Persistent Tiredness (Fatigue)
Physician's Weekly
April 1, 2022
Persistent Tiredness (Fatigue)

Q: I am a 36 year old woman and for the last six months I have been extremely tired all the time. I go to sleep tired, I wake up tired. What could be wrong? Can you recommend a tonic or vitamin?

What you are describing is chronic fatigue. This is whereby one’s tiredness is not helped by rest or sleep and as a result the sufferer is constantly tired for a period of six months or more. In such a case, it may be a symptom of an underlying medical condition. Supplements such as vitamins and tonics are not the first thing that one should turn to when one is experiencing protracted fatigue. Rather, it is highly recommended that you see a doctor in order to determine the exact cause of your tiredness, once identified this can then be specifically managed.

Causes of chronic fatigue

While most of us have suffered from fatigue at some point in our respective lives, however, fatigue is of concern when it becomes long-lasting and or if it is severe.

It has a wide array of causes. Below I’ve shared some of the more common reasons for chronic fatigue:

Hormonal imbalances in women
Diseases affecting major organ systems; especially the liver, kidney, heart, brain, lungs
Sleep apnea
Autoimmune – e.g. Lupus, rheumatoid arthritis, sjorgren’s, inflammatory bowel disease
Mental illness – e.g. depression, anxiety
Sleep disorders
Chronic fatigue syndrome
Secondary to infections – COVID-19, influenza, HIV, glandular fever, urinary tract, tuberculosis
Head injury
Overuse of alcohol
Sedentary lifestyle
Poor dietary habits

Urinary frequency – especially if it awakens the person from sleep
Chronic pain
Having a young infant
Night shifts

When to see a doctor for fatigue?

  • If the fatigue persists for more than 2 weeks in spite of your best efforts to reduce stress, exercise, rest, eat properly and consume adequate amounts of fluids.
  • There should be a lower threshold for seeing the doctor if the fatigue is accompanied by other symptoms.

Determining the cause of fatigue

A very detailed history is critical to determining the cause of the fatigue. The doctor will perform a comprehensive physical examination before deciding if any, and what specific tests that need to be done in order to pin down the cause of the patient’s fatigue.

Tests which are most commonly ordered include:

Bloods: Complete blood count; blood sugar; liver, kidney and thyroid function; autoimmune screen; measuring the level of inflammation in the blood via testing the ESR and CRP; cortisol, Vitamin D, B12, and iron levels may also be ordered.
Urine: Urinalysis for blood, protein, white blood cells, nitrites, glucose,
Stool: Tested for occult blood (X3)
Other tests: Polysomnography for obstructive sleep apnoea, chest x-rays

General Treatment

The specific treatment of fatigue depends on the cause. However, there are some general measures that can be taken:
Healthy eating

  • Adequate fluid intake
  • Regular exercise
  • 6-7 hours of nightly sleep
  • Avoiding stress
  • Pacing oneself – at work and socially
  • Relaxation techniques

    Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale,,, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)
    Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.