Why Am I Always Tired? Common Causes and When to See a Doctor

If you keep asking "why am I always tired?", the most common reasons are not getting enough sleep, stress or low mood, and an unhealthy lifestyle. But if you cannot explain your tiredness and it has gone on for a while without getting better, it may be a sign of a medical condition such as iron deficiency anaemia, an underactive thyroid or diabetes. A doctor can usually start checking for these with simple blood tests.

Tired sometimes, or tired all the time?

Feeling tired after a long day, a late wedding function or a busy week at work is normal. The NHS says it is normal to feel tired sometimes, but if you are tired all the time and do not know why, it could be a sign of a problem.

The key questions are:

• Can you explain it, for example by short nights, a new baby or a stressful period?
• Has it been going on for a while?
• Is it getting better, or staying the same or getting worse?
• Do you have other symptoms along with the tiredness?

Your symptoms can give you clues, but the NHS advises not to self-diagnose. See a doctor if you are worried.

Common everyday causes of tiredness

According to the NHS, common causes of tiredness and fatigue include:

• Sleep problems: not getting enough sleep, or finding it hard to get to sleep (insomnia).
• Lifestyle: an unhealthy diet and not getting much exercise.
• Stress and low mood: stress, depression and dealing with life challenges, such as a death in the family or looking after a new baby.
• Hormonal changes: such as during puberty, pregnancy or the menopause.
• Illnesses: some infections, like glandular fever and COVID-19.
• Medical treatments and medicines: some, like chemotherapy, can cause drowsiness for a while.

In everyday life in Pakistan, a few of these often stack up together: late dinners, chai at night, phones in bed, early starts for work or school, and long hot summer nights that make sleep harder. Working on these first can make a real difference.

Medical conditions that can make you tired

When tiredness comes with certain other symptoms, it can point towards a particular condition. The NHS lists these examples:

If sugar (diabetes) is a worry for you, our guide to the HbA1c test explains one of the blood tests used for it.

Iron deficiency anaemia

Iron deficiency anaemia happens when the body does not have enough iron. The NHS says it is often caused by blood loss or pregnancy. Heavy periods and pregnancy are very common causes. Bleeding in the stomach and intestines is another common cause, which can be linked to things like painkillers called NSAIDs (such as ibuprofen and aspirin), stomach ulcers or piles.

Symptoms can include:

• tiredness and lack of energy
• shortness of breath
• noticeable heartbeats (palpitations)
• paler than usual skin
• headaches

The NHS lists the treatment as iron tablets plus eating iron-rich foods, once the reason for the low iron has been found. Your doctor decides whether you need tablets and for how long. If diet is part of the problem, the NHS suggests eating more dark-green leafy vegetables, fortified cereals and bread, meat, dried fruit such as apricots and raisins, and pulses (beans, peas and lentils, so your daal counts). It also says that large amounts of tea, coffee, milk and dairy make it harder for the body to absorb iron, which is worth knowing in a country that loves its doodh patti.

Do not start iron tablets on your own. It is important to find out why your iron is low first, and the NHS warns that iron tablets must be kept out of the reach of children, because an overdose in a young child can be fatal.

Underactive thyroid

The thyroid is a gland in your neck. In an underactive thyroid (hypothyroidism), it does not make enough hormones. The NHS describes this as a common condition. Symptoms may be mild, usually develop slowly and get worse over time. Common ones include:

• feeling extremely tired
• feeling cold more than usual
• putting on weight
• constipation
• difficulty concentrating, low mood or depression
• dry skin, dry hair or hair loss
• a hoarse voice
• irregular or heavy periods

You are more likely to have it if others in your family have had a thyroid condition. The NHS says it is usually treated with medicine that replaces the missing thyroid hormone, with regular blood tests to make sure the dose is right. Your doctor decides on and adjusts this treatment.

What about vitamin D?

Many people wonder whether low vitamin D is behind their tiredness. It helps to know what the NHS actually says. Its vitamin D page explains that vitamin D helps control the amount of calcium and phosphate in the body, which are needed to keep bones, teeth and muscles healthy. A lack of vitamin D can lead to bone pain from a condition called osteomalacia in adults. That page does not list tiredness as a symptom.

The NHS does say that people with dark skin, for example from a south Asian background, may not make enough vitamin D from sunlight. So may people who are not often outdoors, or who usually wear clothes that cover most of their skin when outside. The body makes vitamin D from direct sunlight on the skin, and it is also found in a few foods, such as oily fish, red meat, egg yolks and some fortified foods.

Vitamin D supplements are not harmless in large amounts. The NHS warns that taking too many over a long time can cause too much calcium to build up in the body, which can weaken the bones and damage the kidneys and heart. Ask your doctor before taking vitamin D supplements, and follow their advice on how much.

Tests a doctor may order

The NHS says you may need tests such as blood tests to check for anaemia, diabetes or an overactive thyroid. Depending on your symptoms, these may include:

• Full blood count (FBC): checks whether your red blood cell count is normal. You do not need to do anything to prepare for it. The same blood test also checks for other types of anaemia, such as vitamin B12 or folate deficiency anaemia.
• Thyroid blood tests: check the levels of thyroid-stimulating hormone (TSH) and thyroxine (T4) in your blood.
• Further tests: if the reason for anaemia is not clear, the doctor may arrange other tests, such as a stool test that looks for hidden blood.

Before ordering tests, the doctor will usually ask about your lifestyle, medical history and family history, and may examine you, for example checking your neck for a swollen thyroid gland. If the cause is still unclear, the NHS says a GP may refer you to a specialist. Most of these blood tests can be done at a local lab, but it is best to have a doctor decide which ones you need and explain the results.

Things you can do to feel less tired

The NHS suggests these steps:

Do:

• have a healthy diet and exercise regularly
• try to stick to the same sleep times and aim for 6 to 9 hours of sleep
• try to relax for a couple of hours before bed, for example by reading or listening to music or a podcast
• keep your sleeping area relaxing: not too bright, noisy or warm

Do not:

• smoke
• drink too much alcohol
• eat, have caffeine (including chai and coffee) or exercise in the couple of hours before sleep
• use smartphones or screens in the hour before sleep

If stress, worry or low mood is behind your tiredness, the NHS says treatment may include talking therapies such as cognitive behavioural therapy (CBT), along with advice on sleep, relaxation and lifestyle.

When to see a doctor

According to the NHS, see a doctor if:

• you have been feeling tired for a few weeks and you are not sure why
• your tiredness affects your daily life
• you feel tired and have other symptoms, such as weight loss or mood changes
• you have been told you make gasping, snorting or choking noises when you are asleep

You should also see a doctor if you think you might have iron deficiency anaemia or an underactive thyroid, if you have heavy periods, or if you notice symptoms like palpitations, shortness of breath or feeling very thirsty and peeing a lot.

Tiredness on its own is rarely an emergency. The NHS notes that, in very rare cases, a severe underactive thyroid can lead to a life-threatening condition called myxoedema coma, which is more common in older people and needs treatment in hospital. If someone seems seriously unwell, call 1122 or go to the nearest emergency department.

You can find PMDC-verified doctors by city and specialty and book a visit on SehatDoc Booking.

Sources

• NHS — Tiredness and fatigue
• NHS — Iron deficiency anaemia
• NHS — Underactive thyroid (hypothyroidism)
• NHS — Vitamin D

Medical note: This guide is for general information and is not a substitute for advice from a doctor who can examine you.