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When is fatigue worrisome?

Last Modified: March 26, 2020

Family Medicine


Fatigue is not uncommon. Odds are we’ve all felt mentally, physically or emotionally drained at one point or another. But how do you know when your feeling of exhaustion is something more? John Falatko, MD, PPG – Internal Medicine, helps explain what fatigue is, common symptoms and when you should seek medical intervention.

What is fatigue?

Fatigue is usually defined as a lack of energy, motivation or an overall feeling of exhaustion or tiredness. Different types of fatigue could include:

  • Exertional fatigue: Your tired feeling could be exercise-induced and include shortness of breath and feeling worn-out or drained more quickly.
  • Cognitive fatigue: This could present as a lack of motivation or internal drive. You could also experience memory issues, brain fog and have trouble processing.
  • Emotional fatigue: This is usually the result of continuous life stressors related to your career, personal life or both.
  • Hypersomnia or excessive daytime sleepiness (EDS): This is a condition in which you feel or have excessive sleepiness during the day. It can occur even after long periods of sleep with people waking up just as tired as when they fell asleep.
What are some common signs/symptoms of fatigue?

The biggest sign or symptom that a patient should be aware of is any kind of abrupt onset that can’t be explained by their known medical illnesses. For example, if you have the flu or mono accompanied by a fever, both can explain why you are fatigued. However, if you’re not suffering from any illnesses and you’ve become very tired quickly and can’t do anything you used to do, you should see your doctor right away.

Other warning signs to be aware of could include:

  • Prolonged presence: If the onset of your fatigue is not abrupt, but rather happening over an extended period and not going away.
  • Unexplained weight loss: If you are suddenly experiencing weight loss for no apparent reason or effort on your part.
  • Skin irritation: If you have developed a rash that you can’t explain and is paired with fatigue.
  • Discomfort: If you are having a lot of new muscle/joint aches and pains that aren’t going away and seem to be worsening over time.
  • Preventative screenings: If you haven’t had your cancer screenings and your age-eligible, you’ll want to speak with your physician. Getting your screenings up to date could help exclude other common causes of your fatigue.
  • Fevers and night sweats: If you’re consistently having unexplained low-grade fevers and/or night sweats that go away and then come back, could be signs of potential underlying illnesses and need to be checked by your primary care provider.
What are the most common causes of fatigue?

There are many reasons someone could be tired such as lack of sleep, poor diet, not enough exercise, anemia, depression, anxiety, medication side effects and more. Fatigue could also be due to a patient’s underlying illness, especially an adult. If you have a condition like congestive heart failure, COPD or asthma, fatigue could be a sign that your condition is getting worse and needs immediate attention.

How do you assess fatigue?

When seeing a patient, it’s important to gather as much information as possible – asking questions and then breaking down the information someone is giving you. The goal is to find a point of reference and then dig in from there. Typically, these are the things we look at during an initial assessment:

  • Daily function: It’s important to examine a patient’s daily functions and find out what’s normal for them, if anything changed and how long it has been different.
  • Medications: In any assessment, we want to know what medications a patient is currently taking, how long they’ve been taking them and if anything new has been introduced. We also want to know the types of medication a patient is taking, including pain meds, opiate-based, anxiety medications, antihistamines, muscle relaxers, etc. This is a crucial part of the process because certain medications could be the cause of their lethargy.
  • Substance abuse: During an initial assessment we also want to know about any substance abuse issues. This could include wine, medication, marijuana and any other illicit drugs.
  • Mood assessment: We also want to assess a patient’s mood and see if they have any anxiety, work or career issues along with other psychological factors that could be contributing to their condition.
  • Physical exam: We will also perform a physical exam to see if any underlying medical conditions could be the culprit.
What are some natural ways to prevent fatigue?

The easiest way to prevent developing fatigue is to train your body. If you are living a lethargic life, you’re going to feel tired. If you’re living an active, healthy life, your body will feel that way. Don’t put yourself at needless risk for developing an unnecessary illness or chronic disease that could affect your body.

How can fatigue be alleviated or treated?

The first and most important step is to identify the cause and improve or eliminate it. Other ways to help alleviate fatigue could include:

  • Medicinal treatment: After an initial assessment and under the advisement of your physician, some treatments could include medication.
  • Physical activity: Starting a regular exercise routine can help improve your cardiovascular health, improving your fitness and endurance. Our bodies were created to move, work and be tested. If properly exercised, you might be surprised at the number of things they can do.
  • Avoid stimulants: Patients should avoid stimulant medications. These do not improve fatigue and put you at risk for dependency and addiction. Appetite stimulating medications and psychotropic medications should also be off-limits. They are not the answer.
What steps should someone take if they are feeling fatigued?

First, and foremost, take an inventory of your life. See if you can identify anything that could be the answer such as working too much, stressors with family or friends, etc. If you still don’t have an answer, set an appointment with your primary care provider and be open and honest.

Final Thoughts

Remember, fatigue is common and can be a result of our current lifestyles, but please don’t ignore the extra things that don’t seem to make sense! If you’re experiencing symptoms that you can’t explain, please see your doctor. 

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