Getting to the bottom of my fatigue
April 9, 2020 12:48 PM   Subscribe

I've always considered myself a "tired person" -- and I'm tired of it. Working from home has presented me with a wonderful, unprecedented opportunity to identify the reasons behind, and potentially correct, my daytime fatigue issues.

I get a consistent 8.5 and 9.5 hours of sleep every day. Despite this, a feeling of dragging, eyelid drooping exhaustion kicks in every day around 2 or 3 pm. In high school and college, I'd take a nap as soon as I got home from classes. As an adult, I relish unscheduled empty weekends, because I feel free to nap whenever the feeling hits without judgement. Otherwise, on workdays, I would drink a caffeinated seltzer water or cup of coffee, drag myself through the rest of the day, and if possible, I take a nap as soon as I got home.

I have had anxiety/depression since I was a teenager. I've been taking SSRIs for about a year, and my anxiety and depression are in remission/under control. I've reduced my consumption of caffeine to one cup of coffee or caffeinated seltzer per day. I rarely consume processed foods /sugar, and I've also reduced my consumption of bread. Before my gym closed, I was exercising about 2 times a week, though somewhat inconsistently due to fluctuations in energy.

I saw a sleep specialist a few weeks ago, and after paying $150 in co-pays, I was informed that my insurance could not cover a sleep study, but that i potentially had some kind of CFS. I don't have the funds to pursue that further, any time soon.

I feel guilty about admitting it, but the pandemic has been wonderful for my quality of life. I'm extremely fortunate to be able to work from home, and I've been taking this opportunity to take daily naps whenever I need to. I limit my media intake, and I'm spending more time ouside gardening than ever before. My sleep schedule has become very consistent... I get to bed between 11 pm and midnight every night, and I wake up around 8 am/8:30 am.

And yet, I'm STILL tired ALL THE TIME! Being such a fatigued person limits my career choices, my ability to socialize or do hobbies...What can I do, during this very unique time, to get a better handle on my fatigue before I have to return to the 9-5 grind 5 days a week?
posted by Anonymouse1618 to Health & Fitness (26 answers total) 31 users marked this as a favorite
Being tired all the time is usually caused by a medical problem, and right now "during this very unique time" there isn't much you can do to get routine non-emergency medical treatment. A good doctor would do a blood workup and probably focus on your iron levels and thyroid. Once this is over and you can safely get bloodwork, that's your best next step.
posted by juniperesque at 12:57 PM on April 9, 2020 [5 favorites]

If you're a person who has menstrual periods, have you been tested for anemia? How's your thyroid?
posted by cooker girl at 12:59 PM on April 9, 2020 [3 favorites]

For me, caffeine is the cure, so not sure why you're cutting back. But yes, when was your last bloodwork and what did it tell you?
posted by sageleaf at 1:03 PM on April 9, 2020 [2 favorites]

Best answer: Hello I am someone with multiple sources of fatigue living with someone with multiple sources of fatigue! Have you been assessed for these various things?

1) Sleep apnea. It sounds like you haven't been able to be assessed for this because insurance, but one thing I would check is whether your insurance would cover a home-based sleep study rather than in the lab. This would also be much cheaper if you have to pay out of pocket. My partner was referred for a sleep study in the lab, and just got a call back saying that they aren't doing any sleep studies at the hospital right now but they can do a home-based one. So might be something to check out.

2) Thyroid issues. Have these ever been checked? You probably can't get this testing right now, but it would be good to try and talk to your GP and get an appointment set up for sometime in the future, to avoid waitlists.

3) Postural orthostatic tachycardia syndrome. How is your blood pressure? Is it generally low? Do you ever get dizzy when you stand up? This might be able to be diagnosed at home with an at-home blood pressure cuff and telemedicine. The treatment for it is generally increased salt, more water, and compression stockings, so if you could get an evaluation via telemedicine you'd be able to start working on this now.

4) Sleep disturbance. I get about 9 hours of sleep a night, but I wake up a lot. It's only ever for 10-15 minutes, so I didn't think it was a problem, but I saw a sleep specialist and they prescribed me Lunesta, and I've seen a noticeable improvement in my fatigue levels. I know you saw a sleep specialist, but if you find yourself waking up at night (even if only for a few minutes) it might be worth calling them or your GP and seeing if you could get medication for a sleep prescription.

5) Inappropriate sinus tachycardia. Do you generally have a fast heart rate, even lying down? There are phone apps that can assess your heart rate (using the flash and camera to assess blood vessels or something like that). If you have a high resting heart rate, this can cause fatigue. Again, if you get some sort of blood pressure cuff with heart monitor, this might be able to be diagnosed via telemedicine. Treatment is usually beta-blockers.
posted by brook horse at 1:05 PM on April 9, 2020 [19 favorites]

All the above from brook horse. After testing and consultation with my doc, I added in B12 and D supplements, and due to other issues cut out foods I appear to be highly allergic to. Some of these issues are also digestive IBS-D related to stress. For that I'm taking a doctor-authorized (I had to find it on my own) cocktail of antihistamines.

