Photo: Kohei Hara/Getty Images
Like everyone else, I wonder all the time: Why am I always tired? But sometime last fall, I started getting extra droopy every afternoon. Even when I’d done all the right things — slept eight hours, eaten a healthy lunch, exercised — I’d be fighting to keep my eyes open by 4 p.m. On one of those days, as I waged war against my thousand-pound eyelids, a friend started complaining to me about her new glasses, which she’d been forced to buy because contact lenses irritated her eyeballs in the dry winter air. As a fellow contact-lens wearer, I realized that perhaps my 4 p.m. sleepiness problem wasn’t that I was tired — maybe my eyes were. When I tested my theory and used Visine drops in the afternoons, my midday nap attacks went away.
Of course, most fatigue problems aren’t so easily solvable. Even the simplest fix — to sleep more — can be hard to come by, especially when there’s an underlying problem in the mix. Unfortunately, most tiredness feels about the same; Lyme disease doesn’t really give you a different flavor of exhaustion than, say, an iron deficiency or garden-variety night of tossing and turning. But if you look at other symptoms accompanying your fatigue, you might find clues to where it’s coming from.
If your tiredness is chronic and inexplicable — or just feels off — you should consult a doctor, as it could be a red flag for something more serious. And either way, it’s a problem you should be able to solve. To understand more about the different types of fatigue, I spoke to Dr. Jaclyn Tolentino, a primary care physician at Parsley Health, as well as Dr. Richard Firshein, a general practitioner and insomnia specialist who runs the Firshein Center in Manhattan. Here are the most common culprits of exhaustion, and how to treat them.
Hormone fluctuations can turn anyone into a nap machine, as anyone who’s ever had PMS knows. But chronic hormonal imbalances can make you sleepy and grumpy all month long. The good news is that doctors can test for the presence of most hormones, so they should be able to diagnose an imbalance if you have one; most are also largely treatable with medication and/or nutritional changes. One common issue is underproduction of estrogen or progesterone, which can cause tiredness, irritability, unpredictable periods, and night sweats. (If you wake up feeling like you’ve just run a marathon in your pajamas, this could be your issue.)
Other hormones that can disrupt your sleep if they get out of whack are melatonin and cortisol, which are produced by your pituitary glands. You can get supplements of the former from almost any drugstore, but Dr. Tolentino recommends taking no more than 3 milligrams. “The amount of melatonin your body produces is tiny compared to the melatonin supplements you can buy, so most people are actually taking much more than the body needs or should have, making the imbalance worse,” she says. In other words, taking melatonin supplements to help you sleep at night could actually be contributing to your overall tiredness during the day — the irony, I know!
If your tiredness coincides with weight gain, dry skin, and constantly feeling cold, you could be having issues with your thyroid, which produces hormones that regulate your metabolism, among other things. “Hypothyroidism is one of the most common conditions associated with fatigue,” says Dr. Tolentino. “Other symptoms of hypothyroidism include constipation, hair loss, and irregular menstrual cycles. If you’re experiencing any of these symptoms, it’s best to consult a doctor as soon as possible.”
Take it from someone who’s frequently anemic no matter how much steak I eat: The tricky part of getting enough vitamins and minerals is that certain nutrients are essential for the absorption of others — so if you aren’t getting enough of one, then you’re probably missing out on a bunch. Common deficiencies that cause fatigue include iron, magnesium (which contributes to the body’s absorption of iron as well as other nutrients), B vitamins, and vitamin D (which your body produces when it’s exposed to sunlight — which doesn’t happen much in the winter). Your doctor can test for all of the above, but for what it’s worth, I’ve been taking magnesium powder every night before bed for the past six months, and it has made a huge difference in how I feel every morning. Dr. Tolentino says she recommends it to many of her patients, because it “binds” to melatonin and supports its production in your body.
