Fatigue and Sleepiness

Sometime during one's lifetime everyone experiences weird feelings of fatigue and sleepiness inspite of a sound health and proper sleep. Tiredness, weakness and sleepiness, as such, have two components - one organic (physical) and other psychological (mental). If one is mentally weak and has some disturbances then one feels weak although he may be physically all right. Similarly, if one is extremely tired physically but gets some good news then he does not feel tired or sleepy.

Fatigue, sleepiness, tiredness or weakness as is often described by a patient has many medical and psychiatric causes, although more often it is idiopathic or difficult to link to a definite cause even more so as it is a subjective symptom.

Medical causes commonly include infective, inflammatory, endocrinal, neuromuscular, autoimmune, malignant and chronic diseases, which sooner or later express themselves.

Psychiatric causes can be the manifestations of anxiety, depression, anger and chronic conflicts apart from drug abuse including alcohol. Monotony can precipitate or aggravate the condition. Lack of exercise or lethargy can produce a similar picture.

Chronic fatigue symptom complex of unknown aetiology has received considerable attention recently as well as in the past. It is characterised by persistent or recurrent debilitating fatigue. It is usually found in healthy heterosexual teenagers and young adults. Females are more affected than males. Although it is a distinct entity now the two commonly missed medical and psychiatric conditions in this context are - hypothyroidism and depression.

As far as the management is concerned, life should have a daily routine starting with a fixed working time in the morning and include graded exercise, work, diversional activities according to one's liking, and socialisation with a smooth sleep pattern at the end of day. One should also try to educate oneself and improve psychological make-up so as to have a positive approach towards life.

Less fatty and spicy foods and more of fresh vegetables and fruits should be consumed.

Cognitive behavioural therapy (CBT) which is an integration of education and behavioural intervention based on biopsychosocial conceptualisation can be of great help in some cases.

In extreme situations multidisciplinary rehabilitation may be of some help.

Dr. A. K. Sarkar MRCP
Consultant Physician