Understanding Fatigue: Why You're Tired and What to Do About It
by Dr. Grace Downs
One of the most common concerns that patients come to our clinic with is the feeling of fatigue. Fatigue is a persistent feeling of physical, mental, or emotional exhaustion that doesn’t go away with rest. It can feel like your body is made of lead, your brain is stuck in a fog, and even small tasks take a surprising amount of effort. Fatigue is often a symptom of something deeper going on in your body or mind—and it's incredibly common. Millions of people experience fatigue regularly, yet it’s often misunderstood, dismissed, or ignored.
Let’s dive into what might be causing persistent fatigue, how it impacts people’s lives, and what can be done to treat fatigue.
Common Causes of Fatigue
There are many different reasons why someone may be experiencing fatigue including
Poor sleep quality or sleep disorders
Mental/emotional stress including burnout, anxiety, and depression
Thyroid disorders
Hormone fluctuations including perimenopause and menopause
Autoimmune conditions like multiple sclerosis, rheumatoid arthritis, and lupus
Nutritional deficiencies
Chronic pain
Other chronic conditions including fibromyalgia and chronic fatigue syndrome (CFS/ME)
This is a short list, with many other causes of fatigue. Often, there are multiple contributing factors to explain why someone is experiencing fatigue.
The Daily Struggle
Living with chronic fatigue can feel like moving through life with an invisible weight strapped to your body. Everyday tasks—like showering, cooking, or walking up stairs—can feel monumental. Many people also experience unpredictable "crashes" where symptoms worsen after even minor activity.
The emotional toll is equally heavy. It’s hard to explain to others why you’re too tired to go out or why you're canceling plans again. Chronic fatigue is often invisible, which can lead to misunderstandings, frustration, and isolation.
So, you may be wondering, what can you do to start to improve your fatigue?
Foundations to Improve Energy
There is no one-size-fits-all treatment, but there are some foundational strategies that can help increase energy levels:
Improving Sleep Quality: While sleep doesn’t always fix chronic fatigue, good sleep hygiene (consistent bedtime, limiting screen time, creating a calming environment) can help and is foundational to improving overall sleep quality. No matter the cause of your fatigue, practicing good sleep hygiene is crucial to feeling better.
Consistent Movement: While sometimes intense exercise can make symptoms worse depending on what the cause of your fatigue is, physical exercises as tolerated can help to improve energy. Many different forms of movement can be helpful, and it is important to find the form of movement that feels the best and most supportive for each individual. For some people this can be high intensity interval training and for others it is light stretching. It is important to find what is best for you given overexertion can worsen symptoms.
Special mention for yoga: We have research to support the use of yoga to improve energy for people with chronic fatigue.
Nutrition and Hydration: Eating regular meals that are well balanced with protein, fiber and healthy fats are important to ensure that low blood sugar isn’t worsening fatigue. Staying well hydrated is also foundational to prevent dehydration and low blood pressure both of which can cause fatigue.
Emotional Support: Fatigue, especially chronic fatigue, often brings grief over lost routines and independence. Support from therapists, support groups, and understanding friends or family is invaluable.
Supplemental Support:
For many people with fatigue, it can be very challenging to start making some of those foundational changes mentioned above because they are truly too tired. In these cases some support through supplements, herbs, or medications can be used.
Vitamin D: Living in the Seattle area it can be very difficult to get enough vitamin D from the sunlight, and low vitamin D can contribute to frequent infections, anxiety, depression, and low energy. Being sure to get adequate amounts is important to support energy, mood, and immune function.
NAC: N-acetylcysteine is a naturally occurring amino acid that is helpful for production of a strong antioxidant in our body called glutathione. This has been used to treat fatigue related to long-COVID, and is one of my favorite supportive therapies for fatigue as well as brain fog that commonly accompanies chronic fatigue.
Herbal adaptogens: These are a group of herbs that help our body adapt to stress. Many times they help to regulate our stress hormone, cortisol, and by supporting this hormone pathway, it can help to increase energy. Some examples of these are Lion’s Mane, Eleuthero, Ashwaghanda, and Tulsi.
Final Thoughts
If you’re someone who lives with chronic fatigue, please know that your experience is valid and your fight is real. You are not lazy. You are not weak. It is not in your head. You are navigating a life that requires incredible resilience.
Fatigue affects many people and can be quite debilitating. Using these tools that were discussed in this blog can help to improve symptoms and overall quality of life, but it is important to be sure to find the cause of your fatigue. This can be done through completing lab work or through other evaluation tools. By finding what is causing your fatigue, we are able to treat it appropriately.
If you’re interested in getting support for your fatigue, please schedule a visit.
see you in clinic,
Dr. Downs
References:
Barlattani, T., Celenza, G., Cavatassi, A., Minutillo, F., Socci, V., Pinci, C., Santini, R., & Pacitti, F. (2025). Neuropsychiatric manifestations of covid-19 disease and post Covid Syndrome: The role of N-acetylcysteine and acetyl-l-carnitine. Current Neuropharmacology, 23(6), 686–704. https://doi.org/10.2174/011570159x343115241030094848
Oka, T., Tanahashi, T., Chijiwa, T., Lkhagvasuren, B., Sudo, N., & Oka, K. (2014). Isometric yoga improves the fatigue and pain of patients with chronic fatigue syndrome who are resistant to conventional therapy: a randomized, controlled trial. BioPsychoSocial medicine, 8(1), 27.
Roy S, Sherman A, Monari-Sparks MJ, Schweiker O, Hunter K. Correction of Low Vitamin D Improves Fatigue: Effect of Correction of Low Vitamin D in Fatigue Study (EViDiF Study). N Am J Med Sci. 2014 Aug;6(8):396-402. doi: 10.4103/1947-2714.139291. PMID: 25210673; PMCID: PMC4158648.