Chronic tiredness

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

shortens longevity.


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


  1. 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:, Email:

[email protected]


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