In our fast-paced society, where work and family demands often consume every waking hour, fatigue is a fact of life. Millions of American experience fatigue, a feeling of weariness, tiredness, or lack of energy that can sap every aspect of life: physical, emotional, social, and spiritual.

Sometimes, fatigue is an acute response to environmental stressors such as excessive physical activity, lack of exercise, insufficient rest or sleep, poor diet, and dehydration. Acute or normal fatigue usually quickly improves if you get more rest or sleep, eat a nutritious diet, and balance your level of physical activity.

Chronic fatigue – which does not improve with rest -- is an entirely different beast. When fatigue persists for more than two weeks despite your best efforts to control it, it can seriously affect your ability to function at work and home, increase your risk of accidents, and ruin your quality of life. 

Causes of Chronic Fatigue

Chronic fatigue is often associated with lifestyle factors such as alcohol use or abuse, caffeine use, excessive or insufficient physical activity, lack of sleep, and a poor diet.
Certain prescription medications also can cause fatigue. These include:

• Antidepressants.
• Antihistamines.
• Blood pressure medications.
• Cough and cold medications.
• Heart medications.
• Prescription pain medications such as opioids.
• Psychological conditions often associated with fatigue include anxiety, depression, grief, and stress. In addition, fatigue may be a sign of a medical condition such as:
• Acute liver failure.
• AIDS.
• Anemia.
• Cancer.
• Chronic fatigue syndrome.
• Chronic kidney failure.
• Chronic obstructive pulmonary disease (COPD).
• Diabetes (Type 1 or Type 2).
• Heart disease.
• Multiple sclerosis.
• Obesity.
• Overactive or underactive thyroid.
• Pregnancy.
• Restless legs syndrome.
• Sleep apnea.

Cancer patients often experience profound fatigue from chemotherapy, which typically lasts for one to two weeks following treatment; and from cancer surgery, which can last for weeks or months.

When to See a Doctor

You should schedule a doctor’s appointment if fatigue persists for longer than two weeks after you’ve taken steps to get enough rest, reduce stress, and eat a better diet.
Your doctor will assess your medical history, conduct a physical examination, and may order tests such as a complete blood count, thyroid function, and imaging studies (CT or MRI scan). He or she also may assess factors affecting fatigue such as mood, social relationships, and thought processes using a 0-10 rating scale in which 0 means no fatigue and 10 means the worst imaginable fatigue.

Seek immediate medical attention for fatigue accompanied by abnormal bleeding, unexplained weight loss or gain, severe abdominal pelvic or back pain, or severe headache. Call 911 if fatigue is associated with thoughts of harming yourself or others, chest pain, shortness of breath, irregular or fast heartbeat, or a feeling that you might lose consciousness.

To measure your level of fatigue, and obtain hints for managing it, the Beth Israel Medical Center’s Department of Pain Medicine and Palliative Care offers an online fatigue test which can be accessed at http://www.stoppain.org/palliative_care/content/fatigue/fatiguesurvey.asp.

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