UK and Spain

Tiredness and fatigue - combatting that tired-all-the-time feeling can be a difficult task sometimes. All of us go through periods in our lives when we are always tired. We lose our zest for life, have no energy and are easily fatigued. We are tired when we wake up in the morning. It is hard to concentrate on daily tasks and to maintain interest in loved ones, friends and leisure activities plus, we often become exceptionally irritable. For some people, this unhappy state of affairs becomes a chronic, permanent condition. It may become overwhelming, leading to debilitating despair.

Doctors sometimes call it the TATT (tired-all-the-time) syndrome. Chronic tiredness is one of the most common reasons for a visit to a general practitioner or alternative therapist. It's also one of the most difficult to treat, because many factors can be involved in the condition, and both doctors and therapists find that the best results come from a truly holistic system of treatment - one in which the physical, psychological, spiritual and emotional facets of the sufferer and their lifestyle are considered.

Diagnosing the cause of tiredness - a full case history will include details of the patient's past, particularly information about any recent traumas, such as a death in the family, the loss of a job, or a divorce. The practitioner will want to know if the tiredness occurs in bouts, and whether these can be related to any traumas or periods of 'feeling low'.

Physical aspects of the tiredness are also important. The practitioner will investigate the patient's diet, for one high in sugar can lead to hypoglycaemia, which could be the cause of the tiredness. Similarly, a lack of iron can lead to anaemia, one of the symptoms of anaemia is tiredness, and which in women can also be caused by heavy periods.

Chronic tiredness can also be a symptom of premenstrual tension or the menopause, both of which are associated with hormonal imbalances. Some women experience a 'new lease of life' when put on hormone replacement therapy. Other hormonal imbalances may be involved - for instance, hypothyroidism, in which the thyroid gland produces too little thyroid hormone or Addison's disease, in which the body has too little adrenal hormone. These are rare conditions, but are easily treated.

On the other hand, myalgic encaphalomyelitis (ME) is difficult both to diagnose and to treat. Besides prolonged tiredness, patients also suffer from extreme exhaustion and muscle aches and pains, particularly after physical exertion. However, recent research has shown that a virus may be implicated in ME, and that information should at least aid diagnosis.

It has been estimated that in the UK some 10-15 per cent of the population suffer from hyperventilation, in which there is shallow, rapid chest-breathing. This leads to chemical changes in the blood - and chronic tiredness. This condition is also difficult to diagnose, but the remedy is simple - patients are retrained to breathe more slowly and deeply. Hyperventilation is often a symptom of stress, and sufferers also need help with overcoming their personal problems.

In fact, doctors and therapists all recognise that one of the main causes of chronic tiredness is not a physical condition at all, but personal problems - often problems that the patient cannot face and has 'hidden'. Once physical causes have been eliminated, practitioners help patients to explore their personal lives, in order to uncover the cause.

For example, some people have unrealistic expectations of themselves - either too high or too low. Such people are often described as 'neurotic' or 'negative affective', and cognitive therapy has been found to be helpful in such cases, for it teaches patients positive thinking.

Unexpressed grief can also result in chronic tiredness. In such cases, people fail to mourn properly after a loss. This can be the loss of a loved one, or even a part of themselves - in the case of a woman, a breast or an unborn child; or in a man, impotence. Grief over the loss of a job or a home can also be a cause.

Unexpressed anger often has the same effects as unexpressed grief. Many people are trapped in an intolerable life situation, and bottle up their rage. This repression uses up much of their energy, and they have little left for other things. Women are particularly prone to this condition. Many are trapped in a marriage or job where they are unable to make full use of their abilities, or their skills are not recognised. A partner may completely dominate them or fail to recognise their need to express their feelings.

In such situations, women lose their self-confidence and become prone to depression, of which tiredness can be a symptom. Eventually they may become dependent on tranquillisers and sleeping pills. Assertiveness training will probably be able to help such patients. Women's groups are often of benefit too, for they help sufferers to talk through their problems and feelings, and to think more positively about themselves and their situation.

Today, many people face unemployment, money problems and poor, overcrowded living conditions. For example, a young family may have to share a home with their in-laws. These situations all put a strain on individuals, and they can all lead to depression. This may manifest itself as chronic tiredness, and in such cases the practitioner needs a great deal of skill to get to the heart of the matter.

The same is true of another condition in which sufferers have lost their faith or sense of purpose in life. They may be perfectly healthy, yet they feel that something is missing. Their life becomes empty of meaning, and chronic tiredness results. This frequently leads them to consult some type of therapist. Chronic tiredness can, in itself, be both debilitating and a cause of worry - which in turn aggravates the condition. Great patience and effort on the part of both practitioner and sufferer are needed to find an effective cure.

Self help for tiredness and fatigue - ensure that you have adequate sleep (see the section on sleep, including insomnia from the link for the sleep page further down below) and, if possible, practise relaxation and breathing exercises. Learn to express your feelings - to let go - and not keep them bottled up. Take sufficient exercise.
Make sure that you eat a well-balanced diet (see the Healthy Diet link further below), with regular meals. Light, high-protein snacks between meals will probably help you to combat the tiredness. Cut down on sugar and avoid stimulants such as caffeine (in coffee, tea and cola drinks).

Make sure that your intake of minerals and vitamins is adequate - zinc, magnesium, potassium, vitamin C and folic acid are particularly important. To make sure, eat extra low-fat dairy products, yeast extracts, wheat germ, fresh and dried fruit, dark green leafy vegetables and soya products. Alternatively, take a proprietary general vitamin and mineral supplement for a month, preferably one including iron. Avoid heavy or stodgy meals at midday, and never eat less than three hours before bedtime.

Some people experience chronic tiredness as a result of boredom. This is very often the case among those who retire from an active, totally absorbing and/or rewarding job. So, take up a new interest or hobby, or rekindle your interest in one that you know you have enjoyed in the past.

Massage - when the tiredness is only temporary, and not a symptom of a medical condition or the companion of muscular fatigue or exhaustion, then a brisk, light tonic, general massage is often the answer, and the means of sparking some new life into the various body systems.

A really vitalising massage could consist of rapid strokes in the direction of the venous return (towards the heart), working up the legs and arms, and over the entire back, from the lumbar to shoulder area. This is followed by stimulating wringing and squeezing techniques, all made at a brisk pace.

Aromotherapy - if the tiredness is due to a physical cause, then try stimulating essential oils, such as black pepper, lemon, lemon grass and rosemary. Either inhale from a tissue, or put six to ten drops into a bath, and stay in the water for ten minutes. For mental exhaustion, use clary sage, savory or rosemary in the same ways.

For tiredness due to ME or postviral symptoms, regular use of essential oils of geranium, thyme, lemon or sage is recommended. Inhale them from a tissue or put them in a bath as above. Alternatively, make a tea by putting two or three drops of oil on a tea bag, and infusing in 1 pint (600ml) of boiling water; stir, remove the tea bag, and drink without milk as needed. Keep the surplus in the fridge, and reheat as required.

Herbal teas - warm camumile tea, drunk a few minutes before sleep has been known to work really well.

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