Why am I always tired? Common causes and what to check

“Why am I always tired?” is one of the most common questions people bring to a health care provider; fatigue is among the top 10 reasons for a primary care visit. Everyone has tired days. What’s worth looking into is tiredness that lasts for weeks, doesn’t lift with rest, or gets in the way of work, parenting or the things you enjoy.

Fatigue rarely has one dramatic cause. More often it’s a mix: short sleep, a stressful season, heavy periods, a nutrient running low. Many of the common causes are straightforward to check, which is where this guide starts.

Why am I always tired? The most common causes

• Lack of quality sleep. A good night’s rest is essential for lasting energy. Insomnia, babies, shift work, perimenopause and stress can chip away at it.
• Sleep apnea. This is a condition where breathing repeatedly stops during sleep. Clues include loud snoring followed by silent pauses, gasping or choking, morning headaches and daytime sleepiness.
• Low iron/ferritin. Common with heavy periods, pregnancy and in people who consume low meat diets. Iron deficiency can cause anemia, where the red blood cells don’t transport oxygen well anymore. Signs include shortness of breath, fatigue even with excessive amounts of sleep, lightheadedness, hair loss, and more.
• Low vitamin B12, more likely if you’re an older adult, eat a vegan diet, or take metformin or acid-reducing medicines. See our guide to B12 deficiency symptoms.
• Stress, worry and low mood. These are among the most common drivers of ongoing tiredness, and they deserve the same attention as a lab result.
• Medication side effects, alcohol or cannabis. Review everything you take, including over-the-counter products.
• Activity levels. Very little movement, or hard training without enough recovery, can both play a part.
• Low thyroid, called hypothyroidism, can cause fatigue, dry skin, constipation and weight gain.
• Chronic infections, like Lyme disease and similar infections, are a cause of fatigue for many patients at Natura.
• Mold illness. Many people think of the respiratory system as the main area mold can hit, but unremitting fatigue is one hallmark of mold illness.

Low vitamin D is common in Manitoba winters, though its link to tiredness is less clear.

Low ferritin symptoms and low iron in women

Iron lets your blood carry oxygen, and ferritin is the protein that stores it. Ferritin drops first; anemia (low hemoglobin) only shows up later, if at all. That means your iron stores can be low even when your blood count looks normal.

Heavy periods and pregnancy are common reasons women run low. Low iron symptoms include:

• tiredness and lack of energy
• shortness of breath or a pounding heart, especially with activity
• paler skin than usual, and headaches
• more hair shedding, a sore tongue, or spoon-shaped nails
• restless legs
• cravings for ice or other non-food items (pica)

Ferritin results take some interpreting. Inflammation, for example from an infection or recent surgery, and liver problems can push ferritin up, so a normal number doesn’t always mean your iron stores are fine. Your practitioner reads it alongside your other results and your history.

Don’t start iron on your own without a test. Too much iron is harmful, and low iron always needs an explanation, since it can also come from bleeding in the gut, especially if you’re not menstruating.

What tests does Dr. Esau, ND typically run for fatigue?

There’s no single “fatigue panel”, but after listening carefully to you, Dr. Esau, ND selects tests with you. Common tests used to work up fatigue include:

• CBC, checking for anemia and infection
• ferritin, iron, TIBC
• vitamin B12
• vitamin D
• TSH
• HbA1C
• kidney and liver panel
• pregnancy test
• testosterone (more in men)

If your results come back normal, that’s useful information, not a dead end. We understand that it isn’t normal to be exhausted after 12 hours of sleep, and we are committed to helping you figure it out even if the first round of testing is normal. Our guide to lab testing with a naturopathic doctor in Manitoba explains how testing and lab fees work.

What can I do about constant tiredness?

• Protect 7 to 9 hours for sleep, with consistent bed and wake times, even on weekends.
• Move most days. Canada’s guidelines suggest 150 minutes a week of moderate to vigorous activity plus strength work twice a week; if you’re running on empty, start smaller and build.
• Eat regular meals that include iron-rich foods such as meat, legumes, dark leafy greens and fortified cereals.
• Go easy on alcohol, which disrupts sleep.
• If you snore loudly or wake gasping, ask your doctor about a sleep apnea assessment.
• Keep a two-week log of sleep, energy, meals, periods and mood, and bring it to your appointment. Patterns that are invisible day to day often stand out on paper.
• Talk to someone if stress or low mood is weighing on you. Counselling with Cameron Plett, M.A. is available at Natura.

Seeing a naturopathic doctor at Natura

Fatigue is common among patients seeking naturopathic care. If you’re struggling with fatigue, reach out. We offer an accelerated initial visit to reduce wait time: a registered nurse completes your intake, including your health history and vital signs, and then you see the naturopathic doctor to put together your plan.

Your ND may do a physical exam and order testing, and you then discuss a plan together. Lab testing ordered by an ND isn’t covered by Manitoba Health; you pay the lab. Prices vary widely depending on what’s tested, but generally start around $75. Lindsay Porter, CSEP-CEP, Natura’s clinical exercise physiologist, builds exercise programs that start where you are. Keep your family doctor in the loop, especially if anything abnormal turns up.