Are you feeling just so tired, yet you have only just returned to work?

Can you believe it?  You have returned to work after a well earned break, yet you feel so tired. It is almost as if you need another holiday!

This is such a common phenomenon. The Royal College of Psychiatrists: rcpsych.ac.uk have estimated that 1 in 5 people feel unusually tired a lot of the time and as many as 1 in 10 people suffer with chronic tiredness. So prevalent are problems with tiredness and fatigue that the acronym TATT (“tired all the time”) has been coined to describe this condition.  Women seem to be particularly affected.

In my psychotherapy practice I see so many people who complain of persistent tiredness, even though they may be sleeping well. For many of them, this problem has been going on for months. The first thing I do is consider their mental state. Could they be depressed? Are there any significant life events that may underpin or trigger tiredness, such as bereavement or relationship breakdown? Are they under particular stress or having work problems? I then ask if they feel unwell or have suffered a recent illness. Chronic fatigue syndrome (CFS) which is a particularly debilitating and often long term medical condition, often follows on from a viral illness. While fatigue is common often accompanying illness in general, CFS is comparatively rare. The next thing to consider, if a particular trigger is not readily apparent, is to refer them to their GP for a routine blood test to rule out an underlying medical condition.

The types of underlying medical conditions to consider are:

Thyroid problems. An underactive thyroid will lead to tiredness, muscle fatigue and aches as well as weight gain. It affects women more than men and is more prevalent with age.

Anaemia. While particularly common in women who have heavy periods and post-menopausal women, this should not be dismissed by men. NHS UK estimate that 1 in 20 men suffer with anaemia. Symptoms include lethargy, heavy muscles, rapid onset of tiredness.

Diabetes. A long term condition caused by excess sugar in the blood, will lead to increased tiredness, along with excessive thirst, frequent urination and weight loss.

Food intolerance. One type of food intolerance where tiredness is a common symptom is Coeliac disease. This is where the body cannot tolerate gluten, which is found in bread, cakes and most cereals. Affecting as many as 250.000 people in the UK, it is estimated** that up to 90% of sufferers do not know they have it. Other primary symptoms include diarrhoea, anaemia and weight loss.

Chronic Fatigue Syndrome. Also known as myalgic encephalomyelitis or ME is a very severe condition, where extreme tiredness often lasting six months or more is commonplace. It often comes about after a viral illness and is sometimes known as post-viral fatigue. While symptoms tend to differ between sufferers, sore throat, joint pain, muscle ache and head ache are common. I have seen many people with this condition, some of them so disabled that they are bed bound. Cognitive Behavioural Therapy (CBT) has been found to be particularly helpful and is something I would recommend. For a list practitioners near you, contact: babcp.com or contact us on steveclifford.co.uk.

Sleep Apnoea. Severe exhaustion during the day can indicate sleep apnoea, particularly where the sufferer is a bad snorer. What appears to happen is that the throat narrows or closes during sleep, which frequently interrupts breathing. AS a result blood oxygen levels drop and sleep is broken. Predominantly affecting middle aged men and compounded by alcohol and smoking. Assessment by a sleep and respiratory specialist is recommended.

Other conditions include:

Pregnancy. The first trimester (12 weeks) is marked by tiredness and often accompanying nausea, breast tenderness as well as absence of menstruation.

Obesity. Tiredness often results from exhaustion as the body has to work harder to carry round excess weight and undertake everyday activities. Shortness of breath and joint pain can also feature with extreme obesity.

Underweight. Lack of muscle strength may lead to tiredness and exhaustion.

Vitamin or mineral deficiency. Important for a healthy lifestyle vitamins and minerals are essential for repair, metabolism and for skin, bone and muscle development. Signs of deficiency include tingling in fingers and toes, mental confusion, tiredness and minor illnesses.

