Fatigue

Fatigue Overview

Fatigue is a common health complaint. It is, however, one of the hardest terms to define, and
a symptom of many different conditions.
Fatigue, also known as weariness, tiredness, exhaustion, or lethargy, is generally defined as a
feeling of lack of energy. Fatigue is not the same as drowsiness, but the desire to sleep may
accompany fatigue. Apathy is a feeling of indifference that may accompany fatigue or exist
independently.
Fatigue is common. Around 20% of Americans claim to have fatigue intense enough to
interfere with their having a normal life. Physical causes are estimated at 20-60%, and
emotional causes are the other 40-80%. The challenge is how to tell what is causing your
fatigue and whether it is serious enough to see your doctor.

Types
Physical fatigue

Physical fatigue or muscle weakness (or "lack of strength") is a direct term for the inability
to exert force with one's muscles to the degree that would be expected given the individual's
general physical fitness.
A test of strength is often used during a diagnosis of a muscular disorder before
the etiology can be identified. Such etiology depends on the type of muscle weakness, which
can be true or perceived as well as central or peripheral. True weakness is substantial, while
perceived rather is a sensation of having to put more effort to do the same task. On the other
hand, central muscle weakness is an overall exhaustion of the whole body, while peripheral
weakness is an exhaustion of individual muscles.

Mental fatigue

In addition to physical, fatigue also includes mental fatigue, not necessarily including any
muscle fatigue. Such a mental fatigue, in turn, can manifest itself both
as somnolence (decreased wakefulness) or just as a general decrease of attention, not
necessarily including sleepiness. It may also be described as more or less decreased level of
consciousness.[citation needed] In any case, this can be dangerous when performing tasks that
require constant concentration, such as driving a vehicle. For instance, a person who is
sufficiently somnolent may experience microsleeps. However, objective cognitive testing
should be done to differentiate the neurocognitive deficits of brain disease from those
attributable to tiredness.

Fatigue Causes

1. Sleep disturbances
a. Not enough sleep

b. Too much sleep

c. Sleep apnea

d. Shift work (changing shifts, night shifts)

e. Alcohol
2. Heart diseases
a. Congestive heart failure (fluid in lungs)

b. Cardiomyopathy (dysfunction of theheart muscle)

3. Lung diseases
a. Asthma

b. Emphysema or chronic obstructive pulmonary disease (COPD)

c. Pneumonia
4. Nutritional disorders
a. Malnutrition (kwashiorkor, protein deficiency or marasmus,
total caloriedeficiency)

b. Obesity

c. Vitamin deficiency (thiamine, B12, B6, folate, vitamin C)

5. Electrolyte disturbances

a. Low potassium
b. Low magnesium

c. Low or high calcium

d. Low sodium
6. Endocrine disorders

a. Low blood sugar or high blood sugar (diabetes)

b. High or low thyroid

c. Low cortisol (Addison disease)

d. High cortisol (Cushing disease)

7. Gastrointestinal disorders

a. Gastroesophageal reflux disease (GERD)

b. Peptic ulcer disease (PUD)

8. Neurological disorders

a. Multiple sclerosis

b. Stroke

c. Lou Gehrig disease

9. Infectious causes

a. Any chronic disease

b. HIV/AIDS

c. Tuberculosis

d. Hepatitis

e. Mononucleosis

f. Chronic fatigue syndrome

g. Urinary tract infections

10. Connective tissue disorders

a. Arthritis (osteoarthritis and rheumatoid arthritis)

b. Lupus (SLE)

c. Fibromyalgia

d. Acromegaly
11. General disorders

a. Cancer

b. Anemia (blood loss or not making enough blood)

12. Gynecologic

a. Pregnancy

b. Menopause
13. Exercise disturbances

a. Lack of exercise

b. Too much exercise (worn out)

c. Excessive workload
14. Psychological

a. Depression (loss of interest, ambition)

b. Anxiety

c. Grief

d. Stress
15. Blood pressure medications work by different mechanisms to decrease blood
pressure. The ultimate decrease in blood pressure also means a decrease in the amount of
work the heart is doing, which can lead to a feeling of fatigue. Sometimes, the drug works
not only on the heart, but also on the central nervous system.

a. Beta-blockers

b. Calcium channel blockers

c. Diuretics

d. ACE inhibitors
16. Heart medications work in different ways to regulate the heartbeat. Fatigue can be
related to the effects the medication has on the heart or to the effects that spill over to other
areas of the body.

a. Digoxin (Lanoxin)

b. Amiodarone (Cordarone, Pacerone)

c. Procainamide (Promine, Rhythmin)
17. Psychological medications used to help depression and anxiety work by increasing
neurotransmitters in the brain that have a calming effect on the body, thus stimulating
fatigue.

a. Antidepressants

b. Antipsychotics

c. Antianxiety medications (such as diazepam [Valium] or zolpidem[Ambien])

18. Narcotics: Many pain medications are opiate derived. Drowsiness can be caused by
opiates.

a. Acetaminophen and codeine (Tylenol with Codeine)

b. Hydrocodone and acetaminophen (Vicodin)

c. Oxycodone and acetaminophen (Percocet)

d. Propoxyphene and acetaminophen (Darvocet)

