Where to start with diagnosing extreme fatigue?
July 24, 2017 6:21 PM   Subscribe

I've been suffering from extreme fatigue for the past six months, and I don't know how to start diagnosing it.

Each morning, I wake up at 6:15 am. I go to yoga at 8 am and practice for an hour in a sweaty environment. I walk to and from yoga.

It's hard for me to eat much in the morning but I usually try to have some small protein before class — something like a hard boiled egg or a grilled chicken strip. (This morning I had grilled salmon). I also try to pre-hydrate by having a 16-oz bottle of water.

Almost every single day, by 10 or 11 am, I am SO EXHAUSTED that I can't keep my eyes open. If and when I take a nap I'll sleep HARD for like 2 hours!

This has pretty much been happening daily since the start of the year. Around that time I made an international move from the Netherlands to Houston (where I have previously lived since 2003). At first I thought it was just fatigue and stress from the move, but I feel like it should have subsided by now.

It's really frustrating me because I work from home and it's interfering with my ability to meet deadlines when I'm losing 2-3 hours a day during what is typically my most productive time.

I have been practicing hot yoga daily for several years and did not have this problem before.
I drink a lot of water — 3-4 liters a day. I take a magnesium supplement, a women's one-a-day and a fe other supplements. I do not drink coffee regularly. I definitely eat enough (probably too much) and I am working on cleaning up my diet right now. I usually go to bed at 10:30 pm and am asleep by 11 pm but I am also working on my sleep hygiene and have begun tracking my sleep.

It is possible that I am not eating enough carbs. It is possible that I am not sleeping enough. I usually wake up on my own before my alarm goes off. I have a history of allergies and they have been really bad this year thanks to Texas's mild winter. I'm also carrying around about 30-40 extra pounds that I need to lose.

Re: sleep hygeine: I track my sleep with my Apple Watch. Last night/today was especially bad. I went to bed at 11 pm and woke up at about 8:10 am (sleeping in and missing yoga). My watch says I got 2 hours of deep sleep out of that nine. I had a meeting during lunchtime when my fatigue would normally hit, but then at about 4:30 pm it struck and I had to take a 30-minute nap. I woke up still feeling groggy.

Friends have suggested I get tested for thyroid issues, but I am also wonder if I might have sleep apnea. I have definitely woken up in the middle of the night with a coughing/choking feeling before. One friend has recommended a functional medicine doctor who specializes in women's health and I'd like to go see her but don't want to waste a ton of time if the issue is something else entirely. Should I go to my GP first? What other factors should I be considering?
posted by Brittanie to Health & Fitness (24 answers total) 7 users marked this as a favorite
Go to your GP, ask for a full blood workup, and use the words "my quality of life is becoming lower and lower, please help". Ask to be checked for hypothyroidism and diabetes. Start there first. That can eliminate a lot right off the bat.
posted by Hermione Granger at 6:31 PM on July 24 [13 favorites]

Hermione Granger has it in one. Most problems with fatigue are pretty easy to diagose and treat (iron deficiency, thyroid, etc.) but if your GP doesn't find anything amiss, your next stop is a rheumatologist. Women present with the majority of autoimmune disorders, many of which have fatigue as a main component.
posted by workerant at 6:47 PM on July 24 [3 favorites]

Your doctor will also probably check you for anemia (hemoglobin, ferritin) and test your Vitamin D & B12 levels.
posted by belladonna at 6:47 PM on July 24 [2 favorites]

I agree with Hermione Granger, but it also sounds like you're only getting 7 hours of sleep which might not be enough. Try getting 8 for a couple of weeks and see how you feel.
posted by gregr at 6:53 PM on July 24 [6 favorites]

Could it be sleep apnea? Especially if allergies are making you congested.
posted by mai at 6:53 PM on July 24

Yes to all of the above. In addition, get a sleep test. Sleep apnea is underdiagnosed in women, especially young women who are not overweight.

