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Understanding the many facets of fatigue

Fatigue is the commonest complaint in medicine.  It is the end result of all diseases and the least specific of all symptoms.  Its presence means that our bodies’ energy reserves are depleted and that we are in a state of energy debt.

Common Fatigue

Type 1, which occurs after overwork or overload and recovers after rest is the consequence of temporary energy debt that is caused by mental or physical exhaustion.  Type 2, which comes when we fall ill and does not resolve with rest, usually resolves after we recover from our illness and are able to pay back all our energy debts.  Type 3, is when we do not recover from our illness because the illness is not curable.  This type of fatigue will continue as a manifestation of our illness as long as we remain ill.  Type 4, comes usually after an acute illness but does not recover after the illness resolves.  When no physical causes can be found, and when the fatigue persists over time, it becomes knows as the Chronic Fatigue Syndrome.

Consequential Fatigue 

Addiction fatigues are consequences of certain common addictions such as tobacco, alcohol, and drugs.  Those addicted to such substances are always lacking in energy and motivation. Obesity fatigues are usually proportional to the degree of overweight.  Sedentary fatigues are caused by lack of exercise and poor physical fitness.

Mental Fatigue 

Depression is the commonest cause of mental fatigue.  Those who suffer from depression may be very fit physically but feel as tired as if they had walked many miles.  Under-stimulation, boredom, and loneliness also cause us to feel tired even though our bodies may be sound.  Having no loves, or passions, or worthy goals is equally devastating to our energy reserves, which are enriched by struggle and diminished by passivity.

Respiratory Fatigue 

Lung diseases such as asthma and emphysema, if they become severe and poorly responsive to treatment, lead to chronic exhaustion.  By reducing oxygen and increasing the effort to breathe, they severely limit physical activity and reduce life’s quality.

Cardiac Fatigue 

Subtle cardiac problems such as silent coronary artery disease, defective heart valves, or mild heart failure are the commonest causes.  The slightest amount of exertion causes major exhaustion, which takes a long time to recover.

Sleep Apnea Fatigue

This is a very common and devastating disorder that may be superimposed on all other types of fatigue.  Its incidence increases with age and with weight both of which cause our upper airways to collapse during sleep.  The collapse occurs during inspiration and temporarily shuts off the airways.  Patients snore loudly, stop breathing for a while, and then gasp for air as if they were drowning. These episodes of oxygen deprivation and increased work of breathing go on throughout the night causing the patient to wake up exhausted and to feel sleepy all day long.  Memory dysfunctions, irritability, headaches, poor concentration, high blood pressure, heart attacks, sudden cardiac death, and resistant depression are among the many serious consequences of Sleep Apnea.

Because we are living longer and becoming fatter with time, more and more of us are developing Sleep Apnea.  The number of people who have this disease has become so huge and its impact on our lives has become so devastating that screening for it is now mandatory.  A simple questionnaire, The Epworth Sleepiness Scale, can identify the suspects and direct them to a sleep laboratory where an overnight sleep study can be preformed confirming the diagnosis.  The treatment is a mask called the C-PAP, which prevents airway collapse by supplying air under pressure.  Regardless of age or weight, everyone who wakes up un-refreshed and remains sleepy and tired by day should take this simple test and whoever scores 10 or more should have a sleep study.

The Epworth Sleepiness Scale

How likely are you to doze off or fall asleep in the following situations?  Use the following scale for each situation and then calculate your total score: (0 = would never doze, 1 = slight chance of dozing, 2 = moderate chance of dosing, 3 = high chance of dozing.)

Activity                                                  Chance of Dozing

Sitting and Reading                                             ___

Watching TV                                                      ___

Sitting inactive in meeting, theater, etc.                ___

Passenger in a car longer than one hour               ___

Reclining in the afternoon to rest                         ___

Sitting and talking to someone                             ___

Sitting quietly after lunch (no alcohol)                   ___

Passenger in a car stopped in traffic                     ___

2009 - ISSUE 89