You can’t sleep because you’re staring at the ceiling, ticking through all the things you messed up that day and didn’t get done, and now you’re extra stressed because you’re stressed, and if you don’t get to sleep soon then you’ll be even more stressed tomorrow, and blah blah stress is bad and we all need to manage it better. But in addition to making you miserable and annoying, chronic stress actually causes the overproduction of cortisol (see No. 1), a hormone that disrupts sleep. Ignore the problem and it spirals, causing weight gain, more sleeplessness, and a whole host of other issues.
You know what you’re supposed to do for stress: Take breaks. Exercise. Cultivate supportive relationships. Meditate. And get enough sleep. But those things take time and energy, which seem in short supply when you’re dealing with a firestorm at work (or just normal life). Dr. Firshein recommends what he calls “mini-meditations,” which he practices himself. “It’s a huge luxury to be able to set aside 30 minutes or an hour to meditate, but if you take just a few moments throughout the day, it can have a similar effect,” he says. “In between every patient, I take ten or 20 seconds to breathe deeply, do some visual imagery, and relax my muscles before I move on. By the end of the day, it adds up to 15 or 20 minutes of meditation.” He urges patients to do the same every time they check their phone, for example, or get a text from a certain person, or get up from their desk at work. “If you reset your mind consistently throughout the day, then it can keep anxiety from sneaking up on you.”
It’s true: Certain genes have been linked to chronic fatigue issues, including a specific one known as the CLOCK gene (yep), which is linked to faulty circadian rhythms. People with wonky CLOCK genes have issues with their metabolism, body temperature, blood pressure, and liver functions, among others. Luckily, it’s very rare.
A more common genetic mutation that could disrupt your sleep is one that affects your body’s ability to process alcohol, says Dr. Firstein. “Alcohol causes a lot of sleep problems in itself, but some people are predisposed to be even more sensitive to it.”
A doctor can test for these genes, although it can be expensive to do so and insurance may not cover the lab costs. Before you go down that rabbit hole, look at your family history — do any of your relatives have similar bad reactions to alcohol, or other symptoms of the CLOCK gene? While you can’t change your own genetic makeup, identifying a genetic issue can help you and your doctor come up with a plan to treat the problems that stem from it.
Speaking of alcohol … and sugar, caffeine, your phone, your laptop, your TV screen, your neighbor’s music, your roommates’ music, LED lighting, your newborn kid, or the fries you just ate, you are surrounded by things that cause you to sleep poorly and be tired the next day. Both Dr. Firshein and Dr. Tolentino said that lifestyle is usually the No. 1 cause of tiredness, but the good news is that you can do something about it.
“We’ve become a little bit lazy around sleep,” says Dr. Firshein. “Good sleep hygiene begins hours before you actually go to bed. It takes discipline to power down at the end of the day, turn off the TV and the computer, and cut back on external light, noise and stimulus.” If you’re not able to do all that (because, come on), he recommends at least wearing blue-light-blocking glasses, dimming the lights, and not eating or exercising within two to three hours of bedtime.
And finally, pony up the $20 to buy an actual alarm clock and put your phone in another room before you go to bed. I’ve personally found this helpful not only for falling and staying asleep, but also for getting out of bed in the morning. Instead of snoozing my phone a million times and then lazing around scrolling through garbage, I actually get up and brush my teeth and start my day after my alarm goes off, for the most part. One other tip: I sleep with a white noise machine and earplugs. (I live next to a fire station, so.)
Does your bedmate frequently shove you in the middle of the night to get you to pipe down? Do you have allergies or get a lot of sinus infections? You might have sleep apnea, a deviated septum, or another issue that inhibits your breathing and stops you from getting the kind of deep sleep that makes you feel truly rested. There are various solutions for these problems, ranging from special breathing machines to surgery; you’ll want to consult a doctor if you suspect you fall into this camp.
Hopefully not! But fatigue is often the most obvious symptom of autoimmune conditions like lupus, fibromyalgia, and Hashimoto’s thyroiditis, says Dr. Tolentino. The same goes for chronic infections like Lyme disease. Often these conditions are accompanied by other symptoms. But just like with sleep apnea, don’t waste time trying to self-diagnose and get to a doctor.
What Kind of Tired Are You?