Experts Explain Why You Feel Constantly Exhausted

A day probably doesn’t go by when you don’t feel at least a little bit tired at some point, and that’s normal. Nevertheless, if you feel like you’re constantly asking yourself “Why am I always tired?” despite doing your best to get a good night’s sleep, you’re not alone: Between 30 and 40% of adults and teens experience some form of sleepiness during the day. But addressing feelings of fatigue or exhaustion doesn’t always mean simply going to bed earlier at night. Sleep plays only one factor in just how energized you feel throughout the day: your diet, how much you exercise, your body’s immune system, other bodily functions, and even daily routine habits could play a role in making you feel sleepy when the sun’s still up.

A panel of health experts assembled by Good Housekeeping — from doctors providing primary care to psychologists specializing in sleep disorders, as well as experts in other fields — say that people who always feel tired may be able to pinpoint the root cause of their condition by thinking about which kind of “tired” they are. Feeling sleepy? It may have to do with how much sleep you’re getting, or having your sleep interrupted. Feeling fatigued? There are separate reasons why this could be occurring, too. If you look at other symptoms or patterns that go hand in hand with your sleepiness, you may discover clues to what’s happening to your body.

If you’re worried about feeling tired all the time due to COVID-19 concerns, think about whether you’re also feeling body pain or other effects “perceived as a fatigue that can be much more extreme than one related to lack of sleep,” says David Gozal, MD, the chairman of child health at University of Missouri Health Care. Dr. Gozal, who has published research on how novel coronavirus intersects with sleep, says infectious diseases like COVID-19 can generate immune responses that may influence our sleep quality or make us feel tired. If you feel particularly exhausted and have trouble breathing, are experiencing muscle pain, cough, fever, or chills, it’s time to reach out to your healthcare provider. Dr. Gozal says feeling consistently exhausted and confused is a warning sign you should keep an eye out for, especially if you are unable to stay awake or have immense difficulty waking up.

Below, we explore the top nine reasons why you might be feeling tired all the time. You’ll also find medical experts explaining how you might be able to start to get pep back in your step.

You’re simply not getting enough sleep.

One in three American adults don’t get enough sleep, according to the Centers for Disease Control and Prevention. And there’s a good chance that you feel tired because you aren’t simply snoozing enough!

Sleep needs vary greatly for most people, says Uma Naidoo, M.D., the director of nutritional and lifestyle psychiatry at Harvard Medical School’s Massachusetts General Hospital. Most adults need to sleep at least seven hours each night, but many don’t realize that other unique health factors may necessitate longer sleep patterns in their case. And even just a few nights of poor sleep can lead to a chronic feeling of tiredness: “I need to understand what a person’s usual sleep schedule looks like, what’s changed recently, and how long they’ve been feeling this way,” says Dr. Naidoo, the author of This Is Your Brain on Food, a guide to the role that food plays on mental health conditions like depression, anxiety, and obsessive-compulsive disorder.

If none of the other factors in this article apply to you, and you get a consistent amount of sleep each night but still feel exhausted, it’s time to seek out help from your primary care provider or a sleep specialist, Dr. Naidoo says.

You’re not getting quality sleep.

Dr. Naidoo stresses that getting seven hours of sleep doesn’t automatically mean it’s quality sleep. “Patients may say to me, ‘Oh, I’m sleeping seven hours, but I’m waking up exhausted.’ So that’s a clue about the quality of sleep,” she explains. High-quality sleep allows your brain to go through all five stages of each sleep cycle, letting you store memories and release hormones to regulate your body’s energy levels the next day, according to the National Institutes of Health. But any number of nighttime interruptions could be hampering your sleep routine — whether it’s a complicated issue like getting up frequently to use the bathroom, or simply because you drank a ton of caffeine before heading to bed, Dr. Naidoo says.

Sleep hygiene often plays a big role in quality sleep for most people: It’s about avoiding triggering foods before bed, setting up an inviting, comfortable space for you to actually fall asleep in, and most importantly, trying to get to sleep by a certain hour each and every night (and sticking to it on weekends!). A 2016 study published in the International Journal of Psychology found that, for adolescents, going to bed at the same time every night resulted in less fatigue and less trouble falling asleep quickly, compared to those who had different sleep routines on the weekends.

You aren’t choosing the right snacks.

