Feeling tired most of the time? Chronic fatigue is very common. Of the
327.18 million Americans, about 10.1 percent of men and about 15.3 percent of
women have chronic fatigue. Of the 7.62 billion people around the globe,
between 17-24 million are afflicted with Chronic Fatigue Syndrome (CFS).
Dozing off while reading or watching the television, having no pep all the
time are all signs of chronic fatigue syndrome. Each month, about 1 in 25 drivers
become drowsy or fall asleep while at the wheels, causing around 72,000
crashes and 44,000 injuries every year.
Occasionally, each of us experiences tiredness, especially after staying
out late at night, or doing chores overtime and not getting enough sleep the night
before. This is understandable, common, and temporary.
However, if the sense of tiredness happens almost all the time during our
wakeful hours, which negatively impacts our concentration, attitude, and
performance, and health, then it is chronic fatigue syndrome, which needs
medical attention. Impairment of sleep increases our risks for accidents and the
development of high blood pressure, depression, obesity, heart attack, stroke,
and other illnesses, including Alzheimer’s and cancer. Sleep deprivation also
Causes of CFS
When we feel tired, drained, and lousy most of the time and we do not
know what is causing the problem, here are some possible culprits to consider:
Sleep deprivation – it is reported that about 33 percent of adults in the
United States are not getting enough sleep. Individuals between 18 and 60, need
at between 7 to 9 hours of sleep a day. Majority of seniors need between 6 to 7
hours a day to function properly. Inability to sleep well could be due to
psychologic or emotional stress, frequently ingesting stimulants like coffee, tea,
cola and energy drinks, or drugs (uppers), etc., habitually watching exciting TV
shows before going to bed, or undiagnosed (untreated) obstructive sleep apnea
(OSA). Lack of sleep is the commonest cause of chronically feeling tired.
Lack of exercise – While physical exercise could make one feel tired, the
experience is temporary after resting, and believe it or not, lack of exercise is an
important factor in Chronic Fatigue Syndrome. Regular exercise reduces the risk
for the development of CFS. Moving around and being active daily re-energize
- A 30-minute walk (brisk walking, if tolerated) at least 5 days a week goes a
long way in boosting our energy and our immune system, and at the same time
reduce our risks for most illnesses, including cancer.
Unhealthy diet – For health in general, reducing carbohydrates (especially
rice) benefits the body in more ways than one. A low carbs diet helps reduce our
risk for diabetes and cardiovascular illness, and also in maintaining healthy body
weight. Besides bread, sweets are to be avoided, except occasionally. For a
nutritional and healthy diet, fill half of your plate with vegetables, and the other
half, with fish (omega 3-rich), or chicken, or lean meat. The less saturated fat, the
better. Protein, even from legumes, is healthy. Fruits (especially berries), nuts
(walnuts, almonds), oat meal, flaxseed, whole grain, and a little dairy are
recommended additions. Like vegetables, these are anti-inflammatory and anti-
oxidant foods items. Naturally, total caloric intake daily is fundamental. Adjust this
depending on your desired weight.
Overwhelming Stress – Emotional and psychological stress, when
unmanaged or unresolved, could lead to CFS. Whether personal, marriage,
social, or financial situation in life is causing the stress, it takes a great toll on
health in general, besides contributing to chronic fatigue.
Illnesses – Any medical condition could lead to longstanding sense of
tiredness. When the body’s homeostasis is imbalance due to the presence of an
illness fatigues ensues. Some of the illnesses are metabolic, like hypothyroidism,
diabetes mellitus, depression, panic disorder, anemia, cardiovascular illnesses,
hormonal issues, and deficiency in any vitamin or mineral, etc.
Management of CFS
Successful resolution of any problem starts with accurate diagnosis
(knowing and defining the condition and its cause).
A significant part in managing chronic tiredness is initial self-analysis and
self-diagnosis, followed by timely medical consultation. Acknowledging the
problem with objectivity and honesty helps the attending physician a lot in
expediting a diagnosis and formulating treatment. It is best not to delay medical
care for chronic tiredness or any medical condition.
For sleep deprivation, one could start with behavioral modification, like
staying away from alcohol and tobacco and the stimulants listed above (coffee,
tea, cola and energy drinks, etc.), not watching television, or having arguments,
before going to bed. Developing a regular sleep schedule helps the brain provide
you better sleep. Not taking a nap also helps. The bedroom should be quiet, dark
(minus lights from electronic devices and other sources), with comfortable
temperature/humidity, bed and pillows. Temporarily shelving all “problems”
during the day, and going to bed with a peaceful mind tremendously aids in
having a good sleep.
A regular routine medical check-up every 6 months or once a year could
provide one a good assessment of his/her health status, and detect any situation
that could cause future health problems. Prevention is essential, and early
diagnosis leads to better management and outcomes.
Obstructive Sleep Apnea
One of the commonest causes of sleep deprivation is Obstructive Sleep
Apnea (OSA). Although signs and symptoms of this condition was described over
2000 years ago and unnamed then, it was in the 1950s and 60s when the
research on this condition started in earnest. It was in the 1970s when scientists
really delved into its nature, causes, and treatment. The condition is seen
especially among snorers and obese individuals, but many non-snorers and
normal-weight individuals have also been found to have OSA.
Those with OSA often hold their breath for an extended period of time
while they are asleep, thus suffocating to some degree and lowering the oxygen
level in their blood, and depriving vital organs of oxygen, and waking up suddenly
gasping for breath. The cause is the collapsing flimsy tissues in the back of the
throat, blocking the airway passage. This “breath-holding-suffocation” could
happen several dozen episodes a night. The bed partner usually notices the
disturbing events and loses sleep too. Chronic, untreated OSA increases the risk
for diabetes, high blood pressure, heart attack, stroke, Alzheimer’s and even
cancer. Untreated OSA has been known to cause heart attack and deaths.
Following a Sleep Study, which confirms the presence of OSA, CPAP is
started. It is a heaven-sent device.
The CPAP system includes a facial mask or a more comfortable nasal
pillow worn during sleep, with a temperature sensing tubing connected to a small
bedside machine (with a humidifier) that pushes ambient air at a pre-determined
pressure to open up the airway passages in the back of the throat and provide
good air-oxygen flow to the lungs, and to all tissues in the body. Besides
resulting in a restful sleep, it also stops the snoring and gasping for breath, and
using CPAP also allows the bedpartner to have a restful sleep. CPAP is the best
state-of-the-art, evidence-based, management for Obstructive Sleep Apnea.
Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and
Las Vegas, Nevada, is a medical lecturer/author, and Chairman of the Filipino United Network-USA, a
501(c)3 humanitarian foundation in the United States. Websites: FUN8888.com, philipSchua.com Email:
Visit philipSchua.com Email: [email protected]