Why am I always tired? Causes in men

You are getting enough sleep. You are still tired.

That gap is the frustrating part. It is also the part that is worth taking to a doctor, because constant tiredness is a symptom with a long list of causes and most of them are checkable.

Here is what sits on that list.

The short version

• Tiredness lasting more than a few weeks is worth investigating rather than pushing through.
• Sleep apnoea is common in Australian men and often goes undiagnosed.
• Low iron in men always warrants a look for the cause, not just a supplement.
• Thyroid function, blood glucose, mood and medications all belong on the list.
• Most causes are found through a conversation and a blood panel your doctor selects.

Why am I always tired?

Constant tiredness is a symptom, not a diagnosis. It has many possible causes, and more than one can be true at once. The most common groups are sleep quality, nutritional and metabolic factors, mood, medications and other medical conditions. Working out which applies to you takes a history, an examination and usually blood tests chosen to fit your picture.

Sleep that is not doing its job

Hours in bed and quality of sleep are different measurements.

Obstructive sleep apnoea is the one worth knowing about. The airway partly closes during sleep, breathing pauses, and you surface briefly without remembering it. The result is a night that looks like eight hours and functions like five.

It is common in Australian men. A Sleep Health Foundation national survey found 12.9% of men reported a diagnosis of obstructive sleep apnoea, compared with 3.7% of women. The Australian Longitudinal Study on Male Health found self-reported diagnosis climbed from 2.2% of men aged 18 to 25 to 7.8% of men aged 45 to 55. Research also suggests a large share of cases are never diagnosed at all.

Signs a partner often notices before you do: loud snoring, pauses in breathing, gasping, and restless sleep. Signs you notice: waking unrefreshed, morning headaches, and falling asleep in the afternoon. Our guide to sleep apnoea symptoms in men goes through it properly.

Shift work, alcohol close to bedtime, and untreated insomnia belong in this group too.

Low iron

Iron deficiency causes tiredness, breathlessness on exertion, poor concentration, restless legs and brittle nails.

There is an important difference between men and women here. In men, iron deficiency is not usually explained by diet alone. Australian clinical guidance is that men with iron deficiency should be assessed for a source of blood loss in the stomach or bowel, because that is the most important cause in this group.

So the useful response to a low iron result in a man is an investigation, not a supplement bought off the shelf. Our guide to low iron and fatigue in men covers what that involves.

Thyroid, glucose and other medical causes

Several conditions present first as tiredness.

• An underactive thyroid slows things down and often brings weight change, cold intolerance and low mood with it.
• High blood glucose can cause tiredness, thirst and frequent urination, and is checked with a blood test.
• Coeliac disease affects absorption and is commonly checked alongside iron studies.
• Kidney and liver conditions, infections, and inflammatory conditions all sit on the list.
• Vitamin B12 deficiency affects energy and concentration.

None of these are diagnosed from symptoms. They are diagnosed from tests your doctor chooses based on what you describe.

Mood, stress and the feedback loop

Low mood and anxiety very commonly present as physical tiredness. That is not the same as the tiredness being imagined.

Sustained stress affects sleep, appetite, activity and motivation, and each of those feeds back into energy. The loop is genuine and it is treatable. It also does not rule out a physical cause running alongside it, which is why both get considered together.

If low mood or anxiety is part of your picture, please raise it with your GP or a mental health professional. If you are in crisis, call 000, or Lifeline on 13 11 14.

Medications and alcohol

A long list of common medications cause tiredness as a side effect, including some blood pressure medicines, antihistamines, and medicines that affect sleep or mood.

Alcohol is worth its own mention. It shortens the time it takes to fall asleep and then fragments the second half of the night, so a few drinks can produce a full night in bed and a poor night of sleep.

Bring a full list of what you take, including anything bought over the counter, to your appointment.

When to see a doctor about tiredness

Book an appointment if tiredness has lasted more than a few weeks, is getting worse, or is affecting your work, your relationships or your driving.

See a doctor promptly if tiredness comes with any of these:

• Unexplained weight loss
• Breathlessness or chest pain
• Fevers or night sweats
• Any bleeding, including blood in your stool
• Falling asleep during the day in situations where you should be alert

What an assessment looks at

A useful assessment starts with the history. When did it start, how does it change through the day, how is your sleep, what else has changed.

From there your doctor decides which tests fit. Commonly considered: a full blood count, iron studies including ferritin, thyroid function, blood glucose or HbA1c, kidney and liver function, and vitamin B12. What gets ordered depends on you.

Sometimes the answer is one clear finding. Often it is two or three smaller things adding up. Both are worth knowing.

If deemed medically appropriate, a doctor may recommend a treatment plan. Treatment is one possible outcome. Advice, monitoring, referral, further investigation or no treatment are others. Individual results vary based on your unique biology. Assessment findings do not guarantee a particular outcome.

Where to go from here

If your sleep is the part that sounds wrong, start with sleep apnoea symptoms in men.

You know how you feel. Our job is to help you understand why, and what your options are. We have been looking after Australian men since 2010.

Book a free consultation and talk it through with us first.

Sources

• Healthdirect, “Fatigue”: healthdirect.gov.au
• Healthdirect, “Iron deficiency”: healthdirect.gov.au
• “Sleep apnoea in Australian men: disease burden, co-morbidities and correlates from the Australian Longitudinal Study on Male Health”, BMC Public Health 2016: pmc.ncbi.nlm.nih.gov
• Better Health Channel, “Sleep apnoea”: betterhealth.vic.gov.au

Common questions

Why am I tired all the time even when I sleep enough?

Time in bed and quality of sleep are different things. Broken or non-restorative sleep can leave you tired after eight hours. Sleep apnoea is one common reason, and it often goes unnoticed. Other causes include low iron, thyroid problems, low mood, medication effects and ongoing stress.

When should I see a doctor about tiredness?

Book an appointment if tiredness has lasted more than a few weeks, is getting worse, is affecting your work or driving, or comes with other symptoms. See a doctor promptly for unexplained weight loss, breathlessness, chest pain, fevers, night sweats or any bleeding.

What blood tests are done for fatigue?

It depends on your history and examination. Doctors commonly consider a full blood count, iron studies including ferritin, thyroid function, blood glucose or HbA1c, kidney and liver function, and vitamin B12. Your doctor decides which tests are relevant to you.

Can stress make you physically tired?

Yes. Sustained stress affects sleep quality, appetite, activity and mood, and all of those feed back into how tired you feel. Low mood and anxiety commonly present as physical tiredness. That does not make the tiredness imagined, and it does not rule out a physical cause.

Is it normal to feel more tired as you get older?

Some change in energy and sleep pattern with age is common. A clear drop from how you used to feel, especially over months rather than years, is worth checking rather than accepting. Age is a reason to look more carefully, not a reason to stop looking.