While it is important to rule out medical conditions, tiredness caused by psychological factors is far more common. A recent survey by the Mental Health Foundation: mentalhealth.org.uk found that nearly a third of the population suffer with severe sleep deprivation. Job stress and money worries contribute significantly to emotional tiredness with many people funding Christmas on credit, yet feeling insecure about their jobs. Unhappiness at work (and often at home) is frequently pushed down and internalised, this requires a lot of effort and can lead to pervasive feelings of tiredness. As a body therapist as well as a talking therapist,  I see many people with headaches, back aches and tiredness, again caused by internalised stress. Over the long term this can lead to skin conditions, stomach ulcers and a myriad of other health complaints. It is not just negative states, however, that can lead to tiredness and exhaustion, but happy events such as weddings, moving house and childbirth. Anyone with a young child will no how exhausting it can be on a day to day basis. When combined with juggling childcare, work and running a household, no wonder tiredness is such a feature of our modern society.

How many men (and women for that matter) reading this, use alcohol on a daily basis to switch off and cope with the stress of work and daily life. Regular use can lead to depression and it also affects sleep, often leading to wakefulness in the middle of the night. Shift working and irregular working hours disrupt circadian rhythm, impacting on sleep and body functioning, leading to peaks and troughs of tiredness.

I have mentioned depression and this is something I should give more space to discuss. Many people experience depression and are not aware of it. Whilst depression is primarily seen as a psychological condition, many physical symptoms are prevalent. These include aches and pains, constipation, weight loss or weight gain and extreme tiredness. This tiredness is part of a global slowing down or retardation. Body functioning, in particular movement becomes slow, simultaneously brain function slows. This leads to poor concentration, slowed thinking, difficulty making decisions and loss of energy and enthusiasm.  Appetite often diminishes, activities normally enjoyed are neglected, everything seems too much; loss of libido and interest in sex, inability to do jobs around the house, deal with finances and even contacting friends goes by the way. Withdrawal goes hand in hand with the aforementioned symptoms, sometimes to the point where staying in bed, not washing or even dressing may be the ultimately result.

Chronic tiredness resulting from lack of sleep is something many people experience. This is treatable and again CBT can be very helpful. If you would like more information on CBT for insomnia see: insomnia-treatment.co.uk.

Here are ten simple tips to help you overcome tiredness.

1. Aim to keep a regular bedtime and rising time, try to establish a pre-bedtime routine gradually winding down ready for bed.

2. Pay attention to “sleep hygiene” which includes ensuring the temperatu re of your bedroom is on the cool side, make sure the bedroom is quiet and dark. Only use the bed for sleep (not work). Sex,is the only exception as it tends to induce sleep

3. Do not engage in exercise in the two hours before bed, also do not eat too close to bedtime and avoid using the computer as it can be too stimulating.

4. Try to put the day to bed, leaving work behind. Keep a diary and reflect on the day, making notes for anything you need to prepare for tomorrow.

5. Have a warm bath or shower in the two hours before bed. Have a milky drink and a light snack, listen to soothing music and dim the lights over the course of the evening in preparation for bed.

6. Try to reduce reliance on alcohol and/or caffeine in the evenings. You may find stopping both helps greatly.

7. If your mood has been low for a two week period, visit your GP and enquire as to whether you might be depressed.

8. Try to eat a balanced diet with regular meals and ensure that you have an adequate fluid intake. Poor nutrition, unbalanced blood sugar and dehydration can all cause tiredness.

9.  Lack of exercise can lead to tiredness. Make 2013 the year you become more physically active. Make sure you do so gradually allowing the body to adjust.

10. Seek specialist help to address relationship, work or money problems rather than putting them off. Remember, you are important and tiredness may just be your body shouting at you, trying to tell you to get things sorted out.

Until next time, Steve Clifford, Cognitive Behavioural Psychotherapist

www.stevecliffordcbt.co.uk

Image refhttp://commons.wikimedia.org/wiki/File%3ATired.jpg                                                                                                                                                                                                       Main reference: “Why am I tired all the time?” – Live Well – NHS Choices  www.nhs.uk

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