A sleep test can also help diagnose if you are suffering from restless leg syndrome or other sleep disturbances. Tell your doctor about your sleep tracker results (that you don't seem to be getting good sleep) and insist on a sleep test.
posted by Rosie M. Banks at 6:54 PM on July 24 [2 favorites]

Do the blood testing work up. All of that stuff above. If one of those does not seem to be the issue, get a sleep test done. Along with apnea, the sleep test could rule out narcolepsy. When you go in for the sleep study consult, be sure to ask them if narcolepsy could be an issue as that requires day time napping test,, and you might want to do everything at one shot for the purposes of insurance.
posted by 101cats at 7:00 PM on July 24

Are you taking any medicine for your allergies? It took me an embarrassingly long time to figure out Zyrtec has started making me drowsy. I took it for years with no problems, but now it seriously knocks me out. Not for about five hours after I take it, though - hence why it was so difficult for my brain to put together, I guess. I thought for months that I'd developed a caffeine addiction so severe it required late afternoon espresso.
posted by something something at 7:07 PM on July 24 [3 favorites]

This would just be a temporary bandaid, but have you thought about going to a later yoga class? It sounds like you have limited energy right now and are concerned about not having more energy for work. If you slept a little later and reserved your energy for work, you could still go to a yoga class later.

But either way definitely go see your doctor and ask them to do a thorough workup.
posted by bunderful at 7:09 PM on July 24

Do you eat an actual meal before 11? Because if I were waking up at 6:615, working out hard, and eating what, a hundred calories or so of food, my blood sugar would pancake right around then. I also don't eat much in the morning but I need food the instant I come back from the gym or I am a puddle of vaguely stinky sloth within the hour.
posted by restless_nomad at 8:05 PM on July 24 [11 favorites]

Medical advice is well covered so let's consider other factors;

How is your mental health? Stress? Depression? Anxiety? You mentioned concerns about missing deadlines. How stressed is that making you? Do you feel it is easily rectified later in the day, or do you feel chronically behind?

Supplements - if you do not drink coffee regularly why are you taking a magnesium supplement? Magnesium has the effect of relaxing the body (magnesium = epsom salt, which is suggested for muscle relaxation).

Have you tried staying out of the hot yoga for a couple of weeks to see if it would make a difference?

All that be great said, as an allergy sufferer I wouldn't be surprised to learn that allergies are the culprit, but it really is worth considering other factors before pumping your body full of meds.
posted by vignettist at 8:12 PM on July 24 [1 favorite]

Well. First things first, you can't diagnose yourself. Go see your GP.

Sleep apnea is super likely given what you describe. I had the same pattern - low sleep numbers on my FitBit, waking up with choking sensation, insane fatigue. My diagnosis? moderate to severe sleep apnea. With treatment, I feel a thousand times better. Like you I delayed getting it checked out because I had attributed it to life stress.

Go see your doctor ASAP. You'll need to start with the GP anyway to get the proper referrals. There are other possibilities that cause fatigue, and MetaFilter can't pinpoint them. Your doctor can get you started. Don't waste any more time. Chances are you really don't have to keep feeling this way, so take action - the sooner you do, the sooner you may find the key that improves your health dramatically.
posted by Miko at 8:17 PM on July 24 [2 favorites]

Nthing "go to your doctor" and "get more sleep". There are a zillion things that can cause fatigue and it's good to have them considered. Sleep apnea is a real possibility.

That said, as someone who had chronic fatigue syndrome, I hope you have a very good relationship with your GP, because let me tell you, a woman going to her GP with a complaint of life-altering fatigue is all too often a woman on track to be dismissed as a histrionic whiner.

If I could change one thing about my early interactions with doctors about fatigue, it's that I would be steely in my preparation to manage those interactions in a way that would have maximized my chances to be read by them as a reasonable human being. That's what it would have taken to get the best care those doctors could give me. I hope things have changed since the 90s, but I wouldn't bet on it. Be prepared to be very alert about how you describe what's happening here.

You may get lazily diagnosed as depressed. It's a nice way to push fatigued patients out of the office quickly. If you're sure you're not depressed -- and yes, that is a big if, especially given your major life changes -- watch out for that and be prepared to advocate for yourself.

