The first step to regaining your energy is discovering the cause of your exhaustion. Claire Turnbull outlines some strong contenders.
It feels like we have a tiredness epidemic on our hands. When I ask people how they are – whether it's a friend, someone on a work call or a fellow parent at the edge of the sportsfield – so often the answer is the same. Busy. Exhausted. Tired.
Sometimes, tiredness makes complete sense. I so clearly remember the days when my boys were young and I was waking many, many times a night. I would walk around in a daze wondering what day it was, who I was, and whether I would ever feel like myself again. If you've been there, or are there right now, you'll know exactly what I mean.
It also makes sense to feel tired after a big night out, a run of broken nights’ sleep, travelling across time zones, or dealing with something particularly stressful. When your body and brain are under pressure, tiredness is the signal that rest and recovery are needed.
But what about the kind of tiredness that doesn’t seem to shift? The tiredness that makes getting through every hour of the day feel really, really hard.
That kind of tiredness is worth paying attention to.
Let's start with sleep
First up, before thinking about what you might be lacking in your diet, what blood tests you might need, or whether a health issue is hiding, the first base to cover off is, unsurprisingly, sleep.
As adults, most of us need around seven to nine hours of good-quality sleep each night to feel and function at our best. And this is the time you actually need to be sleeping, not just in bed. The time to settle in and drift off needs to be added on top.
As much as many of us would like to shortcut this time, the reality is, you just can’t. Even if you feel like you can get away with less sleep and still be “okay”, on some level your brain and body will be paying the price.
The basics to check in with here:
- Get natural light into your eyes in the morning.
- Aim to make your bedtime and wake-up time as consistent as possible, where practical.
- Moderate caffeine and keep it to the earlier part of your day.
- Limit or ideally avoid alcohol in the evenings.
- Make your room dark, quiet, and cool.
Consider the possibility of sleep apnoea
Beyond these foundations, if you snore, wake gasping, have a dry mouth or morning headache, or feel exhausted despite spending enough time in bed, sleep apnoea is something to look into. It is estimated to affect around 20% of adults, and many people will not realise they have it. Treatment depends on the person and severity, but can include lifestyle changes, treating nasal congestion, mouthguards fitted by trained professionals, or CPAP machines.
Other things worth seeking support with include restless legs, pain, anxiety and reflux, as they can affect sleep too.
There are a number of health conditions that can cause tiredness and fatigue, so see if any of these sound like they might line up.
Iron deficiency equals exhaustion
Having experienced iron deficiency myself in my teens and again after my second child, I can vouch for this really being a different kind of tired. A dog-tired, tired to your bones, can’t hold up your toothbrush without wanting to close your eyes kind of tired.
Iron is needed to make haemoglobin, the protein in red blood cells that carries oxygen around your body. When you don’t have enough iron, your body can’t transport oxygen as effectively, which can leave you feeling exhausted, breathless, foggy and unable to exercise or concentrate in the way you normally would.
High risk groups include women with heavy periods, pregnant women, athletes, vegetarians, vegans, babies, children and teenagers. With an estimated 1 in 14 women in New Zealand low in iron and a third of teenage girls not meeting their iron requirements, it is not an uncommon cause of tiredness.
Before heading to the pharmacy to smash down some supplements, please go to your doctor and get your iron levels checked. It is not recommended to take iron supplements without having this confirmed. The reason behind low iron also needs to be investigated as, yes, it can be because you aren’t getting enough through your diet, but it could also be because you aren’t absorbing it properly, or because you are losing blood in some way, whether that is menstrual or internal, which needs to be looked at.
Some other common tiredness causes
Thyroid issues are another possibility. Your thyroid is a small gland in your neck that helps regulate metabolism, energy use, and temperature. Both an underactive thyroid and an overactive thyroid can affect how you feel, and may contribute to tiredness, changes in mood, weight, bowel habits, temperature tolerance, heart rate, or sleep. Thyroid function can be checked through blood tests with your GP.
Elevated blood sugar can also make you feel very tired. If you have too much glucose circulating in your bloodstream, you may also notice excessive thirst, needing to urinate more often, blurred vision or ongoing tiredness. These symptoms may be a sign That you have prediabetes and type 2 diabetes which can be diagnosed based on blood tests.
Vitamin B12 deficiency is another one to consider. B12 is important for red blood cell production and nervous system function, and some people don’t get enough, particularly if they eat little or no animal products, as the main food sources are meat, fish, eggs and dairy. Low B12 can cause tiredness, feeling weak, breathlessness, struggling to remember things, pins and needles, and other neurological symptoms.
Coeliac disease is a condition that can be overlooked. Coeliac New Zealand estimates around 60,000 to 70,000 New Zealanders have coeliac disease, or about 1 in 70, but up to 80% may be unaware they have it. With undiagnosed or untreated coeliac disease, the bowel is unable to absorb nutrients properly, which can lead to deficiencies in iron, folate, calcium and other nutrients, and as a result, excessive tiredness. There are blood tests your doctor can do, but the most important thing is not to eliminate gluten before testing, or you may get a false negative.
Perimenopause and menopause can also play a role. As someone navigates this phase of life myself, I have certainly noticed changes in my own energy levels over recent years. Sleep can become more disrupted. Anxiety can increase. Night sweats can become more common. Periods may become heavier, increasing the risk of low iron. When several of these factors occur together, it is not surprising that many women feel exhausted. This is worth talking through with your GP, as there are options that may help, including menopausal hormone therapy (MHT).
Medications can also have an impact. My brother is a pharmacist and points this one out when people are hunting for the answer to their tiredness and fatigue and can’t find the answer. Certain antihistamines, antidepressants, blood pressure medications, pain medications and other commonly prescribed drugs can all have fatigue as a side effect. If you have noticed new fatigue after starting a medication, it is worth talking to your doctor or pharmacist to see if there may be another option.
Viral illness can also be followed by fatigue in some people. Long Covid and conditions such as ME/CFS (chronic fatigue syndrome) can involve a level of exhaustion that is very different from everyday tiredness and can significantly affect quality of life. I have an uncle and close friend who both struggle with this, and I really appreciate how challenging it can be and how much it impacts your life. Advice here really needs to be tailored to the individual, something my team can help with if you are struggling.
Breathing issues might also be contributing to tiredness. I have recently started training to become a breathing coach after becoming fascinated by the impact breath can have on the nervous system, following a brain injury I had several years ago and my son having major breathing issues. The way we breathe can affect our stress levels, sleep and how safe or wired our body feels. Mouth breathing, shallow breathing or constantly feeling like you cannot get a full breath are all things worth paying attention to.
Carrying significant mental load is also a reality for many of us, beyond the medical issues. For some it's parenting, for others it's caring responsibilities, financial pressure, health concerns, relationship challenges or demanding jobs. It's not necessarily a physical effort that is exhausting, but the constant thinking, planning, organising, remembering and decision-making that comes with modern life. I don’t think this can be underestimated in terms of how much it can impact how tired so many of us feel these days.
When should you see your doctor?
If your tiredness is new, persistent, worsening, affecting your daily life, or simply does not feel like your normal tiredness, it is worth getting checked by a qualified medical professional.
Particularly if it is accompanied by symptoms such as unexplained weight loss, significant changes in appetite, breathlessness, heavy bleeding, ongoing digestive issues, fevers, night sweats, or changes in mood.
It can help to go to your appointment with a timeline of when your symptoms started and any other changes you have noticed. The more information you can provide, the easier it is for your healthcare team to piece the puzzle together.
Claire Turnbull is a registered nutritionist with an honours degree in dietetics, a wellbeing educator and author.
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