Fatigue

• Tiredness or sleepiness that is not relieved by rest 
• Daily activities feel difficult or unduly tiring 
• Low physical or psychological energy 
• Decreased ability to perform physically. For example, muscles may tire easily, reflexes may be slow, and co-ordination may be affected 
• Poor concentration and decision making 
• Mood swings and irritability may occur 
• Motivation may be low 
• Fatigue that is accompanied by symptoms of dizziness; pale skin, lips, gums, nail beds and eyelid linings; rapid heartbeat; shortness of breath (especially when exercising); poor concentration; and/or reduced resistance to infection may indicate iron-deficiency anaemia.
  

Many cases of fatigue are related to lifestyle factors such as insufficient or excessive amounts of sleep, poor eating habits, high stress levels, a sedentary lifestyle or the abuse of drugs and alcohol. Other lifestyle issues may include workplace stress, shift work, and long work hours.

Depression, bereavement, financial anxiety and other mental health problems may also lead to low energy states, as well as to mood swings, low motivation, and irritability. In fact, psychological factors such as these may be involved in the majority of fatigue cases.

Many health problems are also associated with fatigue, including (but not limited to):

• Iron deficiency anaemia 
• Colds, flu and other infections 
• Heart problems 
• Hypothyroidism and other hormonal problems 
• Diabetes 
• Sleep disturbances, including obstructive sleep apnoea 
• Chronic fatigue syndrome and glandular fever 
• Hepatitis, coeliac disease and other conditions affecting the gastrointestinal tract 
• Chronic pain 
• The use of some medicines

In many cases, a combination of these and other factors contribute to fatigue.

• Fatigue that is not improved with adequate sleep, a healthy diet, and stress reduction may indicate an underlying physical or emotional health problem, and should be investigated by your healthcare professional.
• Aim to sleep for around eight hours per night, preferably with regular bedtimes and waking times.
• Stick to a nutritious diet based on plenty of fresh fruit and vegetables, daily serves of lean protein, and complex carbohydrates such as legumes and grains.
• Don’t skip meals, especially breakfast, which helps maintain blood sugar balance, and is essential for sustained energy levels throughout the day. Choose a breakfast based on whole grains, such as natural muesli with low-fat milk and chopped fruit.
• In addition, eating a combination of protein and complex carbohydrates at lunchtime may help you avoid a mid-afternoon energy slump. Examples include a chicken and salad sandwich made with wholegrain bread, chickpea curry with brown rice, and tuna and vegetables with wholegrain pasta.
• Rather than three large meals, eat six smaller meals and snacks throughout the day to sustain your energy levels and balance your blood sugar.  
• Avoid foods high in fat, sugar, or salt.
• Iron from vegetarian sources is not as easily absorbed as iron from meat. Spinach and other leafy green vegetables, legumes and whole grains are important vegetarian sources of iron, along with enriched breads and cereals. Always combine iron-containing foods with foods rich in vitamin C (such as citrus and other fruit, capsicum and broccoli ) in order to improve your body's absorption of iron. 
• Drink at least two litres of water per day, and avoid caffeine-containing beverages (e.g. coffee, tea, cola and energy drinks), as they may contribute to sleep disturbances.
• Stop smoking. It depletes the body of vital oxygen, and aside from its other detrimental effects on health, may contribute to fatigue . Recreational drug use and alcohol abuse can also deplete your energy levels. If necessary, seek professional assistance to help you quit.  
• It may sound contradictory, but increasing the amount of activity you do is a great way to boost your energy levels. Regular exercise also supports healthy balanced moods and a good night’s sleep. However, don’t start a new exercise program without checking with your doctor first.
• Take a break from your computer or workstation every few hours, and use that time to move around, stretch and have a glass of water. Avoid working long hours.
• Schedule regular periods of activities that you find relaxing. This can mean anything from walking the dog to watching a funny movie or going out to dinner with friends. Massage is also of benefit, and as well as being relaxing can help to improve your sleep and relieve muscle tension.
• Learning to relax can improve stress levels and have additional benefits for restful sleep. Techniques worth trying include meditation and yoga. 
• Emotional and practical social support is a very important aspect of stress management. Often talking your problems over with someone helps you to see things from a different slant. This can be helpful in finding solutions to your problems that you hadn’t previously thought of. If there is no family member or friend whom you feel comfortable talking to, ask your healthcare professional for a referral to a counsellor, psychologist or social worker who can help you to pinpoint events or conditions that are stressful to you, and to devise ways of reducing the stress they cause.

• Persistent or excessive fatigue should be investigated by your doctor so that any underlying medical or psychological causes can be treated appropriately.