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Ask Dr. Henry

Ask Dr. Henry by Henry Hochberg, M.D.
Questions and answers on health, wellness, and the doctor-patient relationship.

   Q: Although I am in good health, I am tired all the time. I wake up tired. Most of my free time seems to be spent napping. I know this can't be normal, but my doctor can't find anything wrong with me and is suggesting it's all in my head. Can you help?

   A: I'd have to know more about your specific situation to help you pinpoint the factors contributing to your fatigue, but there are many generalities that might apply.
   There are a great number of physical and mental/emotional situations that can lead to extreme fatigue. The most common ones I see include persistent sleep disturbances; nutritional deficiencies; physical deconditioning; excessive physical activity; hormonal deficiency or imbalance (thyroid, adrenal, ovaries); use of stimulants such as coffee, nicotine, sugar, street drugs, and some pharmaceuticals; allergies; depression; anxiety; fear ... Well, the list is really quite long.
   There are also less common, though serious, causes which I presume your physician has investigated.
   If you are waking up tired, I would first investigate the quality of your sleep. You might be unaware that you are waking up during the night, which can prevent you from reaching the deepest restorative levels of sleep. If you have a lot of things on your mind, you may have trouble falling asleep, or you may fall into a restless sleep. This is one reason I don't recommend watching the 11 p.m. news if you're going to go to sleep at 11:30.
   Look carefully at your use of stimulants at any time after dinner. If you're someone who's very sensitive to caffeine, your use of it any time during the day might affect your sleep.
   Depression can make a person extremely fatigued, and extreme fatigue can make a person depressed. It is useful to sort out what role this may play in your situation.
   I wouldn't recommend the use of sleeping aids, natural or otherwise, without knowing more about your situation. Be assured, though, that many of them exist and can be used safely if really needed.
   Most importantly, don't give up hope that a solution can be found. The body never does anything without a reason. The challenge is to find the reasons for things that are happening and deal with them properly.
   If you are not getting sufficient help from your physician, get another opinion, or look into an alternative. A nutritional analysis would be helpful. Acupuncture and deep relaxation techniques are also extremely useful for helping the body in low energy states.

Henry Hochberg, M.D., is a board certified family physician with a special interest in wellness and natural approaches to health care. Send your health and medical questions to: Ask Dr. Henry, c/o Woodinville Weekly; P.O. Box 587; Woodinville, WA 98072; or e-mail to