But blood tests only go so far. “They show up normal in 90% of the cases we see in primary care,” says Adam, “which is why taking a comprehensive clinical history is key”.
“In healthy individuals, we look at contributing roles of things like exercise, sleep, diet, mental health. It’s really about looking at that individual and the factors that might be important to them,” says Adam. For instance, a person may have young children, which may make uninterrupted sleep a far-off luxury.
Stress, in particular, is a big contributor to fatigue. Tellingly, a 2022 study of more than 16,200 government employees in China found that those who experienced negative stressful life events at baseline were twice as likely to report feeling fatigued at follow-up.
When we’re stressed, our bodies produce a hormone called cortisol, which in turn raises our body temperature and heart rate to gear us up to face a threat. Cortisol levels fluctuate naturally throughout the day, but when they remain elevated, it’s harder to fall asleep and stay asleep. It’s that “tired but wired” feeling, says Whittemore.
Another really common cause of fatigue in otherwise healthy people is sleep disorders or breathing issues, says Blum.
This includes snoring, which occurs when one’s airway is partially or fully blocked. “All snoring is abnormal, and may be a sign of sleep apnoea,” he says, referring to the disorder that causes some sleepers to stop and start breathing repeatedly throughout the night.
All this can disrupt natural sleep patterns and make deep sleep elusive, says Blum. “So people get that seven to nine hours of sleep, but it’s insufficient quality.”
Dehydration is another major cause of fatigue. Other typical culprits include caffeine and alcohol. “I think most people underestimate how much they impact the quality of their sleep,” he says. “Caffeine, for instance, has a half-life of roughly five hours, which means even when you have a cup of coffee at noon, a quarter of that caffeine will remain at midnight.”
Alcohol, especially close to bedtime, can also negatively affect sleep quality in many ways: aggravating breathing problems, disrupting the circadian cycle, and blocking REM sleep. “Oftentimes you will fall asleep maybe a little faster during that first sleep cycle and get a little more deep-sleep,” explains Blum. “But after that, it just kind of bounces us around our lightest stage of sleep, causing more awakening and additional cortisol spikes overnight.”
At the end of the day, Bjørklund explains that the tips for boosting energy are mostly what our rational minds already know: “Embrace a balanced diet, address nutrient deficiencies, maintain good sleep hygiene, manage stress through techniques like mindfulness, engage in regular physical activity, ensure proper hydration, consider therapeutic interventional like cognitive behaviour therapy, and build a support network.”
Implementing those techniques, of course, is another matter entirely. It looks like a rework of my routine is in order.
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