Fatigue • Don't fight, treat!

Fatigue is a useful indicator that the body needs a rest. Hardly defeatable or constant tiredness can also be a symptom of illness and should be examined by a doctor.

Fatigue is a natural and very meaningful signal from our body. With this symptom, he shows us that his energy reserves will soon be used up and he needs rest and relaxation, for example after physical exertion, a stressful day at work or, of course, after a persistent lack of sleep.

When is fatigue pathological?

Fatigue only has a disease value if it cannot be compensated for by sleep and recovery phases or if a disturbed sleep makes sufficient regeneration impossible. Targeted therapy for the sleep disorder is helpful here in order to get a grip on the usually inevitable daytime sleepiness.

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A visit to the doctor is also advisable if there is no obvious reason for the symptoms, but the tiredness persists for a long time or occurs much faster or more violently than usual. An exact diagnosis of the cause is important, because chronic fatigue is a symptom that can occur with various diseases or deficiencies and which affects those affected emotionally.

Being tired reduces productivity and motivation

Fatigue is experienced very differently, the symptoms vary from person to person. Affected people describe, for example, that they feel limp, exhausted and / or quickly at the end of their strength. Often, tiredness is associated with displeasure, lack of motivation, concentration disorders, reduced mental activity and performance. It is not uncommon for people to tend to fall asleep during the day. The perception of tired people can also change. A precise description of the symptoms, the accompanying circumstances and other symptoms will help the doctor to find the cause.

Fatigue has many causes

The causes and triggers of fatigue range from lack of sleep and lack of exercise to mental illness or physical illness.

Fatigue can have many causes and be temporary or long-term (chronic). Often, tiredness is the result of a deficiency, such as insufficient sleep, lack of exercise or insufficient fluid intake. A deficiency in certain vital substances such as iron can also be associated with decreased performance or fatigue. If the iron deficiency persists for a long time, there is a risk of iron deficiency anemia.

Immune system: Defense against disease makes you tired

If the body defends itself against pathogens and the immune system is running at full speed, like at the beginning of a cold or another infection, this can also lead to fatigue. Persistent stress and physical strain also trigger fatigue.

In the cases mentioned, however, being tired is mostly of a temporary nature and can usually be quickly remedied with simple measures, such as restful sleep, sufficient fluid intake or regular exercise in the fresh air. The tiredness associated with harmless infections disappears again as they subside.

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Pregnancy and fatigue

Even during pregnancy, the woman's body is in a permanent state of emergency. In addition to the mother-to-be's circulatory system, the heart must also take care of that of the child; the lungs, kidneys, liver and the immune system must do more. In addition, the increased release of the hormone progesterone puts the body in a relaxed state. The side effect that nature "consciously" takes into account is constant tiredness and the need to rest. Pregnant women should do this as often as possible.

  • Chronic Fatigue Syndrome (ME / CFS) is now considered an independent disease. Use the self-test to see whether you could be affected

Causes of severe and prolonged fatigue

Outside of pregnancy, chronic fatigue is often an expression of a constant physical deficiency (e.g. lack of sleep) and can lead to serious health problems.

Likewise, tiredness that sets in faster than before and / or is associated with a greatly increased need for sleep or cannot be remedied by sleep can be an indication of a serious illness. But it can also be caused by drugs and environmental influences.

The following causes can be considered:

  • Sleep disorders due to persistent lack of sleep or brief respiratory arrest during sleep (sleep apnea)

  • Sedentary lifestyle, alcohol abuse, caffeine, drugs, shift work, noise and other lifestyle factors that can influence a healthy sleep-wake cycle

  • Narcolepsy ("sleeping sickness"), which is characterized by pronounced daytime sleepiness and regular sleep attacks, even during the day (attacks often combined with muscle paralysis and hallucinations)

  • Mental disorders such as anxiety disorders, some of which trigger sleep disorders, but also occur without sheep disorders and can lead to fatigue

  • Psychosocial stress (stress), some of which can be unconscious and cause sleep disorders

  • Fatigue due to Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME / CFS)

  • In fibromyalgia or fibromyalgia syndrome (FMS), a chronic disease that is characterized by recurrent, severe pain in the entire musculoskeletal system, fatigue is also a concomitant symptom.

  • for self-test

    Chronic Fatigue Syndrome (ME / CFS) is now considered an independent disease. Use the self-test to see whether you could be affected

Fatigue due to physical illnesses and deficiencies such as

  • Iron deficiency

  • Potassium deficiency

  • Anemia

  • Hormonal diseases such as hypothyroidism

  • Liver disease (such as hepatitis C)

  • Infections such as glandular fever (post-infectious fatigue)

  • Gluten intolerance (celiac disease)

  • high blood pressure

  • Other diseases (heart disease, multiple sclerosis (MS), infectious diseases such as AIDS / HIV, tuberculosis, borreliosis or tropical diseases)

  • Cancer therapy

  • Fatigue as a side effect of drugs, such as drugs used to treat anxiety and sleep disorders and epilepsy (benzodiazepines), antidepressants, antiallergic drugs (antihistamines), drugs that lower blood pressure (antihypertensive drugs), opiates, and Parkinson's drugs

  • Environmental toxins and influences, for example lead, amalgam, carbon monoxide, hydrocarbons, mold toxins

In addition, fatigue can occur in the context of many other diseases (see also exhaustion).

