Health Matters: Always Tired? Don’t Blame It on Age Just Yet

There is tired.

And then there is tired.

I’m talking about the sort of tiredness where you wake up in the morning and already feel as though you could go back to bed.

You get through breakfast.

You make a cup of coffee.

You tell yourself you’ll feel better later.

But later comes and you’re still exhausted.

By the afternoon you’re struggling to concentrate, and by evening you’ve got absolutely nothing left in the tank.

Then someone says:

“It’s probably your age.”

Perhaps.

But perhaps not.

This is something I have come across many times in pharmacy. People often accept persistent tiredness as an inevitable part of getting older when, in some cases, it is the first clue that something else needs looking at.

Being tired isn’t always the same as fatigue

We all get tired.

A late night, stressful week, long journey or particularly hard day can leave anybody exhausted.

Usually, some rest sorts it out.

Persistent fatigue is different.

It can last for weeks or months and doesn’t necessarily disappear after a good night’s sleep.

Some people describe it as having no energy.

Others say their body feels heavy.

Some find that their concentration isn’t what it used to be.

And occasionally the person sitting in front of me in the pharmacy isn’t really complaining about being sleepy at all.

They’re telling me:

“I just don’t feel like myself.”

That is worth listening to.

First question: are you actually sleeping properly?

Before we start looking for complicated explanations, I usually want to know about sleep.

You can spend eight hours in bed and still have poor-quality sleep.

One important cause is obstructive sleep apnoea.

This happens when the upper airway repeatedly becomes blocked during sleep, causing breathing to stop and start. It can lead to loud snoring, repeated waking and excessive daytime sleepiness. NHS: Sleep apnoea⁠

Sometimes the person doesn’t even realise it’s happening.

Their partner is often the one who says:

“You stop breathing when you’re asleep.”

If you snore heavily, wake up choking or gasping, suffer from morning headaches or feel excessively sleepy during the day, it is worth discussing with your doctor.

Could it be anaemia?

Another common possibility is anaemia.

Iron deficiency is one of the causes, although there are others.

When you are anaemic, your blood has a reduced ability to carry oxygen around the body.

You may feel tired, weak or short of breath.

Some people notice paleness, headaches, dizziness or a racing heartbeat.

Iron deficiency can also occur without obvious symptoms at first.

But here’s an important pharmacy point:

Don’t automatically start taking iron simply because you’re tired.

If iron deficiency is suspected, it is better to establish the cause.

In an adult, particularly someone who wasn’t previously known to be iron deficient, unexplained iron-deficiency anaemia can sometimes be a sign of blood loss or another underlying problem that needs investigating. NHS: Iron deficiency anaemia⁠

Taking an iron tablet and hoping for the best can potentially delay finding out why the deficiency happened in the first place.

What about the thyroid?

Your thyroid may be small, but it has a surprisingly large influence on how you feel.

An underactive thyroid can cause tiredness, feeling unusually cold, weight gain, constipation, dry skin and difficulty concentrating. NHS: Underactive thyroid⁠

It can creep up gradually.

You may not wake up one morning thinking:

“My thyroid isn’t working properly.”

Instead, you simply feel that everything has become harder.

If persistent tiredness comes with several of these symptoms, a blood test may be appropriate.

Could your blood sugar be involved?

Diabetes can also leave people feeling tired.

When blood glucose remains too high, people may experience thirst, frequent urination and fatigue. NHS: Type 2 diabetes⁠

And sometimes people don’t realise they have diabetes at all.

They simply feel unusually tired and assume they aren’t sleeping properly.

This is one reason persistent unexplained fatigue shouldn’t automatically be blamed on age.

A simple blood test can sometimes reveal something important.

Look at your medicines

This is one of the first things I would check in pharmacy.

What medicines are you taking?

Some medicines can cause tiredness, drowsiness or dizziness as a side effect.

This can include certain antihistamines, sleeping tablets, some pain medicines, medicines used for anxiety or depression, and some medicines used to treat high blood pressure.

That doesn’t mean you should stop taking them.

Quite the opposite.

Don’t stop prescribed medication simply because you think it is making you tired.

But if your tiredness started after beginning a new medicine, or became noticeably worse after the dose was changed, tell your pharmacist or doctor.

