I am blessed to care for a lot of young adults in my Endocrinology practice. I enjoy hearing their goals and aspirations. From teaching, to engineering, athletics, and healthcare careers, I love getting updates on their progress. I typically address their thyroid disorders, diabetes, obesity, and PCOS but there is one complaint that I hear from majority of my patients:

There must be something in the water these days because everyone seems to complain of fatigue. For those prehealth students and professional school students out there, this can really impact your chances to be successful. It’s tough to do well when you always want to fall asleep all of the time. I’d like to share with you my S’s of fatigue.

1. Sleep: Never underestimate the power of sleep! I would easily guess over half of Americans either suffer from inadequate amounts of sleep or a specific sleep disorder. It is estimated that 1 in 5 adults has sleep apnea. This disorder can result in a number of problems with fatigue being a primary one. Sleep apnea tends to affect obese patients at a greater frequency although I have seen it in thinner individuals as well. It is always difficult for me to get my patients to actually be evaluated for sleep apnea despite how common it is. Some patients suffer from insomnia, restless leg syndrome, narcolepsy, or circadian rhythm sleep-wake disorders. It is recommended we get 7-9 hours of sleep daily. Don’t be that superman or superwoman character saying you need only 2 hours. There are a number of important physiological activities taking place during the hours of sleep. For students, many have erratic sleep patterns disturbed by long late-night cramming, work, noisy roommates, and (let’s be honest) partying. Working on sleep hygiene can really make a huge difference. [Message me if you need a list of Do’s and Don’ts.]

2. Stress: We all face stress but the medical training path intensifies this. Some handle it well and others don’t. We often underestimate what stress can do to us and we push it to the side. Amongst the many symptoms stress can cause (headaches, chest pain, muscle aches, anxiety, depression) fatigue is certainly high on the list. If I could write a prescription for rest and vacation for my patients I would. Some countries have built in a siesta or mandatory stress relieving techniques. In the United States this is not very common. I highly recommend taking time out of the day to untangle and for many of us this may mean cutting back on activities. It is very easy to overcommit yourself as a student.

3. Sedentary: Get up and move. God did not design our bodies to sit around all day on the computer or couch. This will only lead to deconditioning. It truly disturbs me when I ask my younger patients if they are physical active and they respond by saying they walk around the grocery store. Maybe this is just a Texas thing. It is recommended that all adults get at least 30 minutes of moderate-to-vigorous aerobic exercise at least 5 days a week (or total of 150 minutes per week). Many of us fail to do this. The question I get is, “How can I do that when I am already so tired?” Start small and build up. Use the exercise as a relaxing tool so you can kill two birds with one stone. The benefits of exercise are tremendous. If there was a drug out there that offered this benefit it would be worth thousands of dollars.

4. Substance: Sometimes it is what we consume that is contributing to us feeling tired. This may be in the form of drugs (prescription and illicit), foods, and beverages. Some medications designed to treat allergies, hypertension, cough, seizures, and pain can all contribute to fatigue. Excess caffeine and alcohol may also be a factor. A poor quality diet may lead to nutritional deficiencies and blood sugar dysregulation which may cause fatigue and mood disturbances. Some may also have food allergies. Make sure to get a well-balanced diet with adequate amounts of fruits and veggies. Try your best not to depend on anything to keep you energized.

5. Sickness: Well this is the big one. There is a huge list of medical conditions that can contribute to fatigue. Majority of the time, we are convinced we have a serious disease and often ignore the above issues I have discussed. It is important to address the other S’s above if there is something else going on. The more common illnesses I find in younger individuals include anemia, psychological disturbance, thyroid disorder, obesity, mononucleosis, fibromyalgia, or autoimmune disorder. Other less common diseases can be diabetes, adrenal insufficiency, chronic kidney disease, heart failure, lung disease, cancer, liver failure, low testosterone, infections (viral, bacterial, fungal), multiple sclerosis, chronic fatigue syndrome and chronic pain. Let me offer some reassurance, it is very unlikely that you have one of these less common conditions. These conditions do happen and it can be extremely frustrating trying to get to the bottom of why we are tired but what tends to happen is we lose sleep, become less active and take substances to fight the stress of worrying about what we may have. See what I just did there? We can enter a perpetual fatigue cycle and end up being our own worst enemy. It is best to address what we can while we search for diseases.

So there are a ton of reasons why we are tired. Fatigue is very troubling and frustrating for many of us. My final advice is to address the top 4 S’s. If the fatigue doesn’t resolve then see your primary care physician to investigate for the 5th. Try not to simply place a bandage over the issue. If you have any thoughts or suggestions I’d love to hear from you. Feel free to share with your friends and family.   

Now, I’ve got to go to sleep. Let me know if you yawned at all while reading this.. lol.

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