Why am I so tired all the time?

“Doctor, I’m just exhausted. All the time. I’m so tired, there must be something wrong with me”

Pretty much every GP or family doctor will hear this several times a day. Tiredness is ubiquitous with our fast paced modern lives, but at what point is it more than just our lifestyle and an indicator that something is medically wrong?

Feeling tired all the time, that feeling that even after a long sleep you don’t feel rested. It’s feeling like you could nap at pretty much any time of day. It’s draining for patients and can have a real knock on impact on their quality of life.

 

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There many medical explanations for tiredness such as hypothyroidism, anaemia and depression but it’s important to also examine your own habits and patterns to work out if it’s anything you might be able to change.

 

In my clinic I tend to try approach both the biological and the behavioural aspects of tiredness simultaneously. Lets get you looked at, examined and tested if relevant, but lets take pause to look at you as a whole – how are your stress levels, are you worried about anything, whats happening with your weight and your appetite, when do you go to bed – to get a sense of anything else we might be able to improve upon.

Stress, anxiety and depression can all impact upon our sleep. Often it might be one of the first signs that you might be suffering one of these conditions. Whether it be that your mind is racing over the days events when you try and go to bed, or thinking about the events of tomorrow or the future. Some patients with anxiety report increased palpitations (a sense of the heart racing in the chest) in the evening/night time which enhances their difficulty sleeping. Patients with depression might experience ‘early morning wakening’ when they are unable to stay asleep and wake in the early hours.

Sleep hygiene is often overlooked in the 21st century, we’re more connected than ever with a myriad of devices and with the increasing advent of flexible working we’re checking work emails in the evening and working later and later at home. There is also some misunderstanding about how much sleep we actually need.

Our sleep pattern is regulated by something called a circadian rhythm, an evolutionary clock that tells us to be up when its light and sleep when it’s dark. In the days of our ancestors, this helped us to be productive in the hours when there was light and to rest to in the dark when light sources would have been limited.

Stimulants such as caffeine, alcohol and nicotine as well alarm clocks and devices plus the addition of later working and shopping hours can all interfere with our natural sleep/wake cycle.

How much sleep do we need?  How do you stack up to the numbers below?

  • Newborns (0-3 months ): 14-17 hours each day
  • Infants (4-11 months): 12-15 hours
  • Toddlers (1-2 years): 11-14 hours
  • Preschoolers (3-5): 10-13 hours
  • School age children (6-13): 9-11 hours
  • (14-17): 8-10 hours
  • Younger adults (18-25):  7-9 hours
  • Adults (26-64): 7-9 hours
  • Older adults (65+): 7-8 hours

Sleep is a priority, we need that time to allow our brains to hit the reset button.  Simple but effective techniques for a better night include: sticking to a schedule – set yourself a bed time and try and stick to it, if you are someone who runs through to-do lists for the next day, make a list before you go to bed and put it to one side, getting exercise daily will help to naturally tire you out, make your bedroom as restful as possible – limit those electronic devices and televisions in the room and turn off your phone
Techniques such as deep breathing or meditation can help to quieten your mind to prepare your body for sleep. Try inhaling for three seconds and exhaling for six. Repeat this five times. Then try to tense your toes as tight as possible, then relax, work up your body – tense and relaxing groups of muscles in turn. This helps to give the body a sense of relaxation.

When is tiredness caused by more than a few late nights? We’ve looked at a few of the more common reasons we see in clinic:

Iron deficiency anaemia.

This is the most common nutritional deficiency in the world and is common in women having regular, heavy periods. Blood loss causes us to lose iron, and if we are not able to get enough iron back in through our diet, we can build up a deficit. Besides tiredness, symptoms can include skin that appears more pale, feeling cold,  feeling dizzy or lightheaded, hair loss and brittle nails. Picked up on a blood test, your doctor can advice on a cause of replacement and may recommend further testing to discover the cause.

Hypothyroidism.

The thyroid, a small gland in the neck, is responsible for producing hormones required in many different bodily functions. Symptoms include an inability to tolerate the cold, weight gain, constipation, low mood and of course, tiredness. Again, picked up on a blood test and treatment involves replacing the deficient hormone – usually as a daily tablet.

Chronic fatigue syndrome

Something that has divided medics for years. A condition that causes long-term fatigue, it’s cause is not known. It is thought that it starts with a flu-like illness and there have been suggestions is can have links with mononucleosis, lyme disease and chlamydia. There are no definitive tests to confirm this, so often the process will start by looking for other conditions that might cause tiredness.

Coeliac Disease.

A gluten intolerance that can cause weight loss, bloating, bowel habit changes as well as tiredness. Gluten is found in foods such as breads, cakes and cereals. It’s thought around 1 in 100 people in the UK have coeliac disease, but 90% of those affected do not know they have. Diagnosis involved blood tests and biopsies and is most often managed by avoiding gluten in the diet.

