I have spent a lot of time over the past few years trying to develop a framework for working with fatigue.
The medical system is uniquely poorly designed to help solve fatigue, and I want to share why, and how I approach it.
Firstly, let's define fatigue. Can we quantify it? Is there a lab test for it? Have you ever thought about exactly what you're experiencing? What is happening biologically inside of us when we feel exhausted or depleted?
Fatigue isn't necessarily drowsiness. It's not weakness. It's more like feeling like your battery is drained and it needs to recharge. It's like "I can't do anything and I just have to rest." Or, "I've hit a wall."
But again — what is happening inside our bodies when this happens, and why? I think we have to understand that we are ultimately biological organisms, and our primary instinct and need is survival.
Fatigue can be thought of as our body's awareness that we've been pushed too far — a preservation strategy to protect our bodies.
It's pushing back against a threat, forcing us to slow down or stop to recuperate energy.
Practically, I like to think of fatigue in a few primary ways. As a symptom, fatigue is the "tip of the iceberg," in the sense that it's a manifestation of one or several major problems past the point of compensation. By the time you're "experiencing it," what you feel is just the tip of the iceberg — being represented by what's underwater: the underlying sources of the problem.
As we get older, the threshold at which we might experience fatigue decreases — meaning the same insult to a 20-year-old might not cause a fatigue experience, but in a 70-year-old, it could. That is to say, age isn't necessarily "a cause" of fatigue, but as a general rule, we're subject to the experience more easily.
There are probably many ways to categorize the "buckets" of causes of fatigue, but I think four major buckets make the most sense:
- Organic medical problems
- State of mind
- Sleep quality and quantity
- Iatrogenic (caused by medications or medical treatments)
It's extremely important to understand that there can be a few, or possibly very many, causes that can contribute to the experience of fatigue — and it takes experience and clinical judgment to isolate them, and "weigh" which ones might be more relevant.
Organic medical problems can include obvious things like vitamin deficiencies, metabolic problems, chronic inflammation, and cardiac, pulmonary, renal, or hepatic dysfunction. The list is practically endless.
State of mind: keep in mind (no pun intended) that our physical experience of symptoms is essentially our nervous system — which is, by definition, also our brain and peripheral nerves, sharing the same hardware as our "mind," meaning psychological state, mood, and experience.
Is it any wonder why the medical system fails at finding solutions to fatigue? But in all seriousness, I find this component — the mind — contributes to about half of the causes of fatigue, one way or another. Accumulated stress and trauma. Clinical depression. Feeling stuck, or in a big transition. It's extremely important to understand where one's state of mind is, and how we can begin to improve it when it may be contributing to fatigue.
Sleep quality and quantity. I spend so much time talking to my patients about this, because you really can't expect to not have fatigue if you aren't getting halfway decent sleep. Now, as we continue this list, as you may have already inferred, a lot of it is intertwined. Medical problems can affect sleep. Sleep can affect mood. Mood can affect sleep.
In any case, sleep quality is defined by the ability to feel well rested when you wake, at least most of the time. Deep, and especially REM, sleep are important. REM sleep is so extremely critical because it allows us to process emotions, and I think is a practical requirement for experiencing happiness and joy. Sleep apnea, caffeine, alcohol, overstimulation, and poor sleep hygiene can all affect sleep, and REM sleep specifically. A few clues that there may be an issue with sleep are diastolic blood pressure, and waking up at 3 to 4 AM, which suggests an early AM cortisol spike.
Lastly, iatrogenic sources of poor energy and fatigue include medication side effects, medical treatments like surgery and chemotherapy, and just health anxiety in general.
Once we have this outlined, I like to basically create a road map of all the possible causes, and make a best guess at which ones are most likely contributing — again, this is based on years of clinical experience, and frankly, AI is very bad at this part. Then, lastly, after we've isolated each component, I build a practical, step-by-step approach to fix each one individually.
The good news is, when we take this approach, it's only a matter of time before you start to get your energy back.
Fatigue is extremely disruptive to people's lives, and I'm happy to try to help put the pieces together to help you.
Hope that helps.
Stephen