am i dying

Why Am I Always Tired?

I constantly feel like I’m dragging. Should I get tested for anemia?

You may feel like the walking dead, but before you assume that you have a medical condition or a vitamin deficiency, take a good, hard look at your lifestyle, says Shanna Levine, M.D., instructor of internal medicine at the Icahn School of Medicine at Mount Sinai.

Chiefly, how are you sleeping? Are you getting at least seven hours of quality shut-eye every night? If you’re not, your doctor could help you figure out why. It could be that you’re bad at so-called sleep hygiene, like going to the bed around the same time, avoiding things like food, caffeine, nicotine, and alcohol before bed, getting regular exercise, and reserving your mattress for sleep and sex.

If you do have saintly sleep habits but your partner or family members say that you snore, that’s worth bringing up to your doctor, too. It’s possible that you have a condition called sleep apnea, which makes you stop breathing periodically, Dr. Levine says.

Unfortunately, there are lots and lots of other conditions and habits that can make people exhausted. For instance, depression, anxiety, and stress can manifest as fatigue, she says, but even starting a new medication or supplement or changing your diet could do it, too.

If you’re not eating enough iron-containing foods (like meat, beans, dark, leafy greens, or fortified products) you could feel drained. Iron deficiency on its own could cause fatigue but it can also lead to anemia, or low red-blood cell count. Insufficient amounts of vitamin D could also contribute to tiredness so people who don’t eat fatty fish, egg yolks, or fortified products might be at risk there. (Speaking of food, if you’re tired and also having unpleasant GI symptoms, they could be related. Your doctor can screen you for celiac and Crohn’s disease.)

But there’s something even more basic you could be deficient in: water. Yes, even dehydration can make you feel tired, she says. “I really push on my patients that they should be getting anywhere from 2.5 to 3.5 liters of water depending on their size,” she says. “Really, the only way to do that is by carrying it with you.”

Women face unique circumstances here, and not just because fighting the patriarchy is exhausting. The most common cause of anemia in women is either heavy periods or other gynecologic problems like fibroids, she says. Your blood cells ferry around energy-giving oxygen, and if you’re losing blood, it’s only natural that you’ll feel tired.

“A lot of women have heavy enough periods that they’re never able to recuperate, so they will feel chronically fatigued,” Dr. Levine says. If being able to wear a tampon for eight hours sounds like a miraculous feat to you, you might want to get your iron levels and red-blood count checked. (Don’t discount the possibility that you’re pregnant, as women are notoriously exhausted in the first trimester. If you’re suddenly wiped and literally nothing else has changed, it might be worth buying a pee stick or three.)

Overall, Dr. Levine says she’s a big supporter of eating less packaged food in favor of more fresh stuff and exercising three to five times a week. You may not want to hear this, but working out can improve sleep quality, which is just as important as how much time you spend in bed. Yes, it’s a bit paradoxical that tiring yourself out could give you more energy, but it’s true. Not only can it help you sleep, but “exercise in and of itself releases natural endorphins, like a natural feel-good drug,” which help boost your energy levels. In terms of quality of life, “I don’t know anyone who starts exercising and feels worse,” she says.

With a tired patient, Dr. Levine would start out by talking about diet, exercise, and sleep. Only if they’re lacking in those areas does she look for bigger problems. “If, despite doing lifestyle modification, they can’t seem to get their energy levels back, I’ll do a more thorough review and that’s when we check for the deficiencies.”

So the solution here might be very simple — but very annoying.

Why Am I Always Tired?