partner. This I’ve seen rather frequently in practice: partners who are sleep-deprived themselves from the loud reverberance of progressively worsening snoring, or have become concerned after noting definite pauses in breathing – followed by gasping or choking sounds.
Sound familiar? Take heed of what they’re saying to you, and get it checked out – it shouldn’t be ignored or laughed off.
Neurological symptoms
Disorders of the nervous system can also cause patterns of tiredness. Multiple sclerosis (MS) for instance – a condition where the immune system attacks the brain and spinal cord. Other conditions can damage the nerves which travel to our body and limbs, or the muscles which control movement. Look out for skin numbness or altered sensation, muscle weakness, visual changes, and problems with balance.
Lumps in the neck, armpits or groin
These are areas where lymph nodes cluster – the glands which filter fluid from tissues and have an important role in immune responses. If you notice that they are enlarged and feel like lumps, it is worth getting them checked. Often, this can be the body’s natural response to an infection, such as a virus. But persistent or unexplained swollen glands can also point towards chronic inflammation, and again, in some cases, cancer.
So, if you really are TATT, don’t simply dismiss or normalise it. Make an appointment and talk it through. Finding an explanation can open up options for treatment, potentially making a significant difference to your energy levels, sleep, mood and quality of life.
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