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The question

I am tired all the time, no matter how much sleep I get. What could be causing this?

The answer

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With increasingly busy and stressful work, personal and social lives - everyone experiences low energy or fatigue at times. While you may be getting what seems to be an adequate number of sleep hours, this is just one piece of the energy puzzle.

In general, fatigue is thought to be due to a combination of lifestyle and psychological/medical conditions.

To begin, consider evaluating if there is something in your lifestyle that may be contributing to your tiredness. Lifestyle factors such as dietary choices, sleep behaviors, excessive exercise and stress can all contribute to low energy. For example, while caffeine is a known stimulant - excessive intake can cause withdrawal and in turn cause fatigue.

In terms of diet, caloric intake should equal your energy requirements through a healthy balanced diet. Each individual's requirements vary depending on age, weight, level of fitness and level of activity. Along the same lines, excessive exercise can outstrip your energy stores and lead to fatigue.

While it may seem counter-intuitive to be active when energy is low - regular physical activity (30min/day) has been found to improve energy levels and improve sleep quality.

Finally, your sleep habits are also important to evaluate such as having a regular sleep schedule and getting sufficient hours of sleep. It is important to remember that while the amount of sleep you get may seem adequate - the quality of sleep is just as important to consider.

Certain medications, alcohol and caffeine can effect the depth and quality of sleep, so despite sleeping continuously - it may not be restorative.

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Fatigue can be the hallmark feature of psychological distress or mental health conditions. Along with low mood, low energy is one of the main features of mood conditions such as depression, anxiety and grief. If you are experiencing a change in mood, decreased concentration, increased anxiety or change in your interest to participate in activities you usually enjoy - one of these mental health conditions may be triggering your fatigue.

Also, persistently low energy may be due to a chronic medical condition. There is a wide range of potential conditions that may have fatigue as a key feature including: diabetes, heart disease, thyroid disorder, iron deficiency or anemia, lung disease, cancer, chronic fatigue syndrome and obesity.

Sleep disorders including sleep apnea and restless legs syndrome can effect sleep quality and lead to daytime sleepiness. If in addition to tiredness, you are experiencing alarm symptoms such as weight loss, fever or night sweats - I would strongly urge you to see your doctor to rule out a serious cause.

Send family doctor Sheila Wijayasinghe your questions at She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

Read more Q&As from Dr. Wijayasinghe.

Click here to see Q&As from all of our health experts.

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The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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