Always Tired? When Fatigue Is More Than Getting Older

By Dr. Gabriel Grabowski, specialist in internal medicine and pulmonology

I often see people in my practice who tell me, “I suppose I am just getting older.” They need a rest after ordinary activities, struggle to concentrate, or wake up feeling as though they have barely slept. Age can affect sleep and stamina, but persistent fatigue should not automatically be attributed to getting older.

Fatigue is a symptom, not a diagnosis. Sometimes it follows stress, an infection or disrupted sleep. In other cases, it may be linked to a condition that deserves assessment. My approach in internal medicine is to look at the whole picture rather than assume there is one explanation.

When tiredness deserves a closer look

An occasional tired day is different from exhaustion that continues, worsens or interferes with everyday life. It is worth arranging a medical appointment if fatigue lasts several weeks, has no clear explanation, or limits activities you previously managed comfortably.

I usually ask when the tiredness began, whether it changes during the day, and whether it means sleepiness, muscle weakness or a lack of energy. These distinctions help guide the assessment.

Useful details to note include:

• How long you sleep and whether you feel refreshed afterwards
• Snoring, night-time waking or daytime dozing
• Changes in weight, appetite, bowel habits or mood
• Breathlessness, palpitations, swelling or reduced exercise tolerance
• Medicines, supplements and alcohol use

Medication side effects, persistent pain, depression and other conditions can also contribute. Do not stop prescribed medicines yourself; bring an up-to-date list to your appointment.

Sleep apnoea: enough hours, but unrefreshing sleep

Obstructive sleep apnoea occurs when the upper airway repeatedly narrows or closes during sleep. Breathing is interrupted, and sleep becomes fragmented. People do not always remember waking, so they may believe they have slept well despite feeling exhausted the next day.

Loud snoring, witnessed pauses in breathing, waking with a gasp, morning headaches and daytime sleepiness are possible clues. Not everyone has all these symptoms, and sleep apnoea can occur in people who are not overweight.

As a pulmonologist, I pay particular attention to this pattern. Depending on the findings, an overnight breathing recording at home or a sleep laboratory assessment may be appropriate. Snoring alone does not establish the diagnosis.

If you are struggling to stay awake while driving, do not drive and seek prompt medical advice. This is an important safety issue, whatever the cause of the sleepiness.

Thyroid function and iron deficiency

An underactive thyroid can slow several bodily processes. Alongside fatigue, people may notice sensitivity to cold, constipation, dry skin or weight gain. An overactive thyroid can also cause exhaustion, sometimes with palpitations, sweating and weight loss. Symptoms alone cannot confirm either condition; blood tests help assess thyroid function.

Iron deficiency is another possible cause of reduced energy. Iron is needed to make haemoglobin, which carries oxygen in the blood. A deficiency may lead to anaemia, although symptoms can sometimes occur before anaemia develops.

Assessment may include a blood count and ferritin, a measure of iron stores. Results need interpretation in context because inflammation can affect ferritin levels.

The underlying cause matters. In adults over 50, unexplained iron deficiency should not simply be assumed to reflect diet. Depending on the circumstances, investigation for blood loss, including from the digestive tract, may be needed. I advise against taking iron supplements without assessment: they are not suitable for every cause of fatigue.

When the heart may be involved

Heart conditions can sometimes present as reduced stamina rather than obvious chest discomfort. Heart failure, rhythm disturbances or coronary artery disease may cause fatigue, particularly during exertion.

Clues include breathlessness during familiar activities, swollen ankles, palpitations or difficulty breathing when lying flat. These symptoms can have other causes too, so an examination is important before drawing conclusions.

Depending on the history and examination, tests may include an ECG, blood tests or an ultrasound of the heart. Not everyone with fatigue needs every test.

New chest pressure, severe breathlessness or fainting warrants urgent medical assessment. If symptoms are sudden or severe, contact emergency services rather than waiting for a routine appointment.

Taking the next step

I encourage patients to describe what has changed in practical terms: walking less far, needing more naps, or finding household tasks unusually tiring. A brief sleep and symptom diary can help. The aim is a focused assessment, not indiscriminate testing.

Regular sleep times, balanced meals and activity suited to your current capacity may support wellbeing, but they do not replace examining persistent symptoms.

Consultations are possible at the three practices in Nürnberg, La Cala de Mijas and Estepona. Persistent fatigue is a reasonable subject to bring to a medical appointment, rather than something you must accept as part of ageing.

This article is general information and does not replace a personal medical consultation.