Sleep apnoea.

More common in people with a higher body mass index, where the breathing tube is compromised when patients are lying down, but can also be linked to alcohol intake and smoking.  In sleep apnoea patients will have periods of interruption in their breathing when asleep. Partners might report snoring – or evening being able to hear the moments when breathing is interrupted. Testing involves sleep studies and oxygen monitoring during sleep. Patients with confirmed sleep apnoea will be given advice about how to reduce their risk factors and in more extreme cases a machine (CPAP – continuous positive airway pressure) to wear overnight which helps to move air into the lungs and keep the airways open.

 

We could all do with taking stock of our sleeping habits and taking steps to improve our sleep hygiene. But if you think that there might be something underlying the tiredness, you should always discuss this with your own doctor.

18th Century teeth in the 21st Century

Today is World Oral Health Day. The main aim is to raise awareness of the impact that oral health can have on overall physical health and well being. Unfortunately for us, Britain seems to have given up on its dental health.

To be specific, successive governments appear to have decided that our dental health no longer has the same level of importance and slashed the availability of free dental care. Britain has one dentist for every 2000 people (WHO 2010) which sounds reasonable. However, seeing a dentist on the NHS has become something of a fabled miracle in many parts of the country.

 

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The NHS is happy to clean up your vomit if you get drunk every night, hold your hand if you inject yourself with too much heroin and help you cough up black phlegm if you spend your days chain smoking. If you don’t brush right though, the NHS is not necessarily your friend.

It is now almost impossible to find an NHS dentist. Even if you are lucky enough to secure one of the prized places, people are still charged up to 80 per cent of the cost of treatment. Being a child, being pregnant or being on social welfare and benefits are the main groups that are entitled to free treatment.

 

This has left us with a two-tier dental system. The upper tier pays to see a dentist privately and these patients have the unenviable privilege of paying the highest prices in Europe. The second tier scrambles for an NHS dentist and waits so long for partly subsidised treatment that their teeth can crumble or cause agony in the meantime. There is a third tier who have their own pliers and bits of string! Shockingly, more than one in 20 have said that they resort to DIY surgery.

 

Having bad teeth is not without consequences. For the young and middle aged, bad teeth can make it more difficult to find a good job or a successful relationship. It has been years since I’ve seen a TV presenter without a perfect set of white, straight teeth and as a country, we now spend £360 million on cosmetic dentistry a year.

For the elderly, poor dental health can leave them unable to eat properly or in pain. Gum disease also increases the risk of mouth cancer, and pancreatic cancer in men.

So how can we make sure we care for our teeth? Here are our top tips for a healthy smile:

 

  1. Brush your teeth twice a day with toothpaste that contains fluoride, this will prevent tooth decay, gum disease and bad breath. Brush your teeth for two minutes each time. Some electric toothbrushes now have timers and apps to help make sure we are covering all our teeth for long enough.
  2. Teach children at young age about healthy oral hygiene habits and supervise them until around the age of seven. The earlier this becomes part of their life, the more likely it is to become an engrained routine that will stay with them. Children should start seeing a dentist when their baby (milk) teeth first appear. Baby teeth are thinning and less able to withstand the bacteria that cause tooth decay. Decaying baby teeth can have a negative impact on adult teeth and needing extractions (removal of teeth) can lead to problematic adult teeth.
  3. Health diets which minimise sugars will minimise oral health problems. Fruit juices can be deliciously refreshing but can be high in sugars, try to get into a habit of reading your food labels.
  4. See your dentist! This might sound a bit obvious but just we get an MOT and service on our car by an expert mechanic, it’s also important to have an MOT on your mouth. Your dentist will advise you on how often you need to be seen, it can vary depending on your dental health.
  5. Flossing. Using floss or the small interdental brushes can get to the edges of the teeth that brushing can’t. Think about the last time you washed your car, you wouldn’t get wash the bonnet and the boot (trunk) and leave the doors dirty would you?

Healthy teeth used to be a marker of a modern first world society. If Britain doesn’t make changes soon, our lack of investment in dental care will leave us with 18th century teeth.

Time to hydrate

All this week we’re focusing on Nutrition and Hydration Week, an awareness campaign that could be custom made for us. It’s aim is to spread the important message of maintaining health by considering our nutrition and hydration.

Today we’re looking at the most basic and yet the most vital aspect of nutrition and hydration: Water.

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Why not try infusing your water with fresh fruits or herbs for extra flavour?

Aqua. H2O. Whether you take it still, sparkling, tap or bottled, infused or iced there is no escaping the importance of water to our bodies.

Our bodies are roughly two thirds water and it role is crucial. It can be incredibly difficult to know how much to drink, especially once you start to consider the impact of the exercise, weather and general state of health.

