It’s normal to feel a general level of tiredness throughout your day so long as you can recover after a good night’s sleep or a restful weekend. However, chronic fatigue can be a multidimensional issue with physical, emotional, behavioral, and cognitive components not necessarily related to exertion, rest, or sleep (1). There are three main areas of exhaustion: physical activity, “I don’t have the energy to do daily tasks,” motivation, “I don’t have the desire to do anything today,” and concentration, “I don’t have the ability to focus today” (2). If you have one or more of these symptoms, you may want to analyze your sleep patterns, nutrition, and/or stress.
Sleep is essential for your health and alertness. Although ideal sleep duration can vary between individuals, the general consensus is that you should sleep seven or more hours per night on a regular basis (3). Your sleep should be as uninterrupted as possible in order to allow your brain to go through adequate amounts of non-rapid eye movement (NREM) sleep and one stage of rapid eye movement (REM) sleep (4). Your sleep timing should be as consistent as possible. The human body has a natural circadian rhythm with clock genes that dictate your sleep and wakefulness (5). When you wake up or go to sleep at varying times throughout the week, your body will not operate optimally.
Here are several ways to improve your sleep routine (6). Try to be in bed for at least eight hours in order to get at least seven hours of actual sleep. Try to keep a consistent bedtime and wake-up time everyday (5). Try to limit caffeine intake at least six hours before going to sleep (7). Try to eat your last large meal three hours before bed (8). Turn off all visual or auditory notifications on your electronic devices (9). Try to stop using any screens at least 1 hour before sleeping (10). Try reading a book, listening to relaxing music, meditating, breathing, gentle stretching, a hot bath, or a warm cup of tea before turning in (11)(12). Try to keep the bedroom as dark as possible and on the cooler side (13)(14). Try a white noise machine to prevent outside sounds from waking you in the middle of the night (15). Try to get direct sunlight as soon as you wake up to feel more alert (16). If none of these options seem to work, you may want to seek professional diagnosis for a sleep disorder such insomnia, restless leg syndrome, or sleep apnea.
If you feel like you get enough high quality uninterrupted sleep, you may want to focus on your nutrition. Vitamins and minerals play an essential role in numerous biological pathways such as energy creation, DNA synthesis, oxygen transport, and neuronal functions (17). Individuals with low micronutrients such as iron, B vitamins such as B1, B2, B3, B6, B9, B12, magnesium, and/or zinc can experience mental and physical fatigue symptoms (17). If you are curious about your nutrient numbers, you should get a blood test at a medical facility.
The first nutrient you should test for is iron, because iron deficiency can lead to anemia whose primary symptom is fatigue. At risk populations commonly include children, individuals who are menstruating, and those lacking iron in their diet (18). Iron is essential for creating hemoglobin, which is responsible for transporting oxygen and energy throughout the body. Numerous studies link fatigue with anemia which is characterized by hemoglobin levels below 120 g/L in women or 130 g/L in men (17). If you have low iron, you can eat more red meat, poultry, and seafood for heme iron and fortified grains, nuts, seeds, legumes, and vegetables for non-heme iron (18). If you have been diagnosed as anemic, you should improve your iron levels with a supplement or medical infusions.
Almost all of the B vitamins are involved in at least one and often in several steps of the energy-production system within the cell. When an individual has a significant deficit in any of the B Vitamins, they are likely to experience one of the commonly associated symptoms of fatigue. Here are some examples: lack of thiamine (Vitamin B1) can lead to Beriberi disease. Lack of riboflavin (Vitamin B2) leads to higher risk anemia. Lack of niacin (Vitamin B3) can lead to nonspecific clinical symptoms of fatigue. Lack of pyridoxine (Vitamin B6) can lead to microcytic anemia. Lack of folate (Vitamin B9) can lead to megaloblastic anemia. Lack of cobalamin (Vitamin B12) can result in diminished energy, fatigue, and shortness of breath. At risk populations commonly include older adults, those with anemia, those with gastrointestinal disorders, and vegetarians (19). If you are low in B vitamins, you can eat more red meat, salmon, organ meat, milk, nutritional yeast, and green leafy vegetables. You can also supplement using a multivitamin, a green powder, or medically given Vitamin B injections.
Magnesium is involved with multiple cellular functions, including the production and utilization of ATP and neuromuscular coordination. A deficiency in magnesium can cause fatigue, lethargy, and loss of appetite. At risk populations commonly include people with gastrointestinal diseases, type 2 diabetes, and people with alcohol dependence (20). If you are low in magnesium, you can eat more green leafy vegetables, such as spinach, legumes, nuts, seeds, and whole grains (20). You can also take a multivitamin, ZMA, or a magnesium only supplement.
Zinc is involved in many aspects of cellular metabolism, as well as plays a critical part in the antioxidant defense system (21). Zinc deficiency can affect epidermal, gastrointestinal, central nervous, immune, skeletal, and reproductive systems (22). At risk populations commonly include people with gastrointestinal disorders such as celiac disease, inflammatory bowel disease (IBD), ulcerative colitis and Crohn’s disease, vegetarians (especially vegans), those who are pregnant or lactating, those with sickle cell disease (SCD), and those with alcohol use disorder (23). If you have low zinc, you can eat more meat, fish, eggs, dairy, and seafood, especially oysters which contain more zinc per serving than any other food (23). Zinc can also be found in plants such as beans, nuts, and whole grains but has less bioavailability because of the presence of phytates, which inhibits absorption (23). You can also take a multivitamin, ZMA, or a zinc only supplement to help boost your numbers.
Although stress is a natural part of everyday life, chronic stress may lead to fatigue as well as poor mental health, hypertension, depression, burnout, or stress-related exhaustion disorder (24). The worst part is that any of these results can create a negative feedback loop, leading to more stress and more fatigue (24). When your body experiences persistent surges in your sympathetic nervous system, it can cause chronic inflammation, damages to blood vessels and arteries, increases in blood pressure, and even reductions in brain gray matter volume, all of which can contribute to your fatigue (25). Sources of stress can include inactivity, relationships, emotional disturbances, traumatic events, location-based stressors, or work.
If you suffer from chronic stress, you may want to consider some of the following lifestyle changes in order to alleviate some of your stressors. First, you should try to improve your physical health with exercise and diet (25)(26). Studies have shown a strong bidirectional relationship between physical health and feelings of happiness, more energy, and less stress (27). Second, you can try some type of Mindfulness-Based Stress Reduction (MBSR) program such as controlled breathing, meditation, yoga, or tai-chi, which have been proven to help reduce stress and fatigue (28). Third, you may want to try and connect with nature by breathing fresh air, sitting in the sun, walking outside, swimming in the ocean, or perhaps bathing in a hot spring (29). All of these interventions could help alleviate some of your stressors. Finally, you may want to seek a mental health professional to help with processing any severe emotional problems or traumatic events. Cognitive Behavioral Therapy (CBT) has been shown to reduce fatigue severity in chronic fatigue syndrome (30).
Tackle your fatigue wherever it lies. The causes of chronic fatigue are often broad and insidious, so sussing them out is no easy task. Still, taking the time to cover all of your bases is the smartest way to conquer this exhaustion. Investigate these potential causes yourself, and don’t hesitate to reach out to your medical practitioner.