Friday, September 30, 2022

Are you always Tired?

What causes fatigue and how to fight it. Dr Suresh Agrawal provides answers

Fatigue is not a natural consequence of ageing, it’s more related to the changes that occur due to age and commonly associated diseases. Fatigue is common when you’re fighting any kind of illness, from infections to autoimmune disorders. All of us feel tired some of the time. Usually, it goes away, either with sleep or time.

But if unexplained fatigue continues for more than a few weeks, it’s time to figure out what’s causing it. Keep in mind that more than one culprit may be responsible for causing fatigue.

Here are the reasons that could cause fatigue :

1. Sleep Deprivation – Thomas Alva Edison invented the first practical light bulb some time in 1879- 1880. With this he lighted our homes but took away sleep. Many people are unable to get sound and peaceful sleep, due to various reasons, but light is one of the main culprits. Light has changed our Circadian Rhythm, due to which many people are unable to sleep in time, their brain remains active, by the time brain goes into sleep mode, it is time to get up. 

Many of us simply aren’t getting enough sleep and are paying the price the next day.

It is better to switch off or dim all light emitting sources such as TV, mobile and tube light at least one hour before going to sleep. Maintain a regular sleep pattern, and avoid alcohol at night. Consider keeping a sleep diary to help you identify factors. Keep in mind that as you get older you may not require the seven to nine hours you used to.


2. Obstructive Sleep Apnoea (OSA) – Loud snoring is a clue. OSA is when something blocks part or all of the upper airway, while a person sleeps, and breathing stops involuntarily for brief periods of time during sleep, causing episodes of decreased oxygen supply. As soon as brain receives less oxygen, its sensors get activated, leading to deep long and forceful breath, and this cycle of periodic stoppage of sleep go on all through night. This leads to disturbed sleep and day time somnolence and fatigue. It will be prudent to find out cause of OSA, before prescribing a vitamin, common causes for OSA are obesity, enlarged tonsils and adenoid, and smoking. The standard treatment, a continuous positive airway pressure (CPAP) machine, involves wearing a mask over the nose to force air into the throat and keep the airways open.


3. Anaemia – Anaemia means that your blood has too few red cells or those cells have too little haemoglobin, which transports oxygen through the bloodstream. Haemoglobin is less than 12.5 gm/dl in adults and in children below 11gm/dl. Haemoglobin in Red blood cells present in our body work as courier for Oxygen and other gasses, which are exchanged in lungs during each Respiratory cycle, Haemoglobin carries Oxygen to all cells of our body and brings back carbon dioxide, which are exchanged in lungs. With less Haemoglobin, oxygen carrying capacity will be less, hence less energy.

There are three main reasons older adults become anaemic Kidney disease is one. If your kidneys are not working properly, they may not be able to help your body make the red blood cells it needs. It can also be due to blood loss from somewhere, usually along the gastrointestinal tract or it’s in the bone marrow, which could be due to a malignancy.


4. Hypothyroidism – The thyroid gland in our body produces two related hormones – Thyroxine and Triiodothyronine hormones. These hormones play a critical role in cell differentiation during development and help maintain thermogenic and metabolic homeostasis in our body. Less thyroid hormones mean less metabolic activity in our body and the person will complain of tiredness, irritability and difficulty in doing routine daily works. Thyroid hormone supplement will do wonder to people with Hypothyroidism and bring back their energy.


5. Missing key nutrients in daily diet – People over 50 are more likely to experience nutrient deficiencies – Vitamin B12, Vitamin D and Folic acid will be complaining of fatigue, and by correcting these deficiencies, fatigue will disappear.


6. Depression and Mood Disorders – Depression, being alone and other psychosocial issues are a huge factor in older people.  Depression and mood disorders affect our cognitive functions and ability to sleep, more often in older populations. Exercise can make a huge difference. The best thing for fatigue is physical activity — no matter what the underlying problem. The goal should be 30 minutes daily of moderate-level activity or antidepressant medicines will do work as well.


7. Dehydration – Dehydration can cause the body to feel extremely tired. Sometimes something as simple as drinking a glass of water may relieve from feeling tired. However, for people suffering with chronic fatigue syndrome should be taken care of, as they may require attention replenishing themselves. 


8. Systemic illnesses – Heart disease can cause the heart to pump blood less efficiently and fluid to build up in the lungs. This, in turn, results in shortness of breath and less oxygen supply to the heart and lungs. Heart failure, coronary artery diseases, valvular heart diseases, asthma and chronic obstructive lung disease (COPD) are common causes of fatigue in elderly, and many times may not have been diagnosed in time or underdiagnosed. 


9. Medications – Seniors take a lot of medications, and a lot of those medications tend to make people feel tired. Medicines used for allergy and common cold, sneezing can give rise to fatigue. If a person has started a new medicine and they notice fatigue, they should report this to the doctor. Sometimes just moving the drug to the evening or lowering the dose can help, but sometimes you need to change to a different medicine.

For long-term care, a person should be explained and educated of the condition, its potential impact on physical, psychological and social impact. As far as possible, non sedative medicines should be used in elderly. Practical advice should be given regarding lifestyle modifications. Moderate regular exercise, light dinner, and early to bed will be helpful in many people with chronic fatigue syndrome.

Dr Suresh Agrawal
Dr Suresh Agrawal, an alumnus of Seth G S Medical College and KEM Hospital, Mumbai, has been practicing in Colaba since 1981.

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