Dear Therapist:

I am almost always tired. I get a decent night's sleep, around 7 hours, which is certainly more than most people I know. Still, I have these constant feelings of fatigue throughout the day. I go to the doctor regularly so it isn't like I have some health issue that is causing it. Can this be mental health related? I think I am doing ok and I certainly don't suffer from any serious mental health issues. I guess I am not the happiest at work and it can sometimes be a grind, but most everything else is going pretty well baruch Hashem. Any thoughts as to what can be causing this and what I can do to help it?

Response:

Occam's razor—or the principle of parsimony—basically states that the simplest solution is often the best one. You might wonder why Occam felt the need to state so obvious a fact. As complex individuals, we often tend to overthink things. This is especially so when we deal with something by which we are directly affected. This can make it difficult to think objectively.

There can be many causes for fatigue. Perhaps the most obvious is not getting enough sleep. Although you mentioned that you typically get seven hours of sleep, this may not be enough for you. Sure, many people function perfectly well on less, but the need for sleep is very individualized. Experts have stated that adults need at least seven hours of sleep per day. Note the words “at least.”

It seems that your first step would be to gradually increase your sleep time. Since any positive effect might not be immediate, you will want to remain at one number for a few nights, documenting your level of fatigue for each number. Once the positive effect no longer increases (for instance from eight-and-a-half hours to nine hours) you would know your optimal sleep time (in our example eight-and-a-half hours). There are other factors, so try and be alert to times when you might require a different amount of sleep.

If your sleep time proves not to be the answer, or not the entire answer, the next obvious solution is likely something medical in nature. This can range from something simple (like poor diet or not enough exercise) to something relatively easily treatable (like anemia or sleep apnea) to something more serious (like diabetes or kidney or heart disease). Getting a full physical examination (with EKG, bloodwork, etc.) will help you to identify or eliminate medically-related causes.

If sleep time and medical causes are ruled out, your next consideration might be psychological factors. Anxiety, depression, and other mental health issues can certainly cause fatigue. You mentioned that you are doing okay, and that you have no serious mental health issues. I appreciate your choice of words. Although you don’t suffer from any serious emotional issues, you recognize that we all have at least minor emotional issues.

Most everything exists on a spectrum. We are all on the “anxiety spectrum,” the “depression spectrum,” the “ADHD spectrum,” and many others. Since we all have features of many “disorders,” we are affected by these in various ways. Each person is affected differently. Some people feel fear when anxiety hits. Others may feel angry, while others might become sad. There are many different manifestations of our emotions, and the combinations are innumerable.

Generally speaking, the severity of the effects of our emotional issues can be expected to match the issues themselves. For example, if I am a very slightly anxious individual, I would expect to be affected by this very slightly. However, we all have many emotional issues (slight though they may be) and, as mentioned, we all react differently.

If your tendency is to feel tired as an effect of a few of these, they can combine to cause you to feel fatigued. Of course, this may be your unconscious mind’s way of avoiding what it deems more problematic effects (like sadness or fear). What the unconscious mind is not aware of (because of the very fact that it is not conscious) is that the “treatment” might be worse than the “disease.” A mental health professional may be able to help you identify ways in which your mind may be using defense mechanisms to avoid feeling that should actually be addressed.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro University

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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