You’ve probably heard it before, but health experts can’t stress the connection between diet and our energy levels enough. If you’re reaching for too many refined, processed carbohydrates, it may be causing you to drag throughout your day. “Your blood sugar balance plays a critical role in your energy levels throughout the day, which is why not all carbohydrates are created equal,” Stefani Sassos, MS, RDN, CDN, the Good Housekeeping Institute’s registered dietitian explains. “If you are indulging in high amounts of sugar or refined white carbohydrates like white bread and white pasta, your blood sugar will initially spike up.”

But then comes the crash that you might be experiencing right now. “When the body realizes it has more sugar than it needs, it’ll rapidly produce insulin which results in a sharp drop in blood sugar, or that sugar crash you know so well,” Sassos says. “This abrupt fluctuation in blood sugar levels can lead to symptoms like fatigue, anxiety, and even irritability.” Chronic feelings of fatigue might be tied to your diet holistically, which is just another reason to explore a new eating plan altogether. But start with the snacks you’re reaching for throughout the day, Sassos says, since they can be a high source of refined carbohydrates and sugar in your day — things like desserts, candy, soda, and fruit juice.

“Instead, opt for foods loaded with fiber,” Sassos explains, including fresh vegetables and whole grains or legumes. “Fiber can help to slow the absorption of sugar in the body, improve blood sugar levels, and help you avoid any spikes in blood sugar and insulin production. Plus, pairing your carbs with a protein or healthy fat can also help balance your blood sugar. Instead of having a plain apple, pair it with two tablespoons of natural peanut butter to help slow the release of sugar in the body.”

You aren’t active enough.

You’d think that a sedentary lifestyle would leave you with plenty of extra energy — but that’s far from the reality. Working a desk job during the day and not taking the time to break a sweat before or after work may actually be adding to your fatigue, Sassos says. “When you exercise regularly, this enhances blood flow through the body and helps to efficiently transport oxygen and nutrients to your muscle tissue,” she explains. “In turn, this boosts energy and can reduce your fatigue levels over time.”

Besides providing you energy, getting exercise may also make it easier for you to fall asleep at night. A lack of physical activity during the day may disrupt your body’s natural circadian rhythm, says Jade Wu, Ph.D., a clinical psychologist in the department of psychiatry and behavioral sciences at Duke University. “Because the body is not getting enough cues that it’s daytime, it won’t ramp up the body’s alertness and energy expenditure in the daytime hours,” says Wu, who also hosts the Savvy Psychologist podcast. It makes sense when you think about it: Breaking a sweat during the day allows you to tire out enough to make bedtime so much smoother later.

You might need to take supplements.

Whether it’s because you don’t eat enough protein or are facing a form of anemia, your blood might play a role in feeling chronically tired, especially if your body isn’t making enough key nutrients. While Sassos says most essential nutrients are found in a balanced diet, some people may be chemically imbalanced naturally, which can lead to fatigue, says Dr. Naidoo. Iron, magnesium, B vitamins, and vitamin D are all common nutrients that can play a role in your energy levels. Iron-deficiency anemia affects just under 2 percent of American women, but nearly 6 percent of women face a general iron deficiency. Speaking to your primary care doctor about any nutrient deficiencies that can be addressed by supplements might bring you relief.

Fatigue may also be hormone related, adds Dr. Naidoo. “A low blood count could be making you tired on its own, but it may also be a hormone imbalance,” she explains, adding that blood tests can clue health providers into any thyroid issues. “The imbalance in your thyroid hormone can lead to exhaustion and feeling overly tired, as well as sleeping extra hours.”

You may be experiencing insomnia.

Nearly one in four women experience symptoms of insomnia in their lifetime — and most will have these symptoms for long periods of time. Insomnia impacts your ability to fall asleep, stay asleep throughout the night, or both. “It requires a behavioral/psychological intervention that emphasizes education about sleep, resetting the homeostatic sleep drive, and re-learning good sleep associations,” Wu explains. If you find that you’re carving out enough time to sleep but can’t sleep solidly throughout the night, this is a symptom you should follow up on with your primary care provider.

You may be suffering from allergies.

