TATT: Tired All The Time - is this how you feel?

TATT: Tired All The Time

Doctors use the abbreviation TATT very often as it is such a common complaint. But what is the answer to solving this age-old riddle of tiredness?

There isn't always a simple answer as it could be physiological i.e. related to inadequate sleep, or there could be an underlying medical condition. From the multiple medical causes, it could be related to either the body (physical) or mind (non-physical), which can be worked out based on associated symptoms and signs in addition to specific blood tests. The most common of each type are listed below.


Physical causes include:

1. Anaemia, which is a low concentration of a substance in the blood called haemoglobin. This is the part of the blood that carries oxygen to all areas of the body. When a person is anaemic, apart from tiredness, they may experience shortness of breath, feeling faint, or even chest pain if the anaemia is severe.

Anaemia is most commonly caused by a lack of iron in the body, but can also be caused by having low levels of Vitamin B12 or Folate (Folic Acid). There are other causes such as having a genetic condition where your body doesn't produce enough red blood cells (which carry the haemoglobin) or your body produces abnormal red blood cells. Having a chronic disease such as heart failure or kidney failure can also cause anaemia.

This can be investigated by blood tests, and treated by replacing the underlying deficiency or treating the disease causing the anaemia.

2. Thyroid problems, usually where the thyroid gland doesn't produce enough of the thyroid hormone, i.e. an underactive thyroid. Symptoms apart from tiredness can include weight gain (although this is much more commonly due to eating more than your body needs!), dry skin and hair, feeling cold, and constipation.

This can be investigated by a blood test and treated with thyroid hormone replacement if you are found to have an underactive thyroid gland.

3. Diabetes. This is where the body is unable to regulate sugar in the blood. As a result, a person with diabetes usually has higher than normal levels of blood sugar, resulting in damage to blood vessels and leading on to increasing the risk of heart disease, stroke, eye problems, kidney failure, and foot problems.

Symptoms could include passing urine frequently including waking up at night to pass urine, feeling more thirsty, increased number of viral and other infections including thrush, and blurred vision.

It can be checked with a special blood test (HbA1c) which measures the average blood sugar level over the preceding 6-8 weeks. The initial treatment primarily involves lifestyle changes, and possibly tablet medication if necessary.


Non-physical causes include:

1. Anxiety. This is where a person is generally anxious most of the time. Apart from tiredness, it can lead to symptoms of general worry and panic, difficulty breathing, sensation of heart beating (palpitations), difficulty sleeping, cold or sweaty hands and feet, and dry mouth.

Treatments can include counselling and techniques such as Cognitive Behavioural Therapy (CBT), and Mindfulness. Medication can sometimes help in severe cases.

2. Depression. This is where a person is in a state of perpetual low mood and can cause loss of interest in usual activities, inability to sleep or excessive sleepiness, lack of appetite or overeating, leading on to weight loss or weight gain, low self-esteem, feeling helpless and having little or no hope, in addition to feeling tired all the time and lethargic.

Treatments can again include counselling aiming to resolve the underlying issues causing depression. There is some evidence that medication can help, but only if used with measures to deal with resolution of past problems and developing coping strategies for the present and the future.


Presented above is a brief overview of five common causes of tiredness, although there are many other causes including coeliac disease (sensitivity to gluten/wheat), sleep apnoea (usually in overweight individuals with large necks), and of course the obvious causes such as lack of sleep or shift work disorder involving erratic and poor sleeping patterns.

Tiredness should be regarded as our body's way of telling us that we need to do something to sort it out. In most cases it will simply be that we need to adjust our lives with some rescheduling to ensure good sleeping and eating habits. But it's important to see your GP if any of the symptoms above occur, or are persistent or severe.

Disclaimer: the above article denotes the professional medical opinion of the author, and the general advice contained therein should not be used in isolation as personal medical advice. It is always recommended that you see a medical professional such as your own GP for any personal matters.



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