19. Muscle relaxants work to decrease the contraction of muscles. This relaxation can
lead to total body relaxation, which may cause you to feel fatigued.

a. Cyclobenzaprine (Flexeril)

b. Carisoprodol (Soma)

c. Orphenadrine (Norflex)

Fatigue Symptoms

Symptoms of fatigue include the following:

1. Weakness, lack of energy, tiredness, exhaustion
2. Passing out or feeling as if you are going to pass out
3. Palpitations (feeling your heart beating)
4. Dizziness
5. Vertigo
6. Shortness of breath
When to Seek Medical Care

Generally, you need to see your doctor if you experience any of the following:
1. Fatigue that comes on suddenly
2. Fatigue that is not relieved by adequate rest, adequate sleep, or removal of stressful
factors
3. Fatigue that is accompanied by unexplained symptoms
4. Feeling as if you are going to pass out
5. Unexplained weight changes
6. Menstrual irregularities
7. Any new masses, lumps, or bumps
8. Mild to moderate pain in your head, chest, or abdomen
9. If you experience any of the following, you should go to a hospital’s Emergency
Department:
10. Pass out
11. Chest pain
12. Shortness of breath
13. Bleeding - Rectal bleeding, vomiting blood
14. Severe abdominal, pelvic, or back pain
15. Severe headache
16. Irregular or fast heartbeat
17. Other people or pets in same household have same symptoms (possiblecarbon
monoxide poisoning)

Exams and Tests

If you go to your doctor for evaluation of fatigue, the first thing the doctor will do is take a
complete history of your fatigue along with asking about associated symptoms.
 • The doctor may inquire about these activities and symptoms to determine the
probable cause of your fatigue:

a. Quality

i. Does the level of fatigue remain constant throughout the day? Does
the fatigue get worse as the day goes on, or are you fatigued at the start of the day?

ii. Is there a pattern to your fatigue? Time of day or year? Does your
fatigue occur at regular cycles?
b. Emotional state: Are you feeling unhappiness or disappointment in your life?
c. Sleep pattern

i. How much do you sleep?

ii. What hours to you sleep?

iii. Do you awake rested or fatigued?

iv. How many times do you awake and are you able to fall back asleep?
d. Exercise: Do you get regular exercise? Any exercise?

e. Stress: Have you had any new stressors in your life? Change in relationships,
jobs, school, or living rearrangements?

f. Diet: What is your diet like?

g. Associated symptoms

i. Fever

ii. Pain

iii. Nausea

iv. Vomiting

v. Diarrhea

vi. Blood in urine or stool

vii. Shortness of breath

viii. Chest pain

ix. Constipation
 x. Muscle cramps or aches

xi. Easy bruising

xii. Cough

xiii. Changes in thirst or urination

xiv. Inability to sleep lying flat

xv. Inability to walk up more than one flight of stairs

xvi. Changes in appetite

xvii. Loss or gain of weight

xviii. Menstrual irregularities

xix. Swollen legs

xx. Mass in breast

• Then, a physical exam will be performed, focusing on your vital signs (weight, blood
pressure, heart rate, temperature, breathing rate). Your doctor will look at your general
appearance, listen to your heart, lungs, and abdomen, and perform a pelvic and rectal
exam.

• Your doctor may order some of the following tests:

1. Blood tests - Gives clues to if you have an infection, if you are anemic, or if
you have other problems with your blood or nutrition
2. Urinalysis - Gives clues that point to diabetes, liver disease, or infection
3. Chem-7 - Looks at 7 common substances circulating in your blood. It consists
of 4 electrolytes (sodium, potassium, chloride, and bicarbonate), 2 waste products
of metabolism cleared by normally functioning kidneys (BUN and creatinine) and the
source of energy for your body's cells (glucose).
4. Thyroid function tests - Looks at function of thyroid gland, too high or too
low

5. Pregnancy test

6. Sed rate - Looks for chronic diseases or inflammatory conditions

7. HIV test

8. Chest x-ray - Looks for infection or tumor

9. ECG - An electrical recording that looks at the function of your heart

10. CT scan of head - A 3-dimensional x-ray of the brain to look for strokes,
tumors, or other abnormalities

Fatigue Treatment

Medical Treatment

Many causes of fatigue may be treated with medications.

1. Iron supplements for anemia

2. Medications and machines to help sleep apnea
3. Medications to control your blood sugar
4. Medications to support your thyroid
5. Antibiotics to treat infection
6. Vitamins
7. Recommendations for dietary changes and a sensible exercise program

Prevention
1. Manage your stress: Practice relaxation. Take time out for yourself.
2. Get exercise: Start slowly. Do something you like. Find a good time to exercise. Find a
partner.
3. Check out your medications.
4. Improve your diet: Eat a good breakfast (whole grain cereal, fruit, milk). Add more
fruits and vegetables.
5. Stop the caffeine habit.
6. Give up smoking.
7. Have sex with your spouse or partner.
8. Get enough sleep: Have a routine. Go to bed at the same time every night.
9. Avoid coffee, tea, or caffeinated drinks after 6 pm.
10.Drink no alcohol after dinner and decrease the total amount of alcohol (alcohol interferes
with sleep patterns).