Do not ignore fatigue

Sep 5 2007

Jennifer Sieck knew something had to be done when she would lie in bed most of the day and night.

“It would be a big deal and everyone would get excited if I'd come down to the living room and could sit there for 10 or 20 minutes,” the 38 year old says.

Sieck was more than just drowsy; she was fatigued, and no amount of sleep could shake her exhaustion. “It's not about being tired, it's about being in a state where you are not yourself,” she says.

Feelings like that are so prevalent that an estimated 20 to 30 percent of all primary care patients tell their physician that they feel fatigued, says Andrew Heyman, M.D., M.S., a fellow in integrative medicine in the Family Medicine Department at the University of Michigan Health System.

“Feeling fatigued is something people shouldn't ignore,” Heyman says. “When you feel fatigued and you do the normal activities – such as improving your diet, getting adequate sleep at night and reducing your stress – and you're still fatigued and can't do normal activities, then it's time to see your doctor.”

Many services are available for people experiencing fatigue. At the U-M Health System, for instance, the Sleep Disorders Center diagnoses and treats people who have problems with sleep or alertness. The Chronic Pain & Fatigue Research Center conducts studies on these conditions in order to help caregivers better diagnose and treat their patients. And the U-M Depression Center treats patients who experience fatigue as a symptom of depression.

In a primary care setting, Heyman and his colleagues in Integrative Family Medicine begin with a lengthy and comprehensive evaluation of a patient to diagnose what may be causing each individual's fatigue. They look at sleep problems, as well as adrenal function, the health of the person's digestive tract, stress and other factors that may contribute to the patient's fatigue.

“It was never about my disease,” Sieck says of her care at U-M's Integrative Family Medicine. She recalls that Heyman told her, “I want you to have your life back. I want to see sparkles in your eyes.”

Sieck's treatment included physical therapy, acupuncture, detoxifying baths and meditation. “Now, I might feel fatigued a little bit once in a while, but mostly I'm just tired from time to time. That's great, because I know that I can sleep and get up the next day feeling pretty normal.”

Sieck's fatigue was caused by Crohn's disease, a bowel disorder that is just one of many potential causes of fatigue.

Heyman notes that fatigue rarely stems from a single cause. “A lot of things happen that cause fatigue: our hormone levels change, our respiratory pattern changes, our heart rhythms change,” he says. “It occurs on all levels of the body, at the cellular level, the organ-system level, and can include psychiatric factors such as low energy from depression.”

Some causes of fatigue include, but are not limited to:

• Sleep disorders, such as insomnia and sleep apnea.
• Ongoing pain, including conditions such as fibromyalgia.
• An underactive thyroid, known as hypothyroidism.
• Use of alcohol, illegal drugs, or overuse of medications.
• Depression.
• Diseases such as mononucleosis, tuberculosis and AIDS.
• Malnutrition or eating disorders.
• Cancer.
• Congestive heart failure.
• Diabetes.
• Lupus and other autoimmune disorders.
• Chronic fatigue syndrome.

Possible treatments can include:

• Regularly getting enough sleep. Heyman says most people need about eight hours a night. In the 1940s and 1950s, he says, only about 15 percent of the population had less than seven hours of sleep a night; today, it is closer to 40 percent. U-M Integrative Family Medicine will offer acupuncture for treatment of fatigue in the near future.
• Avoiding caffeine, alcohol and drugs.
• Increases in exercise.
• Prescription medications that help to regulate one's sleep.
• Vitamin and mineral supplements.
• Meditation and breathing exercises.
• Acupuncture, which is showing promise as a treatment to alleviate fatigue.

Heyman notes that the needles used in acupuncture can have a stimulating effect on the body and can give people more energy.

• Physical therapy.
• Treatment of underlying conditions, such as talk therapy for depression.