Do you always feel tired? You’re not alone. Between work, family and friends, and all the other commitments you’re juggling, it’s easy to blame constant fatigue on a busy lifestyle and lack of adequate sleep.

But if you’ve made some simple lifestyle changes—like going to bed earlier and managing stress and you’re still feeling the symptoms of fatigue, you might need professional help.

The reason? Excess exhaustion could be a sign of a more serious medical condition. Here are five sneaky health conditions that could explain your sluggishness.

Medical reasons you’re tired all the time

Anemia

The fatigue caused by anaemia is the result of a lack of red blood cells, which bring oxygen from your lungs to your tissues and cells. You may feel weak and short of breath. Anaemia may be caused by an iron or vitamin deficiency, blood loss, internal bleeding, or a chronic disease such as rheumatoid arthritis, cancer, or kidney failure.

Women of childbearing age are especially susceptible to iron deficiency anemia because of blood loss during menstruation and the body’s need for extra iron during pregnancy and breastfeeding.

The symptoms: Feeling tired all the time is a major one. Others include extreme weakness, difficulty sleeping, lack of concentration, rapid heartbeat, chest pains, and headache. Simple exercise, such as climbing the stairs or walking short distances, can wipe you out.

The tests: A thorough evaluation for anemia includes a physical exam and blood tests, including a complete blood count (CBC), to check the levels of your red blood cells and the hemoglobin in your blood. It’s also standard to check the stool for blood loss.

The treatments: Anemia isn’t a disease; it’s a symptom that something else is going on in your body that needs to be resolved. So, treatment will vary depending on the underlying cause of anemia. It may be as simple as eating more iron-rich foods, but talk to your doctor about the right treatment for you.


Type 2 diabetes

Sugar, also called glucose, is the fuel that keeps your body going. And that means trouble for people with type 2 diabetes who can’t use glucose properly, causing it to build up in the blood. Without enough energy to keep the body running smoothly, people with diabetes often notice fatigue as one of the first warning signs.

The symptoms: Aside from feeling tired all the time, other signs of diabetes include excessive thirst, frequent urination, hunger, weight loss, irritability, yeast infections, and blurred vision.

The tests: There are two major tests for diabetes. The A1C test, which is most common, shows your average blood sugar level over the course of a few months. The fasting plasma glucose test measures your blood glucose level after fasting for 8 hours.

The treatments: Your doctor will advise you on how to control your symptoms through diet changes, oral medications, and/or insulin.


Depression

More than “the blues,” depression is a major illness that affects the way we sleep, eat, and feel about ourselves and others. Without treatment, the symptoms of depression may last for weeks, months, or even years.

The symptoms: We don’t all experience depression in the same way. But commonly, depression can cause decreased energy, changes in sleeping and eating patterns, problems with memory and concentration, and feelings of hopelessness, worthlessness, and negativity.

The tests: There’s no blood test for depression, but your doctor may be able to identify it by asking you a series of questions. If you experience five or more of these symptoms below for more than two weeks, or if they interfere with your life, see your doctor or mental health professional: fatigue or loss of energy; sleeping too little or too much; a persistent sad, anxious, or “empty” mood; reduced appetite and weight loss; increased appetite and weight gain; loss of interest or pleasure in activities once enjoyed; restlessness or irritability; persistent physical symptoms that don’t respond to treatment, such as headaches, chronic pain, or constipation and other digestive disorders; difficulty concentrating, remembering, or making decisions; feeling guilty, hopeless, or worthless; thoughts of death or suicide.

The treatments: Most people who struggle with depression are able to thrive through a combination of talk therapy and medication.


Chronic fatigue

This baffling condition causes a strong fatigue that comes on quickly. People who suffer from Chronic Fatigue Syndrome, CFS, feel too tired to carry on with their normal activities and are easily exhausted with little exertion.

The symptoms: Other signs include headache, muscle and joint pain, weakness, tender lymph nodes, and an inability to concentrate. Chronic Fatigue Syndrome, remains puzzling, because it has no known cause.

The tests: There is none. Your doctor must rule out other conditions with similar symptoms, such as lupus and multiple sclerosis, before making the diagnosis.

The treatments: Sadly, there is no approved medicinal cure for chronic fatigue. Self-care, antidepressants, talk therapy, or joining a support group may help.


Sleep apnea

You could have this sleep-disrupting problem if you wake up feeling tired no matter how much rest you think you got. Sleep apnea symptoms include brief interruptions of breathing during sleep. In the most common type, obstructive sleep apnea, your upper airway actually closes or collapses for 10 seconds or more, which prevents your brain from going into deeper stages of sleep like the REM stage. Someone with obstructive sleep apnea may stop breathing dozens or even hundreds of times a night.

The symptoms: Sleep apnea is often signaled by snoring and is generally followed by tiredness the next day. Because sleep apnea can lead to heart disease, high blood pressure, diabetes, and stroke, it’s important to be tested.

The tests: Your doctor may refer you to a sleep specialist who may want to perform a sleep study either at home or in a lab. This involves an overnight stay at a sleep clinic, where you’ll undergo a polysomnogram, which is a painless test that will monitor your sleep patterns, breathing changes, and brain activity.

The treatments: If you’re diagnosed with sleep apnea, you may be prescribed a CPAP (continuous positive airway pressure) device, a mask that fits over your nose and/or mouth and blows air into your airways while you sleep.


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