Reasons you are always tired and what to do

Feeling tired is a natural response to physical or mental exertion, and it typically goes away after resting. 

Chronic fatigue, on the other hand, is a constant feeling of tiredness and low energy that doesn’t go away even after rest or sleep. It can be frustrating and keep you from feeling your best daily.

Always feeling tired can be due to different factors, from diet to living with health conditions. Here are some of the most common reasons you may feel tired all the time.

Lack of sleep

Not getting enough quality sleep is a common reason you may feel tired.

Sleep deprivation, or not being able to sleep as many hours as your body needs, can result from living with the following:

• insomnia
• sleep apnea
• restless legs syndrome
• mood disorders like anxiety and depression

Symptoms of sleep disorders may include:

• snoring
• gasping for air during sleep
• excessive daytime sleepiness 
• difficulty falling or staying asleep
• not being able to lay still when sleeping

There are various ways to help manage sleep disorders. Depending on your needs, these may include:

• improving sleeping habits, like keeping a good sleeping environment and bedtime schedule
• continuous positive airway pressure (CPAP) therapy for sleep apnea
• cognitive behavioral therapy for insomnia (CBTi)
• oral appliances to relax the jaw
• surgery to widen respiratory airways
• medications like zolpidem (Ambien) and ramelteon (Rozerem), or supplements like melatonin

Thyroid disorders

When the thyroid gland at the front of your neck can’t produce enough hormones or produces too much, you may feel fatigued and have low energy.

The American Thyroid Association explains that some thyroid disorders may cause chronic fatigue — alongside many other symptoms.

For instance, hyperthyroidism may cause:

• unintended weight loss
• tremors and shakiness
• feeling hot and sweaty
• increased appetite
• hair loss
• bulging eyes

While hypothyroidism may lead to: 

• weight gain
• dry skin
• hair loss
• constipation
• feeling cold

Both conditions — but especially hypothyroidism — can make you feel achy and tired all the time.

Medications for thyroid disorders may include:

• Hypothyroidism: levothyroxine (Synthroid, Levoxyl, Euthyrox)
• Hyperthyroidism: methimazole (Tapazole) or propylthiouracil (Propacil)

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Depression

Depression is a common mental health condition. There are different types, like seasonal affective disorder and major depressive disorder.

Depression, particularly long-term untreated depression, often manifests with persistent fatigue, among other symptoms like: 

• feelings of sadness, hopelessness, and irritability
• insomnia or hypersomnia — difficulty sleeping or sleeping more hours than usual
• guilt
• being unable to concentrate
• low motivation 

Ways to manage and treat depression may include:

• psychotherapy like cognitive behavioral therapy or interpersonal therapy
• antidepressant medications like fluoxetine (Prozac), sertraline (Zoloft), and bupropion (Wellbutrin)

Nutrient deficiencies

A 2020 narrative review explains that deficiencies in nutrients like iron, vitamin B12, vitamin C, zinc, and magnesium may make you feel persistently tired. 

Iron deficiency is often related to anemia, which occurs due to low hemoglobin levels. Hemoglobin carries red blood cells around your body, and a low level is a common cause of long-term tiredness.

Depending on the nutrient and severity of the deficiency, other symptoms of deficiencies may include: 

• feeling weak
• muscle aches and cramps
• shortness of breath
• headaches
• nausea
• appetite changes
• memory loss or brain fog

Management strategies and treatments for nutrient deficiencies also depend on the type and severity of the deficiency. They may include:

• iron supplements for anemia, like ferumoxytol (Feraheme)
• vitamin B12 supplements like cyanocobalamin (Nascobal)
• magnesium supplements like magnesium carbonate (Magnotate) 

Diabetes

Diabetes may lead to chronic fatigue in some people, as well as: 

• increased thirst
• frequent urination
• blurred vision

Management and treatment options include:

• insulin therapy like insulin glargine (Lantus), insulin detemir (Levemir), and insulin aspart (Novolog)
• injectable medications like semaglutide (Ozempic, Rybelsus, Wegovy)
• oral medications like metformin (Riomet) and glipizide (Glucotrol)
• lifestyle changes like following a nutrient-dense diet and taking regular exercise

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Heart disease

Your heart pumps oxygen around your body, which helps keep you healthy and energized. There are many types of heart-related conditions, spanning from high blood pressure to acute cardiovascular emergencies.

As well as constantly feeling tired, heart disease may manifest with: 

• chest pain
• shortness of breath
• swelling in your legs and feet
• dizziness
• nausea
• cough

Sometimes, you may feel tired but have no symptoms at all. Only a healthcare professional can give a correct diagnosis. 

Management and treatment options for heart-related conditions may depend on the type and severity of the symptoms alongside your overall health and needs but may include:

• blood pressure medications, such as:
  • the beta-blocker atenolol (Tenormin)
  • the calcium channel blocker amlodipine (Norvasc)
  • the angiotensin-converting enzyme (ACE) inhibitor benazepril (Lotensin)
• surgery, like placing a stent if medications aren’t enough to prevent or treat the disease
• lifestyle changes, including a nutrient-dense diet and more exercise 
• weight loss if you have overweight or obesity
• quitting smoking if you smoke

Lifestyle factors

Lifestyle factors beyond a lack of sleep may contribute to chronic tiredness and fatigue. For instance, eating a diet low in vitamins and minerals or not being as physically active.

Depending on the cause of your tiredness, management options to consider include:

• Exercising regularly: A 2020 randomized controlled trial of 38 people with axial spondyloarthritis found that high intensity exercise and strength training significantly improved energy levels. 
• Following a healthy, balanced diet: A nutrient-dense diet can also improve fatigue. Eating whole grains, vegetables, and omega-3 fatty acids may improve energy. 
• Reducing or stopping smoking and drinking alcohol: A 2023 study found that smoking and drinking alcohol can increase tiredness. So, cutting down or stopping may improve chronic fatigue. 

If you have tried to stop smoking without lasting success, specific over-the-counter remedies and prescription medications may help. You can discuss these options with a healthcare professional:

• nicotine spray or inhaler (Nicotrol)
• varenicline (Chantix)
• bupropion (Wellbutrin)

Lyme disease

Lyme disease is a bacterial infection from the bite of an infected tick. It may cause severe fatigue, among other symptoms like:

• fever 
• headaches
• skin rash
• joint pain

Although there’s no cure for Lyme disease, initial treatment may involve antibiotics:

• doxycycline (Adoxa) 
• amoxicillin (Amoxil)
• cefuroxime (Ceftin)

Arthritis

Arthritis is chronic inflammation in your joints. There are different types of arthritis, many of which may cause long-term fatigue — for example, rheumatoid arthritis.

Other symptoms of arthritis may include: 

• joint pain, stiffness, and swelling
• rash and psoriasis
• fever
• sleep issues

Treatment depends on which type of arthritis you have. Some options may include:

• physical therapy
• weight loss if you have overweight or obesity
• nonsteroidal anti-inflammatory drugs like ibuprofen (Advil)
• disease-modifying antirheumatic drugs like methotrexate (Trexall) and sulfasalazine (Azulfidine)
• biologic agents like adalimumab (Humira) and etanercept (Enbrel)

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Summary

Feeling tired or fatigued is a natural part of life, but it can be frustrating if it becomes continuous.

Potential underlying causes of constantly feeling tired may include nutrient deficiencies, conditions such as Lyme disease and diabetes, and lifestyle factors like smoking or a lack of sleep.

Treatment options are available, from increased exercise to specific medications for each cause.

The best place to start is to talk with a doctor, who can help identify any potential underlying causes and advise on how to address them to get your energy levels back in check.