Although fatigue affects about 25 per cent of the population, it can often be left untreated due to normal test results and no obvious cause
DO YOU wake up in the morning feeling as if you haven’t slept all night? Do you then drag yourself through the day, trying as best you can to carry out your normal work or household/childcare duties? Has this been a pattern of your life for some time?
If so, you are likely to be suffering from fatigue, a complex problem that, according to Dr Joe Fitzgibbon, affects about 25 per cent of the population to some degree.
Fitzgibbon, author of Feeling Tired All The Time (Newleaf), says fatigue is complex for three reasons. “There are no physical signs of illness, only a dreadful feeling. Fatigue may accompany virtually any disease state and there are no laboratory tests that can diagnose or measure fatigue and, in the vast majority of cases, all the investigations are normal.”
For these reasons, fatigue can often confound doctors leaving them helpless in the absence of a diagnosis or course of treatment. However, Fitzgibbon, who runs clinics in Galway and Dublin and colleagues such as Dr Brendan Fitzpatrick in the Slievemore Clinic in Stillorgan, Co Dublin, believes there is a range of treatments for sufferers of fatigue – once specific medical conditions are first ruled out.
The medical conditions that doctors will first investigate in someone who is fatigued include anaemia, diabetes, thyroid disorders, and kidney and liver disease. The most common physical explanations for fatigue are low blood count and disorders of the thyroid gland.
“Once the GP is reassured that there is no significant medical disease, the patient is still left with the problem. The tests are important but you don’t stop there. I’ve met a number of patients who are told they are fine but they know that their quality of life isn’t good,” says Fitzpatrick, who recommends a variety of treatments which include exercise, relaxation, nutritional supplements and/or acupuncture.
“A large number of people overdose on caffeine and a significant minority of them are sensitive to it so I suggest sufferers of fatigue cut down on caffeine gradually. Sugar and yeast sensitivities are other reasons for fatigue,” says Fitzpatrick.
In his book, Tired All The Time, Fitzgibbon gives a comprehensive picture of the common psychological and physical causes of fatigue and then goes on to look at what he calls the forgotten causes of fatigue – sleep and dietary problems.
He questions whether stress and depression are the cause of the fatigue or the result of it. “Are you depressed because you are fatigued or are you fatigued because underneath it all, you are really depressed?” he asks.
Fitzgibbon also suggests that sufferers of fatigue take what he calls a sleep and/or chemical holiday to see if sleep deprivation or chemical sensitivity is a causal factor in their fatigue. He suggests that people can catch up on their sleep debt within a few days although it may take up to six weeks to fully recover from sleep deprivation.
“We now have an epidemic of sleep deprivation with up to 65 per cent of adults admitting that they don’t get enough sleep,” he says. He says not getting enough sleep or exercise and working too long and too hard are contributing to levels of so-called “community fatigue”.
For those who may be suffering from a chemical sensitivity, Fitzgibbon recommends avoidance of all chemical smells. This will involve creating a chemical-free home with the help of other household members.
Fibromyalgia and Chronic Fatigue Syndrome (CFS) are the conditions that are most associated with a profound and chronic feeling of fatigue. Although the symptoms of these conditions overlap significantly, Fitzgibbon says there are distinct entities. “The dominant symptom of fibromyalgia is pain whereas in CFS, it is fatigue. Fibromyalgia patients will say, get rid of my pain. I can live with the fatigue. CFS patients will say, get rid of my fatigue, I can live with the pain,” he says.
Fitzgibbon suggests a 10- point management plan for those suffering from fatigue. These points include getting a diagnosis, talking about your fears, beliefs, frustrations and expectations, establishing a consistent pattern of sleep, rest and activity, starting a graded exercise programme and treating depression, anxiety and any other medical problems.
“Approximately 11 per cent of those who suffer from fatigue will have CFS and about 70 per cent will have anxiety or depression,” explains Fitzgibbon. In terms of managing severe fatigue, I believe cognitive behaviour therapy and graded exercise therapy are very helpful. People do get better and go on to lead fully functioning lives again. When you are treating patients with fatigue, you have to think about their problem and spend time with them. It’s about active management of the problem which draws more on the art of medicine than the science of medicine.”
