How to Know If Your Fatigue Is Normal

If you’re nodding off a few sentences into reading this article (in broad daylight), you and sleep may need to reexamine your relationship.

“To be healthy, you need to get enough sleep,” says family medicine doctor Matthew Goldman, MD. But getting adequate rest can seem as elusive as winning the lottery.

In this Q&A, Dr. Goldman offers ways to once again dream the impossible dream.

Q. How much sleep do adults really need?

A. The amount of sleep you need varies with age. The National Sleep Foundation recommends that people 18-64 years old get seven to nine hours each night. Adults 65 years and older need seven to eight hours per night.

Q. What’s a normal level of fatigue for an adult?

A. Feeling tired is one of the most common complaints doctors hear about. And fatigue is normal if you had a late night and then feel tired the next day.

But fatigue (either normal or extreme) can become a concern when it affects your health and safety. For example, it’s a problem if you’re likely to doze off in situations where you need to maintain alertness, such as while driving or operating heavy machinery.

So talk to your doctor if fatigue is compromising your safety. Your doctor will also want to know how long you’ve been experiencing symptoms to help determine the cause of your exhaustion.

Q. Why am I so tired?

A. Certain lifestyle choices and habits can affect how rested you feel. Poor sleep hygiene, shift work, jet lag and substance use (including alcohol and narcotics) can all contribute to extreme fatigue.

Certain medications can also affect how tired you feel. These include antihistamines, anticonvulsants, antipsychotics, antidepressants, and pain and anti-anxiety medications. So can taking higher-than-recommended dosages of these medications and medication withdrawal (when you stop taking the medicine).

Many health conditions can lead to excessive tiredness, including:

• Anemia (a common blood disorder).
• Electrolyte abnormalities.
• Genetic, neurological and sleep disorders.
• Heart, lung, thyroid or liver conditions.
• Mental health issues, including anxiety, depression and bipolar disorder.
• Metabolic issues, such as diabetes.
• Obesity.
• Rheumatological conditions, such as rheumatoid arthritis.
• Snoring (a breathing disorder).
• Underlying cancer or infectious disease.

Q. How can I prevent fatigue and exhaustion?

A. Good sleep hygiene is important. Try to incorporate these sleep habits into your routine:

DO:

• Sleep only as much as you need to feel rested, and then get out of bed.
• Keep a regular sleep schedule.
• Exercise regularly, preferably at least four to five hours before bedtime.
• Make the bedroom environment conducive to sleep.
• Deal with your worries well before bedtime.

DON’T:

• Try to sleep unless you feel sleepy.
• Drink caffeinated beverages after lunch.
• Drink alcohol near bedtime (no “nightcaps”).
• Smoke, especially in the evening.
• Go to bed hungry.
• Use light-emitting screens before bedtime.

Q. How do you know if fatigue is a sign of a possible health issue?

A. Signs that your fatigue could be a symptom of something more include:

• Lack of physical or mental energy.
• Inability to stay awake and alert or initiate activity.
• Unintentionally falling asleep or falling asleep at inappropriate times.
• Reduced capacity to maintain or complete an activity.
• Becoming easily fatigued.
• Difficulty with concentration, memory or emotional stability.

Tiredness affecting your ability to work, socialize and participate in family activities is also a red flag — as is you or your family needing to make accommodations to deal with your symptoms.

Q. When should you see a doctor for your fatigue?

A. Talk to your provider as soon as you or those around you experience any amount of concern. Simply expressing the problem should lead to a discussion about the topic. 

Your provider will likely want to evaluate you to determine the severity of your symptoms and potential causes. Typically, the evaluation starts with a thorough history and physical exam.

Doctors also use specific questions to measure how tired you feel. Terms like “feeling tired,” “experiencing fatigue,” “having lack of energy” and “feeling especially sleepy” are often used interchangeably. However, it’s important for your provider to distinguish between them to figure out the cause.  

Based on your responses, your doctor can figure out the appropriate approach for diagnosing you. You may need additional testing, such as lab work, imaging or sleep studies, to determine the cause. Once your provider gets to the bottom of the fatigue issue, they can work with you on how to solve it.