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| health > story page |         |
Fatigue: How to know when to see a doctorSeptember 21, 1999
By Laurie Green, M.D. (WebMD) -- Fatigue is one of the most common complaints voiced today and, depending on the cause, it can be one of the easiest symptoms to treat or one of the most elusive. For too many of us, juggling responsibilities at work and at home results in less sleep and little or no exercise. While the stresses and strains of daily life explain a large proportion of fatigue cases, chronic fatigue can also be a consequence of underlying health disorders that mandate investigation. Here's how to determine whether what you need is a lifestyle change or a trip to your doctor. 'Physiological fatigue' is lifestyle-related When mentally and physically healthy people experience an imbalance in diet, exercise or rest, "physiological fatigue" results. A number of lifestyle changes can produce physiological fatigue, including new motherhood, night-shift work or following a new diet. A decrease in exercise can also cause fatigue because of a drop in the level of endorphins, the brain chemicals responsible for "runner's high." Subtle changes in the time or amount of caffeine or alcohol ingested or the secretion of catecholamines (anxiety-producing adrenal hormones that accumulate in response to stress) can also disturb sleep and result in fatigue. The cure? Stress management and a return to a healthy routine can do the trick to alleviate most physiological fatigue. Fatigue can also be a consequence of sleep disturbances or simply not getting enough sleep. It's no surprise that a 1999 National Sleep Foundation poll found that only 35 percent of adults get the recommended eight hours or more of sleep per night during the work week. Of course, not all sleep-related fatigue comes from staying up too late. Normal physical changes which accompany adolescence and aging can also disturb sleep. Both adolescent girls undergoing a growth spurt and perimenopausal women experiencing their first hot flashes can be fatigued as a result of sleep disturbances. In these instances there is a decrease in the amount of dream sleep, or rapid eye movement (REM) sleep. REM sleep allows people to wake up feeling refreshed. Sleeping better requires routine The same poll found that 71 percent of those without a regular sleep schedule had a sleep problem, compared to 58 percent of those who did follow a regular sleep schedule. Why is routine so important? Over the course of a day, a strict rhythm dictates the secretion of numerous hormones and chemicals into both the brain and body. Changes in schedule can disturb this rhythm. Even sleeping in an extra two hours on a weekend can adversely affect sleep. Short-term fatigue that has been present for under six months, does not resolve with rest and excludes physiological fatigue is called "acute fatigue." Once lifestyle issues are identified and corrected, other explanations should be investigated: Food allergies, medications, drugs and alcohol can all produce short-term, acute fatigue. Medical conditions that can cause fatigue include:
Changes in sleep patterns can also produce acute fatigue. Sleep apnea, a common breathing disorder often signaled by snoring and restlessness, affects 12 million Americans, with another 10 million undiagnosed, according to American Sleep Apnea Association estimates. In a person with sleep apnea, sleep is disturbed hundreds of times each night, although the sufferer may awaken only three or four times. The disturbances are caused by airway blockage (when muscles don't relax) and the resulting buildup of carbon dioxide in the blood. Fortunately, sleep apnea is treatable with a device called nasal CPAP (Continuous Positive Airway Pressure). Restless Legs syndrome (RLS), in which there is an irresistible urge to move the legs while inactive, can also disturb sleep. According to the National Sleep Foundation, an estimated 2 percent to 5 percent of the population experiences this condition. RLS is usually treated with medications. Fatigue commonly accompanies certain autoimmune conditions such as fibromyalgia (an inflammation of the muscles) or systemic lupus erythematosus, as well as some infections (tuberculosis, hepatitis, mononucleosis) or malignancies (lymphomas, leukemias). In these cases, symptoms other than fatigue usually define the diagnosis, and when the underlying conditions are treated, fatigue often abates. Chronic fatigue is defined as debilitating fatigue that persists for more than six months, does not resolve with rest and is associated with other symptoms such as fever, sore throat, muscle pain and headaches. Chronic fatigue syndrome (CFS) is more common in women and most commonly strikes at around age 30, although it can affect anyone at any age, according to the Centers for Disease Control and Prevention (CDC). An estimated half a million people in the United States have a CFS-like condition, says the government agency. The actual prevalence of CFS is unknown but is currently under study by CDC. CFS often begins after an infection and is commonly accompanied by depression and fibromyalgia. While the cause can be unclear, many symptoms respond to treatment. Nonsteroidal anti-inflammatory agents such as ibuprofen address the aches and pains of CFS, and antidepressants improve mood and sleep. If you continue to experience fatigue that is not illness-related -- or after having made the appropriate lifestyle changes -- contact your doctor. Remember, though, that a healthy diet, plenty of sleep and regular exercise are the best fatigue busters! Finally, enlist your family or roommates to help; observations from those with whom you live closely may help to identify sleep apnea.
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Chronic fatigue syndrome RELATED SITES: Centers for Disease Control and Prevention: Chronic fatigue syndrome LATEST HEALTH STORIES: China SARS numbers pass 5,000
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