Other things that helped, weighted blanket, fan blowing on me at night, a sleep mask, and earplugs to drown out the snoring from myself and others.

I'm better but not great, I don't know how I'll hold down a full time job when WFH is over. But I'm better than I was two years ago, napping during lunch and sleeping 6pm - 5am
posted by tilde at 1:12 PM on April 9, 2020 [3 favorites]

Ask for your eventual workup to include insulin resistance too - 2-3 pm is prime post-lunch sugar crash territory.
posted by I claim sanctuary at 1:15 PM on April 9, 2020 [9 favorites]

When I experienced chronic fatigue from my early 20s to early 30s it was due to (at the time undxd) Celiac disease. Could you try cutting out gluten? It can take a long time to recover if that is the problem, so it may not make a difference in your fatigue over just a few weeks. Getting a full celiac panel blood test would be most ideal.
posted by ChristineSings at 1:30 PM on April 9, 2020 [2 favorites]

Oh man, I'm the same. I've been tested for ALL THE THINGS (seriously. all of them. Everything has come back normal repeatedly over the course of multiple years and many specialists). I am using this break to get serious about exercise. I read a bunch of studies and it looks like low-moderate exertion exercise ("brisk walk uphill" pace, apparently) 3 or more times a week has been the most effective for fatigue when studied. So not a full high-intensity workout, but enough to get blood pumping. I'm trying really really hard to incorporate this into my day as much as possible, and see if it works. Seriously the evidence that exercise helps fatigue is pretty strong, though I know from experience that it's so so hard to do that when, well, you're fatigued...
posted by brainmouse at 1:39 PM on April 9, 2020 [4 favorites]

Like you, I feel tired almost all of the time. One thing I've learnt while reading up on this topic is that tiredness has very many possible causes. Investigating them is itself exhausting. Good luck to you.

I'm just going to tell you about my eventual diagnosis ...

Last year, I asked my doctor about my tiredness. He gave me a test for sleep apnea, and took a blood sample. Finding nothing unusual, he sent me to a psychiatrist.

The psychiatrist said, with great confidence, that my constant tiredness is a consequence of overwork and anxiety. She prescribed me anti-anxiety medication, and told me to relax and take as much time off work as possible.

The diagnosis was surprising to me. My anxiety seemed like a fairly mild issue - it was strange to think that it might have such great consequences!

So I think you shouldn't rule out the hypothesis that your anxiety is causing your tiredness, even if you seem to have it under control.
posted by HoraceH at 1:58 PM on April 9, 2020 [3 favorites]

The more carbs I eat, the more naps I need.

It’s almost guaranteed that delicious bread with breakfast or lunch makes a nap a necessity later on. I’ve been a remote worker for 4 years and have tested many things. Carb heavy foods like sandwiches, pizza, pasta, sweet potatoes.... zzzz mid afternoon nap. Even if it’s a healthy version with adequate protein and veg.

I’ve kept track of my sleep and exercise (or lack of) with an Apple Watch for years. Regardless of how much sleep or exercise I get, carbs remain a nap cause.
posted by affectionateborg at 2:04 PM on April 9, 2020 [4 favorites]

Could it be postprandial fatigue? You could experiment with eating smaller, more frequent meals and see if it helps.
posted by toastedcheese at 2:09 PM on April 9, 2020

So lots of well-rested, healthy people feel sleepy in the early afternoon. Like, siestas exist for a reason. In your normal work life, I'd say planning a walk for an afternoon break would be a good way to counteract the afternoon sleepy feeling. And maybe let yourself have half a cup of coffee?

And lots of folks are feeling extraordinarily tired now. This Forbes article is just one example of some of the online chatter I've seen about this.

I don't mean to suggest you don't have something else going on. But it might be that what you are experiencing is within the range of normal, too.
posted by bluedaisy at 2:13 PM on April 9, 2020 [3 favorites]

Do you wear glasses? And if not, have you had your eyes tested recently?
posted by pink_gorilla at 2:25 PM on April 9, 2020

You don't say your age or gender. Many women become thyroid deficient as they get older. A doc started me on low-dose thyroid supplement even though my thyroid tested in the normal range, and it helps.

