Tired All the Time
Running on empty, even after a full night in bed? Tiredness is one of the most common reasons people see a GP. The cause is usually sleep, stress, mood or lifestyle, and sometimes a medical condition. Often it鈥檚 a聽mix.
How common: fatigue comes up in about 1 in 70 GP visits in Australia, and is the most common unexplained symptom GPs see.
Common causes: poor or short sleep, a busy life, stress, anxiety, depression and grief, too much caffeine or alcohol, too little exercise, and a new baby. Hormone changes in pregnancy and menopause play a part too.
Medical causes: iron deficiency and anaemia, an underactive or overactive thyroid, diabetes, sleep apnoea, infections such as glandular fever and COVID-19, some medicines, and less often heart, kidney or autoimmune disease or cancer.
When no cause is found: that is common. In one Dutch study, over half of people had no diagnosis a year later and only about 8 in 100 had a physical disease. ME/CFS is diagnosed when extreme fatigue lasts at least 3 months with other features.
The fatigue ladder
Sleep and lifestyle fixes come first. A short list of blood tests finds most treatable causes; a long list rarely adds much.
- Step 1 路 Self-careSleep, caffeine and movementKeep regular sleep times and aim for 6 to 9 hours. Avoid daytime naps and screens in the hour before bed. Caffeine can last up to 7 hours, so stop by early afternoon. Go easy on alcohol, which makes sleep lighter.
- Works
- Even a single 15-minute walk can lift energy. Building up to 150 minutes of moderate activity a week helps over time
- Cost
- Free
- How long
- A few weeks
- Watch for
- Cut caffeine down gradually; stopping suddenly can cause headaches.
Sleep is the only supplement with a 100% ingredient list.
- Step 2 路 GPA talk and examination firstYour GP asks about sleep, mood, stress, periods, snoring, weight changes and medicines, and examines you. If there are no warning signs, waiting about 4 weeks before tests is reasonable.
- Works
- Waiting a few weeks before testing didn鈥檛 make people less satisfied or more anxious in studies
- Cost
- Medicare rebates for the visit
- How long
- 2 to 4 weeks
- Watch for
- Weight loss, fevers or other new symptoms mean testing sooner.
The history finds more than the blood tests. Really.
- Step 3 路 GPA focused set of blood testsUsually a blood count, iron studies, glucose, thyroid, kidney and liver tests, and an inflammation marker, plus a urine test.
- Works
- Modest yield: in an Australian study, about 16 in 100 tests were abnormal and about 4 in 100 people got an important diagnosis. A short list is nearly as useful as a long one
- Cost
- Usually Medicare-covered
- How long
- Results in a few days
- Watch for
- Slightly abnormal results are common and often don鈥檛 explain tiredness.
More tubes, more false alarms.
- Step 4 路 Treat the causeIron, thyroid, sleep apnoea or moodTreatment depends on what鈥檚 found: iron for deficiency, thyroid tablets, a sleep study and treatment for sleep apnoea, or talking therapy such as CBT for stress and depression.
- Works
- Treating a found cause usually helps energy
- Cost
- Varies
- How long
- Weeks to months
- Watch for
- Recheck after treatment to see if it worked.
Fix the leak, then refill the tank.
- Step 5 路 SpecialistReferral when the cause is unclearIf tiredness continues for 3 months or there are other findings, your GP may do more tests or refer you on.
- Works
- Helps sort out less common causes
- Cost
- Specialist fees vary; Medicare rebates with a referral
- How long
- Months
- Watch for
- Bring a symptom and sleep diary.
Unexplained doesn鈥檛 mean imagined.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- A huge panel of blood testsA small set of tests is almost as good at finding serious disease. Big panels mostly find borderline results that lead to more tests.
- Extra caffeine to push throughIt can disrupt sleep for up to 7 hours, making tomorrow worse.
- A nightcap to help you sleepAlcohol makes sleep lighter and can leave you more tired the next day.
- Diagnosing yourself onlineTiredness has many causes. Guessing can lead you down the wrong path. Talk to a GP.
What you can do
- Keep a 2-week diary of sleep, caffeine, alcohol, exercise and energy levels.
- Ask someone if you snore, gasp or stop breathing in your sleep.
- Bring a list of your medicines to your GP.
- If you have heavy periods, read our heavy periods fact sheet; they are a common cause of low iron.
- Be honest with your GP about mood and stress. They are the most common causes.
- Take care with driving if you are very tired.
See your GP if
- You鈥檝e been tired for more than 2 weeks and it isn鈥檛 improving
- Tiredness is stopping you doing normal things
- You鈥檝e lost weight without trying, or your mood has changed
- Someone has noticed you snore, gasp or choke in your sleep
- You鈥檙e older and the tiredness is new
- You also have fevers, night sweats, swollen glands, unusual bleeding or shortness of breath
Tiredness isn鈥檛 laziness. It鈥檚 a symptom worth talking about. If you feel so low that life doesn鈥檛 feel worth living, call 000 or Lifeline on 13 11 14 (Australia), or your local crisis line.
Common questions
Why am I tired all the time?
Most often from poor sleep, stress, low mood or lifestyle. Medical causes include low iron, thyroid problems, diabetes, sleep apnoea and recent infections. Often it is a mix of things.
What blood tests check for tiredness?
A GP usually checks a blood count, iron, glucose, thyroid, kidney and liver function and an inflammation marker. A short list like this finds most treatable causes.
When should I see a doctor about tiredness?
If it lasts more than 2 weeks without improving, affects your daily life, or comes with weight loss, mood changes or other symptoms.
Can tiredness have no cause?
Yes. Many people never get a specific diagnosis, and their tiredness often improves with time and lifestyle changes. If extreme fatigue lasts more than 3 months, your GP may consider ME/CFS.
Helpful resources
- healthdirect: FatigueCauses and when to see a doctor. Free, Australia.
- NHS: Self-help tips to fight tirednessPractical energy tips. Free, UK.
- Trouble sleeping fact sheetWhat works for insomnia. Free, from us.
Evidence and more information
- healthdirect: Fatigue
- NHS: Why am I tired all the time?
- NHS: Self-help tips to fight tiredness
- Australian Family Physician 2014: Fatigue, a rational approach to investigation
maladywise.com/tired-all-the-time/