Why am I tired? (Part 1)
And what to do about it.
Oh, let me count the ways…
Over 40% of adult Americans report feeling tired about half the time, and as much as 50% more women report being tired than men.
Are you one of them?
Fatigue is one of the top health issues my patients report, as either a primary issue or secondary to other problems. Many of us fail to take fatigue as the warning signal it is and just push through….until we can’t.
Why shouldn’t we ignore fatigue? Because it is both a cause and symptom of so many other health issues, including hormonal dysregulations, mental health, gut and digestion issues, obesity, heart disease, Alzheimer's, diabetes, inflammation and autoimmune disease, and more...
So even if you can handle pushing through the fatigue, realize that doing what is necessary to resolve your fatigue will almost always help improve or resolve any of your other health issues as well (mood, digestion, weight, inflammation, etc).
Why are we tired? Often we think that if we just find the one reason, everything will be resolved. But fatigue, like most health conditions, is usually caused by more than one reason. Even when there is a major precipitating event (infection or other illness, a big stressor, or menopause/andropause) your fatigue is usually the result of all the dysregulating events leading up to that trigger
So what are the main causes of fatigue?
Lifestyle matters.
Whatever else the cause, you must start with basic lifestyle factors. So often I’ll have a patient in my office wanting to know if it’s their thyroid, gut, hormones…what is making them tired? “Well how much and how well do you sleep?” is my first question. More often than not, it’s insufficient or poor quality sleep. No matter how optimized we might be able to wrangle your body’s systems, if you aren’t sleeping well/enough, eating nutritiously and moving your body, your going to have some major health deficits.
In order to heal from any other issues, you will need to address foundational lifestyle matters, either concurrently or first.
Healing, Round 1: The Foundations.
Sleep
Nutrition
Exercise/Movement
Stress/Trauma -(internally generated and/or externally)
Sleep. There is actually a major lack of sleep epidemic in the US. And inadequate or unrefreshing sleep is a significant driver of almost all other major health afflictions, from heart disease to diabetes, dementia, to depression and even cancer.
How much sleep is enough?
Most of us need 7-8 hours of sleep. It also needs to be within normal biological times (e.g: 10 pm -7 am) when the body is biologically programmed to do its “house cleaning.”
It can be helpful to use a sleep tracking device, at least for a while, to make sure you are sleeping enough and of good quality. You may not know that you are getting inadequate deep sleep or falling asleep later than you thought. I use a sleep tracker to keep me honest about my sleep habits, and encourage me to prioritize sleep.
Aim for 7-8 hours (8-9 if you have been fatigued) of sleep a night and 1-1.5 hours of deep sleep. If you’re not, this is at least one of the critical issues in causing your fatigue. This alone may go a long way to correcting some of the hormonal and inflammation issues that are bogging you down.
If you just can’t sleep, or if getting enough, good quality sleep isn’t resolving your fatigue, time to call your Functional medicine practitioner to investigate the issue further.
Nutrition and movement. Obesity is also an epidemic in the US. Check out these staggering statistics: in 1990, only one state in the entire US was more than 15% obese, and many were under 10%. Today, only 30 years later, only one state is less than 25% obese, and the majority are 30-35% obese.
Why have we gained so much weight in so little time? Because of a number of elements unique to modern life:
Modern marketing constantly reminds us to eat processed foods.
City structures are prohibitive to walking.
Work schedules can make finding the time to exercise challenging.
Processed-filled grocery stores, fast food, and convenience stores are everywhere. And now you can even get fast food delivered. No need to move even to sit at the drive through.
Non-stop video and social media streaming is the norm.
These factors make us unwitting lab rats in a modern experiment on human health and behavior. We are surrounded and constantly cued to eat highly addictive, calorie-dense, nutritionally void foods and drinks while getting less activity than ever before in human history. Modern technology has eliminated the need to move in order to support basic survival (water, food, shelter, heat) and has normalized non-stop, always accessible videos, media and junk food.
We are poor matches for this environment. Humans have evolved, for the most part, to seek calorie-dense foods and to conserve energy and seek pleasure. This may have enabled us to survive in an unpredictable environment where food was scarce and death around the corner. Now, however, the food industry, social media, and video industries use this to take advantage of us and keep us overfed and numbed out.