I'd even be cautious about using the phrase "extreme fatigue" with your doctor. (This is extreme fatigue for you, but it is not extreme fatigue in a medical sense.) Instead, concentrate on the activities of daily living that your fatigue is interfering with. Make a list, if only for yourself.
posted by sculpin at 8:19 PM on July 24 [7 favorites]

Do you have a functioning carbon monoxide detector? If not, get one ASAP. Even if that's not the case of your fatigue, it would be good to cross it off the list.
posted by slagheap at 8:28 PM on July 24 [2 favorites]

Should I go to my GP first?


What other factors should I be considering?

That fatigue can be an early sign of many fatal conditions.

Where to start with diagnosing extreme fatigue?

Blood test. Urine test.

I drink a lot of water — 3-4 liters a day. I take a magnesium supplement, a women's one-a-day and a fe other supplements.

You might as well stop taking the supplements, since drinking a gallon (!) of water a day will flush them right out of you. I'm no medical professional, this is not medical advice, but unless you live in Death Valley, maybe dial back on the fluids. Water intoxication is no joke. (Do mention this to your doctor.)

I have a history of allergies and they have been really bad this year thanks to Texas's mild winter.

You haven't been taking Benadryl by any chance? That'd do it.
posted by Sys Rq at 8:44 PM on July 24

and use the words "my quality of life is becoming lower and lower, please help".

In my experience, what really gets the doctor to take my problem seriously is to tell them that it's interfering with my ability to work. From your description, it sounds like this would not be untrue at all.
posted by The Underpants Monster at 9:51 PM on July 24 [3 favorites]

It took me an embarrassingly long time to figure out Zyrtec has started making me drowsy. I

Zyrtec puts me in a coma.

Also drop the hot yoga for a while. I like it but in this city it's cold a lot and so they never air out the rooms and have no windows and I get sick every time I go. It's a nasty, moldering mess in there if not properly cleaned and, more importantly, exposed to sunlight.
posted by fshgrl at 10:08 PM on July 24 [4 favorites]

Only getting 2 hours of deep sleep sounds fine/normal - at least according to my fitbit benchmarks (normal range of 12-23%, 2/9=22%). You absolutely should go to your GP first, explain your symptoms and get the easy stuff ruled out. You say you're definitely eating enough but are you eating at the right times? You do eat a proper breakfast after yoga, right?
When you moved from the netherlands to Houston, did you change allergy medications? Check the ingredients, even if its the same brand it may be a different formulation. I would try not taking it for a few days and see if it makes a difference. Like something something, it took my other half an embarassingly long time to figure out his afternoon naps were caused by his antihistamine.
posted by missmagenta at 4:14 AM on July 25

Last year I had a bad problem with fatigue. I hadn't been taking any allergy medication at all but when I started I was able to sleep better and that helped with the fatigue.
posted by bunderful at 4:41 AM on July 25

Get your pulmonary function tested too. You could be suffering from shortness of breath due to asthma without having asthma attacks, and this could have suddenly ramped up because of your change in environments.
posted by Jane the Brown at 5:00 AM on July 25

Make sure you're getting vitamins B12 and D. And see a doctor. There are various things that could cause this.
posted by theora55 at 6:08 AM on July 25

Get the blood work. When this happened to me, it ended up being mono.
posted by 4ster at 6:19 AM on July 25 [1 favorite]

What time of day do you take your magnesium supplement? Is it a time-release form, or an immediate-release form? A major side effect of magnesium is sleepiness, so it is best to take an immediate-release form at bedtime, when sleepiness is not a problem. If you take it in the morning, it can make you feel very tired when you want to be doing things. Same thing can happen if you take a time-release form (e.g., "Slow Mag") at bedtime but it doesn't get absorbed until sometime the next morning.
posted by artistic verisimilitude at 5:30 PM on July 25 [1 favorite]

Thanks everyone — I have an appointment with my GP tomorrow.
posted by Brittanie at 7:03 PM on July 25 [1 favorite]

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