Vitamin D may help, and I feel better when I eat red meat at least once a week, for B12 and iron. These are no-risk, so worth trying.
posted by theora55 at 3:08 PM on April 9, 2020 [1 favorite]

I used to have this before I got my insulin resistance in check. Now even if I want that 3pm crash nap my energy levels won’t allow it.
posted by Young Kullervo at 3:55 PM on April 9, 2020

Working from home has presented me with a wonderful, unprecedented opportunity to identify the reasons behind, and potentially correct, my daytime fatigue issues.

I mean, not really? You're going to need a healthcare provider. You need to start with the Big 5: Big Five: B12, Vit D, Folate, Thyroid, Mono/Epstein Barr. Apnea is a second-line go-to.

I was so exhausted for so many years that I cried when my GP ruled out a thyroid condition. I was desperate for a treatment, and failing that, at least a diagnosis. A diagnosis of pernicious anemia and regular B12 injections have made a huge difference. (And, PA causes depression and anxiety, so...)
posted by DarlingBri at 4:15 PM on April 9, 2020 [1 favorite]

When I started working full time last year I was plagued - absolutely plagued with - that after lunch slump. It actually felt painful I was so tired. I cut out carbs entirely at lunch. Breakfast was very light on carbs. My tiredness improved exponentially and almost immediately. I still have other low energy and tiredness issues that I’m always working on, but at least this cut out that after lunch excruciating exhaustion.
posted by Sassyfras at 4:41 PM on April 9, 2020 [3 favorites]

Best answer: I was SO TIRED in my early 30s. And getting fat. And cold all the time, and bruising. My thyroid levels always came back "normal." Then my primary went on sabbatical, and the woman who replaced her took one look at me and said "let's try a low dose of synthroid." After three days I woke up and felt ... LIKE ME. Rested. I didn't know how very tired I'd been until I wasn't.

Now I order a low dose of synthroid from MeFi-recommended (It says you need a prescription. Shhhh. You do not.)

Good luck.
posted by cyndigo at 5:00 PM on April 9, 2020 [11 favorites]

I've been surprised how willing doctors are to meet. I hesitate to encourage this (we cancelled multiple non emergency appointments), but just FYI.
posted by slidell at 5:19 PM on April 9, 2020

In addition to all of the above, I have a simple suggestion. What about getting to bed earlier? I am convinced that sleep is more restful and sound the earlier you go to bed. I am more well rested going to bed at 10pm and sleeping 8-9 hours than I am going to bed at 12am and sleeping 8-9 hours.
posted by rglass at 6:02 PM on April 9, 2020 [1 favorite]

The more carbs I eat, the more naps I need.

Cutting carbs out of my life was my solution to this as well. Turns out, for me, if my blood glucose rises much over about 150 (180 being an acceptable 1 hour past eating level for most people) I get very sleepy (among other things). So, getting more exercise and eating a super low carb diet has solved afternoon sleepiness and a few other medical issues.
posted by anastasiav at 6:04 PM on April 9, 2020

By "tired" do you actually mean "sleepy"? If so, also consider that ADHD-Inattentive might be one possible cause.
posted by MiraK at 6:34 PM on April 9, 2020 [2 favorites]

Seconding what HoraceH said. Chronic anxiety is very commonly coincident with depression, and can really take a toll on one's energy levels. Constantly heightened levels of cortisol, adrenaline, & other hormones that were meant to spike, infrequently, then die down... but if they are 'on' all the time, that really takes a toll on the body; not just from the energy-usage case, but also by causing the body to need additional care, feeding, healing.

Also... there was a time in my life when my breakfast didn't include much by the way of fat and protein. And I struggled in many ways similar to what you have described. After I changed that, (thanks AskMe!) and habituated more protein and fat in a morning-time meal, it really helped my energy levels throughout the day. If/when I skipped breakfast, or when it was primarily carbs, it would REALLY hit me in the afternoon, regardless of the size or quality of Lunch I'd had.

Best of luck to you as you travel down this path of discovery and self-care.
posted by armoir from antproof case at 10:50 PM on April 9, 2020

I was on SSRI’s for a long time and I’m convinced they contributed to my feelings of fatigue. I finally started seeing an actual psychiatrist and she agreed. She switched me to Wellbutrin which is different from an SSRI and it’s helped a ton.
posted by beandip at 1:57 AM on April 10, 2020 [1 favorite]

Best answer: Sensory processing issues can do this. Even if you are not on the spectrum, it is worth checking if there are any patterns around your crashes. It's an old adage that if your baby won't sleep put it in the car and go for a drive. The changing visuals, white noise and motion makes most babies conk right out. This means that it is possible that when some portions of your sensory systems get stimulated they need to go through the metabolic cleaning process of sleep. For many people things that others do not consider intense can be exhausting.