Understanding that your poor habits aren’t simply character flaw but a mismatch between biology and modern life can be a game-changing approach to understanding your behavior and empowering you to make different changes.
But how do I change??!
For many people, breaking these habits and behaviors isn’t as simple as willpower or knowing better. Most of the people I counsel about weight loss could literally write a book about it for others. People finally break free of their destructive lifestyle habits when they untangle the emotional attachments, deep patterns, and unconscious beliefs that drive their choices.
The science of behavior change tells us that in order to make healthy changes stick, most humans need:
To take it one step at a time. Don’t overhaul your whole life overnight and expect it to stick.
Choose one doable change, and make growth your habit, not a revolution.
Engage with like-minded peers and social groups. You absolutely will end up doing what your friends do. It’s like expecting an alcoholic to break their drinking habit while maintaining the same group of drinking friends and hangouts. You need a new crew.
Find and make friends with people who are living lifestyles you want to emulate. Fitness groups, meditation groups, hiking clubs, etc. Allow your social network to elevate you.
Ask for external support and seek external accountability. We are infinitely more likely to stick to your healthy habits if we ask friends, family and coworkers to support these changes.
A common trigger I hear is “well I won’t be able to stick to my healthy habit because I’m doing XYZ with a friend/colleague/family member.” People say it as if it is a given that it isn’t possible to maintain their healthy lifestyle choice in a particular situation. Ask and simply require others to accept and support your new health habits. They would if it were an acute medical issue (eg: peanut allergy or diabetes). And in reality, your healthy habits are a medical issue: a long term one.
Engage a therapist, health coach, life coach or similar professional support.
Data tells us we are more successful in changing our lifestyle behaviors when guided, supported, and held accountable by an expert. A friend may make you feel better, but you want someone who will give you the facts and give you constructive ways to accomplish your goals.
Work with an expert Functional medicine, therapist, and/or health coach. It can be hard to navigate your way through new and unknown ways of living. Do you go low carb or vegetarian? Is the exercise you got enough or too little? Do you have physical or mental health issues preventing you from manifesting good health?
You don’t need to be the expert for yourself. Having trained guides will maximize your success.
Stress & Trauma.
Last but certainly not least, chronic or severe stressors that go unresolved are a major ‘pathogen’ in the body. The nervous, immune, and hormone (endocrine) systems are all one system. So an anxious or busy nervous system also directly dysregulates these other systems, contributing to inflammation and hormonal issues, major causes of fatigue.
Studies like the ACE (adverse childhood events) and books like The Body Keeps the Score detail how stressors create genuine biological impacts. To even say 'mind-body connection’ is inaccurate because it implies there is any separation to begin with. The mind-body is one congruently functioning machine with constant molecular and electrical communication.
When your nervous system is constantly ‘on the go’ or existing in an anxious or traumatic state, you lose energy before even doing anything else. While many of my patients are aware that they need to work on their diet and exercise, many seem unaware that their nervous system constantly being on alert, anxious, or pulled in several different directions is also a major driver of their health issues: especially fatigue.
So if stress -whether simmering long-term or severe and sudden- has come into your life then it is as important to address as diet, sleep, exercise in restoring your health and energy. And sometimes more so.
How to heal from stress. This almost always requires a professional therapist or counselor, but can always start with whatever trauma-informed and mindfulness guided activities are immediately available for you:
Neurofeedback devices such as the Muse headband and David’s Delight Pro.
Overcoming codependency
Healing from narcissism
When do I need professional help?
Often correcting these lifestyle factors will go a long way to restoring our natural energy for most of us. But sometimes, it’s only part of the picture.
This is because:
Your body just can’t recover on its own.
Something else is causing fatigue (like infections, toxins, mold, inflammation, autoimmune disease, GI disorders, malabsorption/nutrient insufficiencies, etc.)
Age. Yes, biology winds down, and we just don’t repair like we did when we were younger.
Whether you just want an expert assessment to help you figure things out and guide you, or you have more complex health issues driving your fatigue, join the many others who have found renewed health and energy through working with us at InHealthRVA.
Stay tuned for more in this series, “Why am I tired? And what to do about it” for continued articles on the many drivers of fatigue.