Nearly 80% of people (children included) living with seasonal allergies report that their symptoms are much more active at night, says Kathleen Dass, MD, an allergist immunologist at the Michigan Allergy, Asthma, and Immunology Center. The flare ups of impaired breathing can severely affect the ability to get a good night’s sleep; the same is true for people whose skin reacts to allergens. “Allergy cells, called mast cells, have their own circadian rhythm, and they are most active at night when we are trying to fall asleep,” Dr. Dass says. “This is why people with seasonal or year-round allergies will complain of more stuffiness or runny nose when they’re trying to fall asleep. It’s also why eczema or hive sufferers will itch more at night and why asthmatics are more likely to go to the emergency room in the middle of the night.”

Dr. Dass says her patients often take naps to unknowingly make up for a lack of sleep they’re receiving during the night, but there’s more proactive steps you can take if you believe you are suffering from allergies. “For instance, if you have a dust mite allergy, removing animals [from your bedroom] and adding dust mite covers to your mattress and pillows can help decrease symptoms,” she explains. “Plus, pollen tends to be worse during early mornings, or late in the evening, so keeping windows closed can help you sleep better.”

Of course, seeing an allergist could relieve the stress you’re placing on your sleep routine. Dr. Dass says professionals can work on changing your sleep environment, or suggest proper HEPA-filtration for your home, or even prescribe new medication to reduce your allergies’ impact on bedtime. “We can prescribe medications for specific symptoms, such as a nasal antihistamine for nasal congestion, which can also help with snoring.”

You may have too many lights on — or, conversely, be missing the sun.

Lighting plays a huge role in sleep hygiene at night, but the amount of light you surround yourself with at bedtime shouldn’t be the only time you take note of your surroundings. Mariana Figueiro, the director of the Rensselaer Polytechnic Institute’s Lighting Research Center and a professor of architecture, has conducted extensive research on the field of light and its impact on our holistic health. Her research has established that exposing ourselves to certain colors of light at different times of the day can influence our energy, Figuerio tells Good Housekeeping. “Lighting can help increase energy and reduce sleepiness. It is like a cup of coffee,” she says. “It increases brain activities, makes us feel less sleepy, and increases our energy levels and vitality… Being daytime species, humans need high levels of light during the day to maintain alertness. It seems like our brain is designed to ‘see’ bright light during the day.”

If you’re constantly working in a poorly lit area during your workday, you may feel unnecessarily sleepy — and may have a harder time falling asleep later when it’s naturally dark in your bedroom. “Exposure to higher levels of sunlight during the day can help us sleep better at night because it promotes synchronization between our internal clock and our actual watches,” Figuerio explains, citing her 2017 study published in Sleep Health. “The lack of light at the right time — throughout the day, especially in the morning — and too much light at the wrong time — during evening hours — will throw off the timing of our internal clock. We won’t be able to do the right thing at the right time.”

When you wake up, it’s important to increase light exposure naturally to help yourself wake up; take the dog out, or simply go for a walk yourself. Around bedtime, dim as many of the lights in your home as you can at least two hours before bedtime to help your body get ready for sleep. Try to leave all electronics out of your bedroom if you can, or at least keep them at arm’s length from your bed, as the light emanating from electronics can counteract natural feelings of sleepiness.

Your mental health could be at risk.

“The amount of sleep you’re receiving is not the only, nor the first, question I would ask patients who tell me they are feeling tired all the time,” Wu says. “One of the cardinal symptoms of both depression and generalized anxiety disorder is chronic tiredness. In the case of depression, the body is physiologically “shut down.” In the case of anxiety, the body is chronically tense, hyper vigilant, and stressed, which is exhausting.”

There are so many cognitive conditions that can play a role in influencing your physical energy levels, says Laura Mueller, LICSW, a Texas- and Minnesota-based therapist specializing in multiple disciplines of cognitive behavioral therapy. “From a mental health standpoint, I would also be looking to see if chronic conditions that affect sleep are at play, including bipolar disorder, or post traumatic stress,” Mueller explains.

If you’re unable to pinpoint any particular symptoms to speak about with your primary care provider, try thinking about your schedule currently and social aspects of your life at the moment — have you been feeling particularly stressed these past few months? For most, stress alone can impact energy levels, Wu explains, even if you haven’t been diagnosed with a pre-existing cognitive condition. “Chronic stress is also a major contributor to fatigue. Whether it’s stress to one’s job, relationships, finances, discrimination, world events (including a pandemic!), it keeps the body in a fight-or-flight mode, which is exhausting,” she says.

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