Check for fatigue occurring after consistent low level noise, or after a session with higher noise levels. Think about if there are some kinds of noise that are especially annoying and if these could be triggers. Observe if processing words with your auditory system is exhausting. For many people listening to people talk can overload them after a short while. If you are someone overloaded by listening to words you will probably be tempted to doodle or do something with your hands whenever you are trying to concentrate on listening to a speaker, so this is a clue that reducing the voices in your environment might help.

Check for fatigue occurring after exposure to sunlight, to blue spectrum lights as produced by screens, or to moving light as when there are branches swaying in the wind outside your window, or going outside and doing stuff, or watching videos and looking at moving objects on screens. Does going out to the mall or driving leave you staggering with exhaustion soon after you come home? Check if fatigue occurs when you repeatedly transition from stronger light levels to lower light levels, as when walking through your home at night with some lights on and some lights off.

Check if working in the kitchen near the garbage can exhausts you, or if you get tired faster when you can smell the laundry detergent used to wash the clothes you are wearing.

Check if there are tactile triggers, such as contact with the bare skin of your own body, or tight clothes, or heavy clothes, or clothes that don't breath, or scratchy tags and pinching shoes. Check if more extreme changes in temperature such as when getting in and out of a hot shower in a cold bathroom triggers fatigue, and check if lying in a bath of a perfect temperature seems to help. Also check if a weighted blanket worn while working at home makes you less fatigued, or if sleeping under one makes you sleep better and wake up more rested. You don't have to buy one to test, you can improvise one with a heavy wool coat, or if your bed is large enough some solid things on either side of you pinning your regular blankets down.

Check if micro nap retreats into a low stimulation situation to pre-empt crashes could help. Spending five minutes in a stairwell sitting down with your eyes closed, or in a washroom cubicle, or in bed with the lights off every hour or two or three can help. Removing yourself from sounds and lights and from planning thoughts and just disassociating will give your brain a break. Observe if your brain refuses to rest during breaks like this and ruminates or worries. If your thoughts don't slow down when you are taking a break then your brain is running intensely enough that it is no wonder you feel fatigue.

Chart your anxiety level and any feelings of time pressure or inadequacy and see if the fatigue hits from feeling hurried, or scared, or not knowing how you will manage. Check if problem solving and sequencing results in fatigue. Many people find planning to be a huge drain on their blood sugar. There is some fun data on the calories burned during an intense chess match versus an intense sports competition. Sitting and playing chess can require as much system resources as running back and forth does. Thinking is an intense calorie burning activity that results in metabolic by products that need to be cleaned out. When you sleep your brain cells shrink which enables circulation to occur that is blocked during waking periods. Basically that's when garbage removal occurs in the brain. Your muscles can get this done whenever they are not pumped, but the brain requires sleep. It also burns more calories than any other organ in your body, especially by weight.

Preempt fatigue periods by planning to rest before it seems reasonable. Make sure you hydrate. Most bosses do not think you should take five minutes rest every forty-five minutes, so you may feel like you are a failure and something is wrong with you if you can't sustain a two hour work period without getting wiped out afterwards, but working only in forty-five minutes bursts of concentration are a standard recommendation, such as with the pomodoro technique.

Check if using your memory is triggering fatigue. Do you get tired more quickly when you are learning new things? Do you get tired more quickly when you are recalling things that take some extra effort to retrieve? If memory retrieval is an issue - and even if it isn't - try to reduce the things you are carrying around in your working memory and see if writing things down and using lists helps reduce your fatigue. Take a serious break from any and all multitasking as much as you can. Simply limiting multitasking could make a gigantic difference.

Get into the habit of stopping every few moments and doing a sensory and emotional wellness check. What do you feel right now? If you realise you are constantly angry at your customers or clients or boss, or constantly feeling hopeless or trapped, or constantly feeling minor indigestion, or the arms of your chair are digging into your sides, you may be using a whole lot of brain power and thus energy to ignore those things and work through them. You also want to learn to listen to signals like the desire to get up and stretch, or cravings for something salty. We are taught to ignore all that. It's one of the chief purposes of school, which trains kids not to snack on potato chips and not to do jumping jacks when they are in the classroom, but once we learn to ignore our impulses we may seriously neglect our physical needs even when we are no longer in school or at work, or in a social situation where it would be rude to act on those impulses.
posted by Jane the Brown at 7:09 AM on April 10, 2020 [11 favorites]

I almost feel silly saying this, but try drinking more water (or other non-sugary liquids.) I've never found some One True Solution to my fatigue (despite tests), but watching carbohydrate intake (as mentioned above) and drinking a lot more water seem to help somewhat. I'll also add that for me even whole grains or beans can make trouble if I'm not careful.
posted by needs more cowbell at 6:45 AM on April 11, 2020 [1 favorite]

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