“I’m feeling tired day after day.”
“I drink tons of coffee, but my mind is still a fog.”
“I get sleep, but I seem to wake up more tired than when I laid down last night!”
“Do I have Chronic Fatigue Syndrome?”
The short answer? Probably not.
It is important to understand that Chronic Fatigue Syndrome (or CFS) is a diagnosis of exclusion. It is one that is only given when all other possible explanations have been ruled out and accounts for just 0.5% to 1% of people. In fact, many doctors hesitate to give a CFS diagnosis at all due to the lack of knowledge around it. (See my blog “7 Possible Causes of Chronic Fatigue Syndrome” for more information.)
The name “Chronic Fatigue Syndrome” can be misleading, because fatigue may, indeed, be a chronic problem in your life. In the majority of cases however, the cause can actually be attributed to lifestyle factors or another medical condition.
On the other hand, this is NOT to say that a persistent lack of energy isn’t a problem or that it shouldn’t be addressed. On the contrary, it should! Chronic fatigue – syndrome or not – can seriously affect a person’s quality of life and may be an indication of a more serious health problem.
“Why Am I So Tired?” Common Causes of Fatigue
Factors like lack of sleep or a very active lifestyle are two obvious contributors, but there are many common lifestyle factors which many people don’t realize are wearing them down, and several other health conditions which may be causing the fatigue as well. These include, but are not limited to:
- Sleep Problems and Fatigue. Caused by a noisy sleep environment, poor sleep hygiene (bad sleeping habits), sleep apnea, frequent urination, a baby, a pet, insomnia, narcolepsy, restless leg syndrome, pregnancy or change in work hours, chronic use of sleep medcations.
- Anemia, Nutrient Deficiencies and Fatigue. Anemia, which is common in women, can be a major cause of fatigue. Iron B12 and folic acid deficiency can cause both anemia and fatigue. Deficiencies in nutrients coenzyme Q10, magnesium, ribose, carnitine and B vitamins can contribute to fatigue. Electrolyte imbalance including low levels of potassium, sodium and calcium may also leave you feeling slugish.
- Certain Medications and Fatigue. Including anti-depressants, anti-anxiety medications, Tylenol with codeine, Vicodin, Percocet, muscle relaxants, sedatives, antihistamines, steroids, some blood pressure medications and drug or alcohol abuse – including marijuana and tobacco smoking.
- Too Much Caffeine and Fatigue. Though caffeine can give people a short burst of energy, long-term use or abuse can actually have the opposite effect.
- Mental Health Problems and Fatigue. Such as depression, stress, anxiety, bipolar disorder, eating disorders, grief and bereavement.
- Pain and Fatigue. Caused by arthritis, muscle cramps, poor posture, repetitive motion injuries, or just a bad mattress or bed frame, among other things.
- Infection. Including influenza or colds, mononucleosis and urinary tract infection (UTI), to name a few.
- Metabolic/Endocrine Problems and Fatigue. Such as hyper or hypothyroidism, diabetes, electrolyte abnormalities, anemia, kidney disease, myopathy, Graves disease, liver disease and Cushing’s disease.
- Gastrointestinal Problems and Fatigue. Including poor eating habits, food intolerance or mild food allergy, acid reflux, irritable bowel syndrome (IBS) and ulcerative colitis.
- Heart or Lung Abnormalities and Fatigue. Such as heart disease, congestive heart failure, chronic obstructive pulmonary disease (COPD), asthma, arrhythmias, pneumonia and sleep apnea.
- Overexertion and Fatigue. Which may be caused by not having proper life balance while doing demanding home projects, rigorous exercise routines or a job requiring hard labor.
If you are dealing with persistent fatigue you need to rule out the serious causes, I would recommend that you see your doctor. In addition to the factors listed above, symptoms of chronic fatigue syndrome bear a striking resemblance to fibromyalgia, lupus, Lyme Disease and multiple sclerosis. A doctor should be able to hone in on the true cause or causes of your fatigue problem and work with you to address any underlying issues.
“So, what is Chronic Fatigue Syndrome?” Symptoms of Chronic Fatigue
Though, as I said, Chronic Fatigue Syndrome is rarely the real cause of persistent fatigue, for 0.5 to 1% of the population, it’s the best answer we have. CDC and Oxford (British) diagnostic criteria for Chronic Fatigue Syndrome or CFS include:
- Patient has clinically evaluated, unexplained, persistent or relapsing fatigue that is:
- Not a result of ongoing exertion
- Isn’t substantially relieved by rest.
- Is of new or definite onset (not lifelong)
- Resulting in a substantial reduction in previous levels of activity.
- Patient has four or more of the following symptoms that persist or recur during 6 or more consecutive months of illness and that do not predate the fatigue:
- Impaired memory or concentration
- Postexertional malaise (extreme, prolonged exhaustion and sickness following physical or mental activity)
- Unrefreshing sleep
- Muscle pain
- Multijoint pain without swelling or redness
- Headaches of a new type or severity
- Sore throat that's frequent or recurring
- Tender cervical or axillary lymph nodes
- Patient does NOT fit any of the following criteria:
- Active, unresolved, or suspected disease that is likely to cause fatigue
- Psychotic, melancholic, or bipolar depression (but not uncomplicated major depression)
- Psychotic disorders
- Anorexia or bulimia nervosa
Dr. Jeff M.D.