Why You May Be Tired All the Time and What to Do About It
By Dhanya Venugopal, MD
Feeling tired all the time has become a common part of modern life, but constant fatigue is not something you should ignore. Understanding the cause of your tiredness is the first step toward feeling better. Fatigue can generally be grouped into several main categories: lifestyle, stress, nutrition, medical reasons, and psychological reasons.
Lifestyle factors, especially sleep, play a major role. Adults should aim for an average of 6 to 8 hours of sleep each night, while children need about 9–10 hours. Ask yourself: Are you sleeping well? How long does it take you to fall asleep after going to bed? Do you wake up frequently during the night? Do you feel refreshed in the morning? The quality of your sleep can be affected by what you eat. Spicy and fatty foods can trigger acid reflux and thirst, leading to awakenings during the night.
Good “sleep hygiene” is essential for restoring energy. This includes going to bed and waking up at regular times, eating your last meal 2–3 hours before bedtime, and reducing fluid intake in the evening. Turning off screens an hour before bed and dimming the lights helps the body produce melatonin, the hormone that regulates the sleep–wake cycle. Calming activities such as listening to music, reading a book, or meditating can help prepare the body and mind for sleep.
Exercise is another important lifestyle factor. Workouts earlier in the day help reinforce the natural sleep–wake cycle. In the evening, light to moderate activities such as brisk walking, yoga, or stretching can be beneficial. However, vigorous exercise right before bed may raise body temperature and heart rate, making it harder to fall asleep.
Nutrition and gut health also play a major role in fatigue. Clinicians recommend eating protein-rich foods every day, noting that as we age, our muscles need more protein to maintain themselves. A daily diet rich in fruits and vegetables supports overall health and energy levels. In contrast, excess carbohydrates can cause blood sugar spikes and crashes, contributing to feelings of tiredness. Patients are encouraged to “eat quality food rather than quantity.”
Stress is another common driver of fatigue. Stress-related fatigue often feels like a deep, persistent exhaustion that is not relieved by rest. It can be associated with brain fog, short-term memory problems, sore muscles, a weakened immune system, and lack of motivation. Strategies to reduce stress include practicing good sleep hygiene, engaging in moderate physical exercise, using deep breathing techniques, meditating, and maintaining good nutrition.
Even after improving sleep, exercise, diet, and stress management, some people may still feel fatigued. In these cases, medical causes should be considered. Common medical reasons for fatigue include anemia (which may result from poor nutrition, malabsorption, menstrual blood loss in reproductive-age women, or cancer), thyroid disorders (both low and high thyroid hormone levels), heart failure, and lung conditions such as COPD, which can cause breathlessness and chronic cough. Nutritional deficiencies, particularly vitamin D and vitamin B12, are also frequent contributors to fatigue.
Other medical conditions linked to fatigue include diabetes, autoimmune disorders such as systemic lupus erythematosus (SLE) and rheumatoid arthritis, and sleep apnea, a condition in which breathing repeatedly stops during sleep due to upper airway collapse, causing multiple awakenings and morning tiredness. Certain medications, including some allergy and cold medicines, anti-anxiety medications such as Xanax and Valium, beta blockers like metoprolol, seizure medications, and diuretics (“water pills”) can cause fatigue or electrolyte imbalances that lead to tiredness. Daily alcohol use, obesity, and psychological conditions such as depression, anxiety, post-traumatic stress disorder (PTSD), and bipolar disorder are also significant contributors.
A step-by-step approach to treating fatigue is recommended. Start by improving sleep hygiene and staying well hydrated, especially in hot weather. Focus on eating protein-rich foods, reducing carbohydrates and fatty foods, and increasing fruits and vegetables. Find ways to calm your mind and reduce stress, making time for relaxation and self-care. Regular exercise, including practices such as yoga and tai chi, can help energize the body. If obesity is a factor, weight loss can significantly improve energy levels; “being lighter makes you more energetic.” Patients are also advised to stop using alcohol, tobacco, and other recreational drugs.
For those taking allergy medications with sedative effects, using them at night may help with sleep while reducing daytime drowsiness. Most importantly, if fatigue persists despite these lifestyle changes, individuals are encouraged to see a doctor to evaluate potential medical causes. People with symptoms of sleep apnea, such as loud snoring, pauses in breathing during sleep, or persistent morning fatigue, should talk with their clinician about sleep studies and follow medical recommendations.
To learn more about how to address constant fatigue, contact your primary care provider.
Dhanya Venugopal, MD, is a second-year internal medicine resident at UNC Health Southeastern. In addition to offering services you’d expect from a community healthcare system, UNC Health Southeastern provides a number of specialized services that are unique to our system and not available anywhere else in the region. To schedule an appointment, call our referral line at 984-974-CARE. To learn more, visit UNCHealthSE.org.
