Five hidden reasons you're tired all the time - signs and when to see a GP

Many of us are familiar with the struggle to keep our eyes open, perhaps nodding off in front of the telly or during a movie.

This type of weariness is quite common, whether you're juggling parenthood, grappling with stress, or just caught up in the hustle and bustle of life. Yet, when fatigue becomes overwhelming, it may be more than just sleep deprivation it could be an alarm bell for health issues that might require a GP's attention.

The NHS acknowledges that occasional tiredness is perfectly normal, but persistent exhaustion could signal something more concerning. The health service advises: "It's normal to feel tired sometimes. But if you're tired all the time and do not know why, it could be a sign of a problem."

There are many apparent reasons for feeling tired and fatigued such as:

• not getting enough sleep or finding it hard to get to sleep (insomnia)

• an unhealthy lifestyle (such as having an unhealthy diet and not getting much exercise)

• stress, depression and dealing with life challenges, such as bereavement or looking after a new baby

• hormonal changes (such as during puberty, pregnancy or the menopause)

• some illnesses, like glandular fever and COVID-19

• some medical treatments and medicines, like chemotherapy, which can cause drowsiness for a while

However, the NHS cautions that if your sense of exhaustion has been lingering and shows no signs of improving, it's crucial to consult a healthcare professional, as reported by the Mirror. The NHS further notes: "If you cannot explain why you're tired and it's been going on for a while and not getting any better, it may be a sign of a medical condition.

"Your symptoms might give you an idea of what's causing your tiredness or fatigue. But do not self-diagnose see a GP if you're worried."

Conditions that may cause chronic fatigue

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Sleep apnoea

Sleep apnoea, characterized by your breathing starting and stopping during sleep due to narrowing airways, is one potentially tough-to-identify source of excessive fatigue.

It carries links to:

• obesity

• having a large neck

• getting older – although children and young adults can also get it

• having other family members with sleep apnoea

• smoking and drinking alcohol

• having large tonsils or adenoids

• sleeping on your back

• a condition called chronic obstructive pulmonary disease (COPD)

The most prevalent type is known as obstructive sleep apnoea (OSA). It's crucial to treat sleep apnoea as it can lead to severe complications such as high blood pressure, diabetes, heart disease, or depression.

Since it happens while you're asleep, it can take years to identify - if you think you might have it, ask someone to watch you while you sleep.

Lifestyle changes like losing weight, stopping smoking, and reducing alcohol intake can sometimes manage it. However, many people need to use a device called a CPAP machine, which pumps air into a mask you wear over your mouth or nose while you sleep.

Sleep apnoea symptoms primarily occur when you are asleep. They include:

• breathing stopping and starting

• making gasping, snorting or choking noises

• waking up a lot

• loud snoring

During the day, you may also:

• feel very tired

• find it hard to concentrate

• have mood swings

• have a headache when you wake up

Iron deficiency anaemia

Symptoms such as lack of energy, noticeable heartbeats (heart palpitations), shortness of breath, and pale skin could indicate iron deficiency anaemia. This condition is caused by a lack of iron, often due to blood loss or pregnancy. It's treated with iron tablets and by consuming iron-rich foods.

If you suspect you have an iron deficiency, blood tests will examine your red blood cell count, and if it's low, you'll be given iron tablets to increase your levels.

Symptoms of iron deficiency anaemia can include:

• tiredness and lack of energy

• shortness of breath

• noticeable heartbeats (heart palpitations)

• paler than usual skin

• headaches

Diabetes

Feeling excessively tired, unusually thirsty, urinating more frequently (especially at night), and experiencing weight loss could be signs of diabetes. This condition results in a person's blood sugar level becoming too high.

Diabetes develops when your pancreas fails to produce sufficient insulin or any at all, or when your body doesn't respond appropriately to the effects of insulin. There are two types of this condition.

Type 1 diabetes is a lifelong ailment where the body's immune system attacks and destroys the cells that produce insulin. On the other hand, type 2 diabetes occurs when the body does not generate enough insulin, or the body's cells do not react properly to insulin.

Type 2 diabetes is significantly more prevalent than type 1. In the UK, over 90 per cent of all adults with diabetes have type 2.

There are no lifestyle modifications you can make to decrease your risk of type 1 diabetes. However, you can reduce the risk of type 2 diabetes through healthy eating, regular exercise, and maintaining a healthy body weight.

You may be more susceptible to type 2 diabetes if you:

• are living with overweight or obesity

• do not have a healthy diet

• have a family history of type 2 diabetes

• are of Asian, Black African or African Caribbean origin

• take certain medicines such as steroids for a long time

• have high blood pressure

• have had gestational diabetes during pregnancy

Type 1 diabetes can develop rapidly over weeks or even days. Weight loss is common in people with type 1 diabetes when it first develops and before it's treated, but it's less common in people with type 2 diabetes.

Many people live with type 2 diabetes for years without knowing because the early symptoms tend to be general, or there are no symptoms at all.

Symptoms of diabetes include:

• feeling very thirsty

• peeing more frequently than usual, particularly at night

• feeling very tired

• weight loss and loss of muscle bulk

• itching around the penis or vagina, or frequent episodes of thrush

• blurred vision

Overactive thyroid

If you're constantly feeling tired, restless, anxious, irritable and experiencing muscle weakness, it could be a sign of an overactive thyroid (hyperthyroidism). This condition occurs when the thyroid gland, a small butterfly-shaped gland in your neck, produces too much thyroid hormone.

These hormones play a crucial role in regulating things like your heart rate and body temperature. The NHS warns that having an excess of these hormones can lead to unpleasant and potentially serious health issues that may require treatment.

While anyone can develop an overactive thyroid, it's about 10 times more common in women than men and typically occurs between the ages of 20 and 40.

An overactive thyroid can cause a wide range of symptoms, including:

• nervousness, anxiety and irritability

• mood swings

• difficulty sleeping

• persistent tiredness and weakness

• sensitivity to heat

• swelling in your neck from an enlarged thyroid gland (goitre)

• an irregular and/or unusually fast heart rate (palpitations)

• twitching or trembling

• weight loss

If you notice any signs of an overactive thyroid, it's important to consult with your GP. A simple blood test can determine how well your thyroid is functioning. If diagnosed with hyperthyroidism, treatments can include medication, radiotherapy or in some cases, surgery.

ME/CFS

If you've been dealing with extreme fatigue for at least three months, so severe that it hinders your daily activities, along with problems related to thinking, memory, concentration or flu-like symptoms, it could be myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). This condition can affect anyone, including children.

The four main symptoms of ME/CFS are:

• feeling extremely tired all the time (fatigue), which can make daily activities like taking a shower, or going to work or school, difficult

• sleep problems, including insomnia, sleeping too much, feeling like you have not slept properly and feeling exhausted or stiff when you wake up

• problems with thinking, concentration and memory (brain fog)

• symptoms getting worse after physical or mental activity, and possibly taking weeks to get better (also called post-exertional malaise, or PEM)

People with ME/CFS often experience pain in various parts of their body, as well as flu-like symptoms like fever, headaches, and aching joints or muscles. However, these symptoms are similar to those of other illnesses, so it's crucial to consult a GP for an accurate diagnosis.

The cause of ME remains a mystery, and there is currently no cure. However, there are methods to manage the symptoms, including strategies to optimise energy use and medication to control pain and sleep issues.

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