Tiredness that won't go away: common causes, when to investigate and what helps

“I'm always tired.” It is one of the phrases most often heard in doctors' surgeries and one of the most frequent complaints in primary care. Waking without energy, dragging yourself through the day, reaching the weekend unable to recover. For many people, it is the result of insufficient sleep, stress and pace of life. For others, it is the sign of a health problem that is worth investigating.

This article helps you understand the difference, know when to see a doctor and what you can do to regain energy.

Why am I always tired?

Tiredness rarely has a single cause. A systematic review of tiredness in primary care showed that the most frequent causes are mood disorders, such as depression and anxiety, and that serious diseases, such as cancer, are rare when there are no other warning signs (Stadje et al., 2016). In many people, no specific disease is found, and tiredness improves with changes in daily life.

Everyday causes

• Insufficient sleep: adults generally need 7 to 9 hours a night (Hirshkowitz et al., 2015). Many people sleep less during the week and try to make up for it at weekends, without success.
• Poor-quality sleep: screens late at night, irregular schedules, a hot or noisy bedroom, caffeine in the afternoon, alcohol in the evening.
• Chronic stress and overload: keeping the body on alert for weeks consumes energy and disturbs sleep. See Body on alert: physical signs of chronic stress and how to switch off.
• A sedentary lifestyle: spending the day seated reduces fitness, and the body tires more easily.
• Irregular eating: skipping meals, excess sugar and ultra-processed food, little water.
• Alcohol: disturbs sleep quality, even when it helps you fall asleep.
• Shift work and frequent travel.

Medical causes to consider

• Anaemia and iron deficiency: very common in women of childbearing age. Even without anaemia, low iron levels (low ferritin) can cause tiredness: in one trial, iron supplementation reduced tiredness in women with low ferritin without anaemia (Vaucher et al., 2012).
• Thyroid: hypothyroidism causes tiredness, weight gain, feeling cold and dry skin.
• Diabetes: especially when accompanied by thirst, passing a lot of urine and weight loss.
• Sleep apnoea: loud snoring, pauses in breathing and daytime sleepiness.
• Depression and anxiety: tiredness, lack of interest, changes in sleep and appetite.
• Vitamin B12 or vitamin D deficiencies.
• Recent infections: tiredness can last weeks after flu, COVID-19 or glandular fever.
• Medicines: some antihistamines, antidepressants, anxiolytics and antihypertensives.
• Kidney, liver, heart or autoimmune diseases, less frequent.
• Myalgic encephalomyelitis / chronic fatigue syndrome: intense, persistent tiredness that worsens after physical or mental exertion and does not improve with rest. It requires a medical diagnosis and careful management of activity (NICE, 2021).

Tiredness, drowsiness or weakness?

It is worth distinguishing:

• Tiredness (fatigue): lack of physical or mental energy.
• Sleepiness: a wish to sleep, falling asleep easily during the day. It suggests sleep problems, such as apnoea.
• Muscle weakness: difficulty exerting force, climbing stairs or lifting objects. It requires medical assessment.

When to see a doctor

Book an appointment with your family doctor if:

What to expect from the appointment

The doctor will ask when it began, how your sleep, mood, diet, work, medication and other symptoms are, and carry out a physical examination. Depending on the case, they may request tests such as:

• Full blood count (for anaemia and infections).
• Ferritin (iron stores).
• Thyroid function (TSH).
• Glucose or glycated haemoglobin (diabetes).
• Kidney and liver function.
• Vitamin B12, and possibly vitamin D.
• Markers of inflammation.

In most cases, blood tests are normal, which is also useful information: it helps to focus on sleep, stress and habits. It can be useful to bring to the appointment a two-week record of hours of sleep, energy level and relevant events.

Avoid taking supplements on your own (especially iron) before having tests: excess iron is also harmful and can mask the diagnosis.

What helps to regain energy

1. Protect sleep

• Regular bedtimes and wake-up times, even at weekends.
• Aim for 7 to 9 hours a night.
• Dark, cool, quiet bedroom.
• Screens off 30 to 60 minutes before bedtime.
• Caffeine only in the morning and early afternoon. Alcohol in moderation and well before bedtime.
• If you have persistent insomnia, speak to your doctor: cognitive behavioural therapy for insomnia is the first-line treatment.

2. Move, even when tired

It seems counterintuitive, but a meta-analysis of 70 studies concluded that regular exercise increases the feeling of energy and reduces fatigue in sedentary people, healthy people or those with chronic conditions (Puetz et al., 2006). Start slowly: walks of 10 to 20 minutes, gradually increasing. An important exception: in people with myalgic encephalomyelitis / chronic fatigue syndrome, exertion can worsen symptoms, and progressive exercise is not recommended (NICE, 2021). In that case, activity should be managed under medical guidance.

3. Managing stress and load

• Identify what is using up the most energy: work, caring for others, financial worries.
• Short breaks throughout the day.
• Activities that truly rest you: being with friends, nature, hobbies.
• Relaxation and breathing techniques.
• Psychological help, if the overload is persistent or there are signs of burnout.

4. Diet and hydration

Regular meals, with protein, vegetables, fruit and wholegrain cereals, and water throughout the day. Sugar spikes and very heavy meals tend to leave you more tired afterwards.

5. And massage?

Massage reduces anxiety and tension and may improve sleep quality, according to meta-analyses and reviews (Moyer et al., 2004; Field, 2016). In people with tiredness associated with stress, muscle tension or poor-quality sleep, it can be a good support: a moment for the body to come out of alert mode, relieve tension in the neck and back and prepare for more restorative sleep.

What massage does not do: correct anaemia, a thyroid problem, sleep apnoea or depression. If tiredness has a medical cause, that cause should be treated. Massage complements, it does not replace.

For those who mainly want to regain energy, a relaxing massage, at the end of the day or before the weekend, is generally the most useful choice. See Relaxing or deep tissue massage: which to choose.

Warning signs

See a doctor promptly if the tiredness comes with:

Call 112 for chest pain, sudden shortness of breath, fainting or confusion.

If the tiredness comes with deep sadness, despair or thoughts that life is not worth living, do not keep it to yourself. Speak to someone you trust and seek help: SNS 24 (808 24 24 24) offers psychological counselling, and in a situation of danger call 112.

At Luxmed Clinic

At Luxmed Clinic, in Algés, relaxing massages are designed for those who need to slow down, relieve accumulated tension and rest better. Before the session, we talk about your general state and, if the tiredness has signs that warrant investigation, we recommend that you speak to your doctor. Massages are carried out by a massage therapist.

Massage is a wellbeing complement and does not replace medical diagnosis or treatment. Results vary from person to person.

Frequently asked questions