Diagnosis: what the doctor examines

Those who are constantly tired should question their living and sleeping habits and, if necessary, consult a doctor to clarify the causes.

The doctor can use the detailed patient discussion to diagnose or find the cause of fatigue. The physical examination as well as laboratory tests and apparatus-based procedures provide further information; observation of sleep activity in the sleep laboratory may also be informative.

Discussion with the patient (anamnesis) in the event of permanent fatigue

In the patient consultation, the doctor asks, for example, the quality (moderate tiredness or tendency to fall asleep during the day?), The duration and daily progression of the tiredness and how much the patient suffers from tiredness in everyday life. For example, are family, professional and other social concerns restricted (e.g. leisure activities, workload)?

Are there any other symptoms, such as sadness, depression, gait disorders, or other physical complaints such as weight changes, fever, or pain, that might indicate a psychological or physical cause of the tiredness? Does the person suffer from a chronic illness or is he / she taking medication? Is he possibly exposed to environmental influences (exhaust gases, chemicals, …) at work that can cause tiredness?

Sleep quality and general lifestyle factors

The question of sleep quality and general lifestyle factors is also very important and fundamental.

  • Are you having trouble falling asleep or staying asleep?
  • Does the partner observe pauses in breathing that are interrupted by loud snoring (sleep apnea) or attacks of suffocation?
  • Is sleep disturbed by noise, brooding, or other factors?
  • Are there partnerships, – professional or other problems and / or stressful influences?
  • When does the person go to bed?
  • What is his other way of life (consumption of alcohol, exercise, diet, sport, working hours and many more)?

Physical exam to diagnose fatigue

The further procedure for the physical examination depends on the results of the patient interview. If there are no precise indications as to what leads to tiredness, the doctor will carry out a full-body examination in order to reliably identify a possible physical cause of the tiredness. He listens to the heart and respiratory tract, examines the mucous membranes and scans the liver, spleen and lymph nodes. He also checks whether a nervous system disease may be related to fatigue. To do this, he examines, among other things, the state of tension in the muscles and the muscle reflexes.

Other diagnostic procedures

Blood tests may also be necessary to determine, for example, blood counts, blood sugar levels, thyroid hormones, inflammation factors and liver values.

If there is a concrete suspicion, further procedures, for example apparatus-based, follow. These can be diagnostic examinations in the sleep laboratory, with which, among other things, brief respiratory arrests during the sheep (sleep apnea) and related sleep disorders can be recognized as reasons for fatigue.

Treatment of fatigue

For many who suffer from chronic fatigue, simply sleeping in properly is easier said than done. Many need help from medicine.

The doctor's treatment of fatigue depends on the cause. If a mental or physical illness has been found to be the cause of the tiredness, the primary aim is to treat the illness with appropriate therapy.

In many cases, fatigue starts with an imbalance between performance and relaxation. Illness, personal crises and stress often lead those affected to withdraw from activities. A cycle of lack of activity, decreasing resilience and the experience of tiredness and displeasure, coupled with reduced physical performance, quickly develops. Changes in lifestyle and daily routine can sometimes help break the cycle of fatigue.

What can alleviate tiredness

This includes, above all, regular physical activity such as cycling, swimming, gymnastics or walks in the fresh air. Behavioral therapies, learning behavioral strategies and relaxation techniques, along with other measures, can also be essential components of the therapy plan that the doctor develops together with the patient.

Sleep disorders can be reduced by the following measures:

  • Regulated sleep rhythm (getting up at the same time every day)
  • Do not go to bed until you are tired
  • Use relaxation rituals before going to bed (relaxation techniques, warm baths, reading, listening to music, meditation)
  • Don't sleep during the day
  • Avoid drinks containing caffeine from the afternoon onwards
  • Refrain from alcohol
  • Exercise regularly or at least exercise moderately

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Drug therapy for fatigue

Occasionally, the temporary use of sleeping pills or calming remedies from naturopathy (for example based on valerian) can help to find a healthy sleep again. It is advisable to consult a doctor or pharmacist here.

In addition, preparations are now available that can help with tiredness and exhaustion as a result of stress or nervous strain to achieve more inner stability and to go through everyday life with more energy. Ask your doctor or pharmacist about this.

Depending on the cause of the tiredness, the therapy plan can also contain several of the treatment strategies mentioned.

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expert advice

Expert advice for questions about fatigue:

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