The real reasons you’re so tired

Feeling exhausted all the time is a common complaint, but more than not getting enough sleep, these health issues may be the cause.

Portrait of Tammy Strobel

Women are more likely to suffer from adrenal fatigue

If you feel unhappy and irritable, as well as constantly exhausted, you could be suffering from adrenal fatigue. It affects many more women than men and happens when the adrenal glands – two walnut-sized glands that sit just above the kidneys – are overworked.

Under normal circumstances, they produce the hormone cortisol to regulate blood pressure, the immune system and the body’s response to stress. “However, when they are out of balance, they can disrupt production of other hormones such as adrenaline,” says naturopath Marek Doyle. “This can lead to problems such as disturbed sleep and a constant feeling of exhaustion.”

Adrenal fatigue is regarded with scepticism by some doctors, which is why many sufferers seek alternative help to alleviate symptoms. Marek suggests eating five small meals a day, with high-protein snacks such as boiled eggs in between, to help stabilise blood sugar. Regular exercise and making time to relax will also help.

It could be undiagnosed type 2 diabetes

Type 2 diabetes develops when your body can’t produce enough insulin or doesn’t respond to insulin as it should. Insulin is a hormone that controls the amount of glucose in your blood, and moves glucose from the blood into your cells, where it’s converted into energy.

If you’re suffering from undiagnosed type 2 diabetes, you’re likely to feel tired even after a good night’s sleep, says Dr Stephen Lawrence, diabetes clinical lead doctor for the Royal College of General Practitioners in the United Kingdom.

“Even if you wake up feeling fine, undiagnosed sufferers may find themselves feeling chronically tired about halfway through the day. This is because the body is inefficiently metabolising energy stores as a result of the condition.”

Though there’s no cure, type 2 diabetes can be managed by eating a healthy, balanced diet with regular meals and doing regular exercise to keep weight down (obesity is a trigger for the condition). In some cases, the drug Metformin is prescribed to help the body use glucose effectively.

Perhaps you’re not drinking enough water

A survey of general practitioners in the United Kingdom found that one in five people who see a doctor because they feel tired is actually dehydrated. And this lack of fluids may be the reason why you feel constantly worn out.

As we become dehydrated, blood volume is reduced, so the heart has to work harder to pump the same amount of blood around the body. As well as feeling lethargic, you may actually feel quite weak.

The solution is obvious – just drink more. The European Food Safety Authority recommends that women should drink about 1.6 litres of fluid (about eight tumbler-size glasses) and men should drink about two litres (10 glasses) of fluid a day. This includes tea, coffee, milk and fruit juice. You can also get water from fruits and vegetables, so opt for fruits such as grapes and watermelon, which have a high fluid content.

You might have a magnesium deficiency

“Magnesium is needed for the release of energy from food,” explains dietitian Helen Bond, of the British Dietetic Association, and many people aren’t getting enough of it. The recommended daily intake of the mineral for adults is 420mg for men and 320mg for women.

“So if you’re deficient, you may feel sapped of energy and experience a general fatigue. It may also interrupt sleep since it can cause leg cramps, which will also compound tiredness.”

Top up on these sources of magnesium: whole grains, green leafy vegetables, nuts and meat. Eating a daily 90g serving of spinach, 30g of Brazil nuts and 75g of wholegrain rice should help you hit the target and avoid having to take supplements.

Managing stress levels will also help as adrenaline and cortisol, released in “fight or flight” situations, deplete the body’s natural stores of magnesium.

Are you suffering from anaemia?

Anaemia happens when there are fewer red blood cells than normal in the blood or when these cells contain an abnormally low amount of haemoglobin – the substance that carries oxygen around the body.

There are various types of anaemia, including iron-deficient anaemia and vitamin B12- deficient anaemia, explains Dr Mark Vanderpump, consultant endocrinologist at the Royal Free Hospital in London. “Both forms prevent oxygen from being carried around the body, which is why sufferers feel so tired all the time.”

Pregnancy, heavy periods or gastrointestinal bleeding, perhaps as a result of a stomach ulcer, increase the risk of iron-deficient anaemia. The condition is usually diagnosed with a blood test (which your general practitioner can arrange), and then treated with supplements and increasing iron in the diet (kale, spinach and sunflower seeds are good sources). Vitamin B12 or folate-deficiency anaemia is usually treated with injections or tablets.

Your thyroid isn’t working as it should

The thyroid, a bow tie-shaped gland in front of the windpipe, produces a variety of hormones – most notably thyroxine – which regulate body temperature and the rate at which we burn fuel.

“When you have little or no thyroid hormones, your metabolic processes slow down, and the body works less effectively, so you feel tired,” says Dr Vanderpump. “This tiredness can range from a general fatigue to feelings of exhaustion.”

Other symptoms include dry skin, thinning hair, brittle nails, cold hands and feet, and a hoarse or croaky voice. Diagnosis is made with a blood test and the condition is treated with a thyroxine-replacement medicine, to restore hormone levels.

Sleep apnoea could be affecting your rest

If you feel exhausted all day long, can’t concentrate and even fall asleep whenever you sit still – even when eating – then you may be suffering from sleep apnoea, a condition that occurs while you are asleep.

The muscles and soft tissues in the throat relax and collapse during sleep, so the airways become blocked, for up to 10 seconds or more. The sufferer then starts breathing again, often with a “snort” or gasp. This can happen up to 100 times a night.

“The condition can leave you exhausted as it interrupts deep, slow-wave sleep and rapid eye movement (REM) sleep, which is a time of healing and growth in the body,” explains Russell Foster, professor of neuroscience at the University of Oxford.

Losing weight and quitting smoking will help keep airway passages open. Sleeping on your side, rather than your back, may also help.

My Reading Room


It could be that his testosterone levels have fallen. Testosterone is the hormone that gives men their energy – so a deficiency not only causes them to feel tired but weak as well.

Age is a risk factor (levels fall by about 1 per cent a year by the time a man is 30) but low testosterone can also be caused by diabetes, obesity and excessive alcohol consumption.

Falling levels can also lead to loss of muscle mass, so your husband may feel tired following any physical activity. “Other symptoms can include lack of libido, erectile dysfunction and lack of facial (and body) hair,” adds Professor Chris Eden, consultant urologist at the Royal Surrey County Hospital in the United Kingdom.

Low testosterone is diagnosed with a blood test and treated with hormone replacement therapy in the form of a skin gel or patch.