Tired of being fatigued all the time
October 5, 2019 12:41 AM   Subscribe

I've been feeling fatigued for the past two months. Not sleepy or lethargic, just physically heavy or "droopy"--like I'm wearing a lead suit and I just really really want to go lie down. It seems to get worse after moderate physical activity (or significantly worse after strenuous activity), until I've had a nap or been back to bed. I'm less tired after I've rested. I've been to the doctor but they haven't figured anything out yet. I'm hoping the internet might have some good suggestions for things to talk about with them or try before my next appointment.

Other than the asthma and headaches mentioned below, I'm a healthy 36-year old male, and I get a good amount of exercise. I can generally function okay during the day (work is mostly at a desk), everything is just way more draining than it should be. I've read many of the previous questions about fatigue here but nothing is an obvious fit.

Other info:

- I felt like this for basically all of March of this year, after which it went away (e.g. from April until August) and I chalked it up to winter doldrums.

- Test results for blood (iron, vitamin D, magnesium, lipids, metabolic, infection, etc...) and urine were in-bounds. I've been taking a daily multivitamin.

- I don't generally feel depressed--I will often be alert and in a good mood but really wanting to go lie down and rest.

- Sleep doesn't seem to be a factor--I wake up in the morning feeling rested and, since I've been making a real effor to sleep enough and regularly, I'm less sleepy at work than I have been for most of my life. I haven't recently started snoring.

- I started getting tired immediately after going for a teeth cleaning at the dentist (like, I walked to the dentist at lunch and then I got tired that afternoon). Doesn't seem likely to be the cause but the timing made it noticeable.

- I was on vacation for one week in a different part of the country during this period, which makes environmental factors seem less likely.

- My head also feels a bit strange. Like my eyes are a bit sore (usually my eyes get sore when I'm getting sick; but this is not as sore as that, just a little bit sore).

- I tried doing a super restricted diet this week (literally only chicken, rice, sweet potatoes--I realize it's not super healthy and I won't be continuing) and have felt as or more tired than usual.

- I have seasonal asthma (spring and summer due to allergies) and get regular (roughly weekly) headaches, which I thought were sinus headaches until recently but apparently those aren't really a thing.

posted by anonymous to Health & Fitness (24 answers total) 16 users marked this as a favorite
I note you say you don't feel depressed, but 'lead suit' is exactly how I described how I felt through some of my depressive periods. Depression is weird because you don't have to feel sad, your body can do it for you.

Otherwise, the bit that stood out was the sore eyes which can be a symptom in some autoimmune diseases (uveitis I think is the spelling) but just throwing that out as I have an autoimmune disease and was told to look out for it. And autoimmune diseases are all about crushing fatigue.

Good luck. Fatigue has so many causes it's such a pain to investigate.
posted by kitten magic at 1:13 AM on October 5, 2019 [1 favorite]

sweet potatoes could be part of the reason you are feeling tired. But shouldn't account for the other factors. What is your water intake like? I had some of the same symptoms you have. But mine was related to bad bacteria that had made a home in my stomach. I could barely eat, move, or sleep. But based on what you said I don't think this is something you have.
posted by nomdicstephen at 1:23 AM on October 5, 2019

Did you get antibiotics when you had your teeth cleaned?

Dental procedures are associated with increased risk of bacterial infections in the blood, including (rarely) endocarditis.

The page I linked mentions an uptick in such cases when guidelines were changed in the UK to eliminate routine antibiotic prophylaxis associated with some dental procedures.

I would ask my doctor for a course of antibiotics and see what happened.
posted by jamjam at 1:49 AM on October 5, 2019 [2 favorites]

The immediate though that sprang to my mind was an under active thyroid - I had similar experiences, and that was my diagnosis. I would have thought that the bloods you had taken would have checked for this, but I mention it just in case. Feel better soon.
posted by JJZByBffqU at 1:58 AM on October 5, 2019 [10 favorites]

The tests to make sure are covered for fatigue are the Big Five: B12, Vit D, Folate, Thyroid, Mono. Apnea is a second-line go-to.
posted by DarlingBri at 2:53 AM on October 5, 2019 [16 favorites]

For menstruating people, ferritin (which measures iron stores) is an important blood test. I’m not sure it’s quite as useful for guys, but probably worth checking if you are getting other labs drawn. I felt that lead suit fatigue (I described it as feeling like a baby elephant was sitting on my chest) when my ferritin was really low but my hemoglobin and hematocrit were normal (no anemia). Some extra iron (in my case, in an infusion) helped a ton.
posted by bananacabana at 2:57 AM on October 5, 2019 [5 favorites]

If you has asthma, you may be having poor quality sleep from apnea like poor oxygen flow. I live with a dude with chronic asthma and he snores like a motherfucker - except when he doesn't, and isn't breathing at all. It's observably worse when his asthma is playing up and I can monitor that like three rooms over during bad spells.