Sometimes changing the timing, dose or medicine can solve the problem.

And then there is vitamin B12

Vitamin B12 is important for healthy red blood cells and the nervous system.

A deficiency can cause tiredness and weakness, but it can also cause neurological symptoms such as numbness, pins and needles, balance problems or cognitive changes. NHS: Vitamin B12 or folate deficiency anaemia⁠

The risk can be higher in certain groups, including people with absorption problems and those taking some medicines for prolonged periods.

Again, the answer isn’t simply:

“Take a multivitamin.”

If there is a genuine deficiency, finding the reason for it matters.

Are you drinking enough?

This sounds almost too simple.

But dehydration can make you feel tired, dizzy and generally unwell.

Older adults can be particularly vulnerable because the sensation of thirst may become less reliable with age.

Hot Malaysian weather certainly doesn’t help.

If you’re sweating heavily, exercising or simply spending a lot of time outdoors, your fluid requirements can increase.

And remember that excessive alcohol can also contribute to dehydration and disrupt sleep.

Don’t forget your mental health

Stress can be exhausting.

So can anxiety.

And depression doesn’t always present as sadness.

For some people, the main symptom is losing interest in things, feeling slowed down and having no energy.

That doesn’t mean that every person who is tired is depressed.

It simply means we shouldn’t look only for physical explanations.

The mind and body aren’t two completely separate machines.

They affect each other.

When tiredness needs investigating

This is the part I would not ignore.

If you have been persistently tired for several weeks without an obvious explanation, speak to your doctor.

Particularly if the tiredness is accompanied by:

• Unexplained weight loss
• Persistent fever or night sweats
• Breathlessness
• Chest pain
• Palpitations
• Significant weakness
• Persistent headaches
• Blood in your stools or urine
• Unusual bleeding
• Changes in your bowel habits
• Excessive thirst or urination
• Numbness or weakness
• Significant changes in mood
• Snoring with pauses in breathing
• Fatigue that is progressively getting worse

And if you suddenly develop severe weakness, chest pain, significant breathing difficulty, confusion or fainting, that’s not something to put down to being tired.

Seek urgent medical attention.

What might your doctor check?

There’s no single “fatigue test”.

The investigations depend on your symptoms, age, medical history and examination.

Your doctor may consider blood tests looking for problems such as anaemia, thyroid disease, diabetes or vitamin deficiencies, among other possibilities.

Sometimes the answer is surprisingly straightforward.

Sometimes it takes a little more detective work.

That’s why describing exactly what you mean by “tired” is useful.

Are you sleepy?

Do you lack physical energy?

Are you breathless?

Do you wake repeatedly?

Have you lost interest in things?

Did it start after a new medicine?

The more specific you can be, the more useful the conversation becomes.

What can you do yourself?

There are some basics worth getting right.

Try to keep a regular sleep schedule.

Get some daylight and physical activity during the day.

Eat regular, balanced meals rather than surviving on coffee and biscuits.

Drink enough fluid.

Keep alcohol within sensible limits.

And don’t rely on energy drinks to mask persistent exhaustion.

If you’re inactive, gradually increasing physical activity can actually improve energy levels and sleep for many people.

But don’t push through unexplained severe fatigue, especially if exercise makes you unusually breathless, dizzy or causes chest discomfort.

The important message

Getting older doesn’t automatically mean you should feel exhausted all the time.

Yes, our bodies change.

We may not recover from a late night quite as quickly as we did at 25.

But persistent, unexplained fatigue deserves an explanation.

It might turn out to be something relatively simple.

Perhaps you’re sleeping badly.

Perhaps a medicine is contributing.

Perhaps you’re dehydrated.

But it could also be anaemia, thyroid disease, diabetes, sleep apnoea or another condition that needs attention.

So the next time someone tells you:

“I’m just tired. I suppose it’s my age.”

Don’t necessarily accept that answer.

Listen to your body.

And if the tiredness doesn’t go away, get it checked.

Because getting older is inevitable.

Being permanently exhausted shouldn’t simply be accepted as part of the deal.

Until next time, look after yourself — and don’t ignore what your body is trying to tell you.

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