Why am I always so tired?

Occasionai spelis of tiredness are common, but constant fatigue is not. Have a look at your lifestyle. The common reasons for tiredness include poor sleeping patterns, iack of exercise, or stress.

Certain medical conditions like anaemia, hypothyroidism, diabetes and high biood pressure can cause tiredness. Poor nutrition can contribute.

I wonder if I'm eating the right food?

It's easy to reach for a chocolate bar when you need a boost, but sugary foods burn fast and leave you in a slump. Better to refuel on slower-burning foods like fruit or wholegrain bread - your energy levels will be steadier and last longer.

Have a balanced diet and drink plenty of plain water - mild dehydration can sap you too. Avoid caffeine and alcohol - they interfere with sleep.

Could I be anaemic?

It's possible. Anaemia is a common condition. If you are anaemic, your blood isn't able to transport enough oxygen around your body and you feel weak and tired. Women run a higher risk of anaemia because of menstruation. However in both sexes, anaemia may be a sign of more serious underlying disease such as blood disorders or bleeding which has not been noticed. Ask your doctor for a blood check. Don't put yourself on iron supplements without medical advice.

Will exercise make me better or worse?

It's reasonable to allow your body to recuperate if you have overstretched yourself or are recovering from illness - but not for too long. Exercise gets your circulation going, lifts your mood, relieves stress and promotes sleep. If you don't have a regular exercise habit, you may be tired because your stress has nowhere to go. Your body is constantly in 'neutral' and your batteries are never full. Build up your exercise gradually - exhausting yourself with too much too soon will only put you off.

Could it be hormonal?

It could be. Hypothyroidism - when your thyroid gland doesn't produce enough hormones - is often undiagnosed because the only symptom may be tiredness. Diabetes is another hormonal cause. One of the early signs of diabetes is fatigue. It is also common for women to feel tired before or during a period - and pregnant women are often tired due to changes in their hormone levels.

I'm taking medication - could that be the cause?

Yes. Certain heart medications such as beta-blockers may cause fatigue. Antihistamines for allergic conditions make you feel drowsy. Cold and flu remedies contain drug combinations that make you sleepy, or contain caffeine, which interferes with sleep. Drugs used to treat neurological conditions such as Parkinson's disease or epilepsy often cause drowsiness. Anti-anxiety and anti-depressive medicines may do the same.

I notice I've been more easily upset recently - could it be linked?

Being tired can lower your threshold for coping. On the other hand, emotional strain such as anger, grief or anxiety are extremely tiring. When you are stressed, your body tenses, your heart beats faster and you breathe more quickly but less efficiently.

You tire more easily as a result. More serious psychological upset, such as depression, often causes sleep disturbance such as waking too early. People who are anxious may find it difficult to fall asleep instead. Either way you don't get enough sleep and begin the next day even less able to cope - and so on.

Actualiy I sleep for eight hours a night but still wake up tired - why?

Do you snore? Some people snore so badly that they stop breathing for significant periods in their sleep and deprive themselves of oxygen. This condition, known as 'sleep apnoea' (say 'apnia') is linked to high blood pressure.

Other people fidget so much in their sleep that they wake up often during the night, and are short of sleep even if they don't know it. Also, as we get older we tend not to sleep as well or for as long - and this is not helped by common ageing problems such as urinary freguency both day and night.

How can I get help?

Tell your doctor about your problem. Blood and urine tests can easily rule out common causes like anaemia, diabetes and hypothyroidism. A blood pressure and prostate check should also be included. If your tiredness occurs pre-menstrually, you may consider going on the oral contraceptive pill to regulate your cycles.

If you are on medication, review them with your doctor and see if any changes can be made. If you are under emotional stress your doctor may provide support, refer you for counselling or for psychiatric help in more serious cases. Sleep disturbances are now dealt with at special sleep clinics.

Maybe I just need a holiday?

Maybe you do - a break from your usual routine can do wonders if you have got yourself bogged down. If all the health checks are normal, the reason for tiredness is likely to be in your lifestyle and diet. An imbalanced lifestyle may not always be easy to change, but do consider holidays, career breaks or even a change in direction.

And if you are looking for a quick fix, bear in mind that an expensive holiday simply does what an exercise routine provides on a daily basis - a chance to recover, relax and recharge.

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