It's not really like traditional apnea when you just stop breathing - your overall oxygen count drops, but not enough to wake you up. Ghastly stuff.

Do you share a sleep space with anyone who can weigh in on what your breathing is like when you're asleep? They may have good info for you re. your breathing at night. You can also download sleep monitors that are noise activated and will record any snoring you might not know you have.
posted by Jilder at 4:41 AM on October 5, 2019 [2 favorites]

I would ask my doctor for a course of antibiotics and see what happened.

Your doctor would be negligent if he or she prescribed antibiotics for no reason. That's how multiple-drug resistant superbugs are created.

Could it be allergies, OP? My allergies and associated asthma have been very bad this autumn and I definitely feel droopy often.
posted by easy, lucky, free at 5:05 AM on October 5, 2019 [8 favorites]

The tests to make sure are covered for fatigue are the Big Five: B12, Vit D, Folate, Thyroid, Mono. Apnea is a second-line go-to.

Test for lyme, too, if you're in an area with lyme.
posted by PhoBWanKenobi at 5:09 AM on October 5, 2019 [2 favorites]

When was the last time you had an eye exam? Have you had your A1C tested? Diabetes can cause fatigue and eye changes. An eye exam can reveal any changes to your eyes caused by diabetes.

You don't necessarily have to be a heavy snorer to suffer from sleep apnea. There is a device to test it, prescribed by your doctor, that you can use at home, then return to the sleep lab. It might be worth testing for that, just to make sure.

My D levels are within range, technically (33), but I still feel better when I take a supplement, with my doctor's okay.
posted by Marie Mon Dieu at 5:29 AM on October 5, 2019 [2 favorites]

Any chance of a neurological insult? New pillows, bumped your head, new monitor, new window?

Is it possible you are now clenching or grinding your teeth?

Any change in prescriptions or over the counter meds? Buying a bottle of name brand antihistamines instead of generic, or starting to take B vitamins count.

Can you do a thorough sinus rinse with saline to make sure that you are breathing comfortably.

You may have reached a stage in metabolism where sugar now metabolizes at a different rate. The solution to that is to start taking in small quantities of protein during the day, such as drinking milk and eating a couple of crackers with it instead of drinking coffee, or eating a half dozen nuts.

Any psychological changes, such as the realization that you will never get around to starting training to run marathons, or realizing that you resent your long dead father as much as you cherish him, or realizing that there is no room for you to advance at work and you will have to eventually job hunt? Major psychological changes also count, such as realizing that your mother is an old woman and no longer going to be able to help you with things, or that your wife is having extra-marital affairs or that you yourself would have an affair, should an opportunity present itself.

Can you check your breathing to ensure that you are breathing as deeply as usual. If you are breathing from your chest instead of your belly, a symptom of anxiety or maybe bad posture, or maybe a lung infection, or maybe trying to avoid a smell in your environment, the result can be insufficient oxygen.

Has your seating arrangement changed? Posture problems can result in chronic fatigue.

Are you watching enough news to have been tipped over into a chronic anxiety state? Has your formerly peaceful facebook flipped over from no longer being a refuge to a place where someone is going to get angry and say angry or dehumanizing things?

Has anything about your bed changed? You might be sleeping badly because you are too warm or your feet are cold or you are allergic to your mildewed pillows or troubled by off gassing from those nice new pillows.
posted by Jane the Brown at 5:31 AM on October 5, 2019 [1 favorite]

If you get your thyroid checked, make sure they also check the T4. Most tests don't seem to do more than T3, and for me the T4 is also important. If you are told your levels are "normal" ask if they are in the lower range. The lower range of normal makes me feel like I'm wearing a lead suit, too.
posted by Enid Lareg at 5:39 AM on October 5, 2019 [3 favorites]

You mentioned that your iron levels are within the normal range, but if they are on the high end of normal you might consider asking your doctor about Hemochromatosis, which is common in Ireland and among those of Irish descent. It’s counterintuitive that high iron could make one fatigued but apparently it can.

