Fatigue is a common health complaint. It is, however, one of the hardest terms to define, and a symptom of many different conditions. Fatigue, also known as weariness, tiredness, exhaustion, or lethargy, is generally defined as a feeling of lack of energy. Fatigue is not the same as drowsiness, but the desire to sleep may accompany fatigue. Apathy is a feeling of indifference that may accompany fatigue or exist independently. Fatigue is common. Around 20% of Americans claim to have fatigue intense enough to interfere with their having a normal life. Physical causes are estimated at 20-60%, and emotional causes are the other 40-80%. The challenge is how to tell what is causing your fatigue and whether it is serious enough to see your doctor.

FATIGUE CAUSES

* Sleep disturbances
o Not enough sleep
o Too much sleep
o Sleep apnea
o Shift work (changing shifts, night shifts)
o Alcohol

* Heart diseases
o Congestive heart failure (fluid in lungs)
o Cardiomyopathy (dysfunction of the heart muscle)

* Lung diseases
o Asthma
o Emphysema or chronic obstructive pulmonary disease (COPD)
o Pneumonia

* Nutritional disorders
o Malnutrition (kwashiorkor, protein deficiency or marasmus, total calorie deficiency)
o Obesity
o Vitamin deficiency (thiamine, B12, B6, folate, vitamin C)

* Electrolyte disturbances
o Low potassium
o Low magnesium
o Low or high calcium
o Low sodium

* Endocrine disorders
o Low blood sugar or high blood sugar (diabetes)
o High or low thyroid
o Low cortisol (Addison disease)
o High cortisol (Cushing disease)

* Gastrointestinal disorders
o Gastroesophageal reflux disease (GERD)
o Peptic ulcer disease (PUD)

* Neurological disorders
o Multiple sclerosis
o Stroke
o Lou Gehrig disease

* Infectious causes
o Any chronic disease
o HIV/AIDS
o Tuberculosis
o Hepatitis
o Mononucleosis
o Chronic fatigue syndrome
o Urinary tract infections

* Connective tissue disorders
o Arthritis (osteoarthritis and rheumatoid arthritis)
o Lupus (SLE)
o Fibromyalgia
o Acromegaly

* General disorders
o Cancer
o Anemia (blood loss or not making enough blood)

* Gynecologic
o Pregnancy
o Menopause

* Exercise disturbances
o Lack of exercise
o Too much exercise (worn out)
o Excessive workload

* Psychological
o Depression (loss of interest, ambition)
o Anxiety
o Grief
o Stress

* Blood pressure medications work by different mechanisms to decrease blood pressure. The ultimate decrease in blood pressure also means a decrease in the amount of work the heart is doing, which can lead to a feeling of fatigue. Sometimes, the drug works not only on the heart, but also on the central nervous system.

o Beta-blockers
o Calcium channel blockers
o Diuretics
o ACE inhibitors

* Heart medications work in different ways to regulate the heartbeat. Fatigue can be related to the effects the medication has on the heart or to the effects that spill over to other areas of the body.

o Digoxin (Lanoxin)
o Amiodarone (Cordarone, Pacerone)
o Procainamide (Promine, Rhythmin)

* Psychological medications used to help depression and anxiety work by increasing neurotransmitters in the brain that have a calming effect on the body, thus stimulating fatigue.

o Antidepressants
o Antipsychotics
o Antianxiety medications (such as diazepam [Valium] or zolpidem [Ambien])

* Narcotics: Many pain medications are opiate derived. Drowsiness can be caused by opiates.
o Acetaminophen and codeine (Tylenol with Codeine)
o Hydrocodone and acetaminophen (Vicodin)
o Oxycodone and acetaminophen (Percocet)
o Propoxyphene and acetaminophen (Darvocet)

* Muscle relaxants work to decrease the contraction of muscles. This relaxation can lead to total body relaxation, which may cause you to feel fatigued.
o Cyclobenzaprine (Flexeril)
o Carisoprodol (Soma)
o Orphenadrine (Norflex)

FATIGUE SYMPTOMS

Symptoms of fatigue include the following:
* Weakness, lack of energy, tiredness, exhaustion
* Passing out or feeling as if you are going to pass out
* Palpitations (feeling your heart beating)
* Dizziness
* Vertigo

* Shortness of breath

HOW CAN FATIGUE BE MANAGED?

Fatigue has so many different causes and patterns and it may require the use of many strategies for effective treatment. For these reasons, it is important that you discuss your symptoms with your nurse or physician in order to devise an individual plan that will work. While there are no standard medical treatments for fatigue, new tools exist for evaluating and coping with fatigue. The following suggestions may also help you to cope with fatigue and have more energy:

Treat anemia: Anemia is the most common cause of fatigue in cancer patients. It is also very treatable. Learn more about the diagnosis and treatment of Anemia.

Maintain good nutrition: Maintaining good nutritional intake during treatment is especially important because cancer treatments increase the nutritional demands of the body. However, treatments may also cause you to lose your appetite, or feel full early (Early satiety). Work with a dietician or nutritional specialist to ensure that you are getting proper nutrition.

Conserve energy: Try to be realistic about how much energy you have and what you can and can’t do. Only do the things that are most important and ask friends or family for help. It is important to recognize which activities create the most fatigue and also note the frequency, degree, and duration of fatigue so that you can report these to your doctor. If you’re having difficulty managing fatigue, you may wish to ask your nurse or doctor to help family members understand how they can help.

Maintaining normal rest and sleep patterns is important for ensuring quality rest. Plan your daily activities carefully, and schedule rest times between activities throughout your day. Try to rest when you feel the worst and do your activities when you feel better.

Evaluate medications: Review your medications with your doctor, pharmacist, or nurse to ensure that the medications are not causing or contributing to your symptoms.

Exercise: While conserving energy is important, it is equally important to understand that too much rest or inactivity can actually decrease the body’s ability to produce energy and can worsen fatigue. Moderate daily exercise, such as walking, may help to increase your energy level.

Manage stress: Counseling, support services, and medications can all play a role in reducing stress and thereby alleviating fatigue.