Water is not just important for the normal functioning of our bodies. It can have a crucial role in weight loss. Drinking with your meal or between meals can help to increase your sense of fullness. Those hunger pangs might not be hunger, often it’s thirst.

The human body has evolved to be a highly sophisticated filtration system. A series of chemical reactions and responses triggering further reactions and responses to maintain as steady state as possible (homeostasis).

The amount we drink is triggered by our thirst response. We drink when we’re thirsty, our body utilises the fluid it needs and any excess is eliminated by the kidneys or bowels. To counteract this loss, the thirst cycle starts again.

 

The actual amounts we are recommended to drink can vary depending on what study you read. In general terms, the European Food Safety Authority suggest 2L for men and 1.6L for women. Within the UK, the average bottle of water is about 500ml – so a man would need around four of these and women just over three.

However, it starts to get more complicated when you factor in the level of activity that you engage in, your physical health, your size and weight and whether it’s a hot day or not.

I often find I am encouraging my patients to drink more, and there seems to be some confusion over what we should be drinking. Water is always going to be the best option. Alcohol may feel like it quenches your thirst but it’s a diuretic meaning you’ll pass urine more frequently which may actually dehydrate you. The hangover effect and the ubiquitous headache with alcohol, in part, is due to this dehydration mechanism. One option is to alternate your alcoholic drinks with a glass of water to help counteract the dehydration.

Fruit juices and soft drinks are also options, but these can contain high amounts of sugars so should be drunk in moderation.

The vast majority of tea and coffee, unless you choose a de-caffeinated option, contain some caffeine. Caffeine can also have a mild diuretic effect and can hinder your hydration.

Dehydration, a state whereby the body lacks fluid, may cause you to feel thirsty or pass urine which is darker in colour or stronger smelling. You might also feel sluggish, light headed and or have a dry mouth.

Children and the elderly, are more at risk of becoming dehydrated. Signs that might give your doctor cause for concern is if children are becoming drowsy, having fewer wet nappies or if they are breathing more quickly. Older people often may not realise that they are dehydrated and confusion is a common presentation of dehydration in the elderly.

Patients experiencing vomiting, diarrhoea or sweats as a result of a fever can become dehydrated quickly unless they are able to replace the extra water lost from the body.

*Originally written for The Independent July 2015, rewritten for blog post March 2017.

World Kidney Day 2017 : Kidney Disease and Obesity

Annually, a global event is held to help drive awareness of kidney problems and how we can all help to protect these vital organs. This year the theme is ‘Kidney disease and obesity’.

Our kidneys are organs like no other in the body, acting as a filtration system for our blood helping us to eliminate toxins as well as playing a crucial role in other functions such as controlling blood pressure.

It’s a myth that kidney disease only effects elderly people, and whilst it is true that some forms of kidney problems are more common as we age, kidney disease can strike at any age.

 

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So how does obesity link to kidney disease?

It is a sad fact that obesity levels are on the rise across the world, in all age ranges. Carrying extra weight places increased pressure on so many different bodily systems – including our kidneys. Patients who are obese are at an increased risk of diabetes and high blood pressure – both of which can, in turn, increase the risk of developing kidney troubles. It is estimated that by 2025, 18% of all men and 21% of all women worldwide will be obese.

What is more worrying to us as doctors is the rate of childhood obesity and the alarming frequency we see it in our clinics. Children are developing problems, normally associated with adults, at a younger and younger age. Radical action is needed to ensure that we are setting up our future generations for the healthiest possible lives.

One of our main passions in our work is promoting the preventability of disease. We know that there are many things in life, and in health, that we have no control over, but if we can help to reduce the factors that increase our risk of illness we have at least taken a step in the right direction.
Obesity is largely preventable. It isn’t easy, but it is preventable. 

 

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One of the key themes of this World Kidney Day is to promote the achievability and affordability of healthy choices in helping us to tackle the global obesity epidemic. As practicing GP’s we often hear from patients that it costs more to eat healthily, and there is some truth in that. When you can get a burger in minutes for less than a couple of pounds it is too easy to see why we as a global community battle our weight.

However being informed about healthy choices, and armed with a little forward planning, it is possible to eat well without breaking the bank. Celebrity chefs including the likes of Jamie Oliver often provide the breakdown of a cost per head per meal – and these fall well below the cost of a take away.

Quick Kidney Facts (www.worldkidneyday.co.uk)

  • Our kidneys will filter around 180 litres of blood every day. That’s the same amount as just under 55 cans of an average sized canned drink.
  • Kidney failure can be fatal without dialysis or transplant
  • 64,000 people in the UK are currently being treated for kidney failure
  • 3,300 kidney transplants take place in the UK each year but over 5,200 are still waiting
  • Every year in the UK there are an estimated 40,000 premature deaths related to chronic kidney disease

 

Why not take a few moments to read more about world kidney day on their website?

 

–Alex