Hoping you feel better soon.
posted by slmorri at 5:56 AM on October 5, 2019 [1 favorite]

have you had a cardiac workup? Fatigue that is worse with activity can be a symptom of a cardiac problem, which wouldn’t show up with just routine labs. Did your primary care provider do an EKG at any point? Also-how well is your asthma managed? Do you take a regular controller medication? Are you having to use a rescue inhaler regularly? Asthma that isn’t optimally managed can also lead to increased tiredness with activity AND increased demand on your heart.

I can’t tell from your question where you are in the world, but I would encourage you to ask for referral to a specialist if at all possible. Six plus months is a long time for someone your age to feel this way. Best of luck.
posted by little mouth at 6:11 AM on October 5, 2019 [1 favorite]

If you get your thyroid checked, make sure they also check the T4. Most tests don't seem to do more than T3, and for me the T4 is also important. If you are told your levels are "normal" ask if they are in the lower range. The lower range of normal makes me feel like I'm wearing a lead suit, too.

Yes, this. I had the lead suit feeling (I described it as feeling as if someone turned up the gravity) when I was undiagnosed hypothyroid. My blood tests were "normal" so it took a while to find a doctor who would diagnose based on symptoms rather than relying solely on the blood test. That feeling returns when for whatever reason my thyroid levels start to go up. Many doctors still use outdated TSH ranges with an upper limit as high as 5 or 10 so check the reference range on your TSH, and ask to have your Free T3 and Free T4 tested as well.
posted by Preserver at 6:16 AM on October 5, 2019 [2 favorites]

When I was taking Zyrtec for allergies I felt so fatigued I actually fell asleep on the floor of my husband’s office. If you are taking an allergy med, try switching.
posted by mai at 6:35 AM on October 5, 2019 [2 favorites]

Another voice that many doctors will not begin with all the possible tests for hypothyroidism, because most cases can be caught by the first one or two. But even if your TSH came back normal, your free T4 may not. And even if both of those do (or especially if one comes back just slightly marginal), your antibody (anti-TPO) may not - that's for instance indicative of Hashimoto's, which is hypothyroidism caused by an autoimmune disorder (or which is an autoimmune disorder that causes hypothyroidism? I'm not a doctor).

Best wishes figuring this out.
posted by solotoro at 6:54 AM on October 5, 2019 [1 favorite]

If your Vitamin D levels are low but increasing the dose doesn't help, have your calcium levels checked, even though you're not the highest probability demographic (which is being a female in her 50s or 60s). Parathyroids (not the same as your thyroid) run amok and overproducing parathyroid hormone cause calcium to be leached from your bones which, in turn, causes Vitamin D to go down. The excess calcium can settle in your brain and cause heavy fatigue, memory issues and general brain fog. It's in endocrinologists' territory. I had three (out of four) parathyroids removed and felt like the proverbial million bucks immediately.
posted by carmicha at 7:28 AM on October 5, 2019 [3 favorites]

If all your blood tests come back normal—DarlingBri’s list above is superb—it’s probably time for a sleep study. There are a myriad of functional sleep disorders that could be causing this.
posted by Automocar at 7:54 AM on October 5, 2019

Test results for blood (iron, vitamin D, magnesium, lipids, metabolic, infection, etc...) and urine were in-bounds.

No thyroid panel? Fatigue seems like something you should have a thyroid panel done for to rule out possible issues. Not just TSH, the full panel.
posted by yohko at 1:15 PM on October 5, 2019

After having similar struggles and many blood tests, I was found to have
1. Sleep Apnea (led to CPAP)
2. Low testosterone (led to HRT)
3. Extremely high blood lipids

Get some more bloodwork from your Dr. Many great suggestions above (Vitamin B, D; thyroid) but ask also for Testosterone check.

Good luck. Keep searching. It takes awhile but you will find the help you need.
posted by armoir from antproof case at 1:42 PM on October 5, 2019

P.s. how are your blood lipids? Any chance you have high cholesterol and possibly related disorders?
posted by armoir from antproof case at 4:21 PM on October 5, 2019

Have you been tested for deficiency in
vitamin D
vitamin C?

That last one is missed by a lot of doctors, but it's important - if you have a reduced ability to absorb vitamin C from your diet, it can make you very ill and eventually even kill you [through bleeding in the brain].

Some people need vitamin C supplements despite eating lots of fruit and vegetables, because they don't adequately absorb vitamin C from food due to irritable bowel syndrome or other reasons.
posted by Murderbot at 8:16 PM on October 5, 2019

I had similar symptoms and found out my testosterone level was low (but still 'in range'), which is typical for aging men. Upping my levels changed my life.

Also definitely consider allergy shots...
posted by mrmarley at 7:53 AM on October 6, 2019

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