Fatigue and more fatigue

Fatigue has many causes – above all: too little sleep. Constant tiredness sometimes indicates certain illnesses or a chronic fatigue syndrome. Fatigue is no joking matter.

Last week I went to a department store and one of the manikins was wearing what looked like an old dirty army uniform. Had the staff made a mistake? But when I got closer the stains were part of the design, there was even a ripped knee. The display was called “Summer Fatigues”. I asked one of the staff members about the display and she explained that in the Army they have two uniforms. Dress Uniform and Fatigues. Simple math says that soldiers are either in their Parade attire or they are conducting activities that cause fatigue. When you see films of men and women crawling on their stomachs through mud, covered by bob wire; whilst someone shoots bullets over their heads. It becomes easy to understand why those clothes are called Fatigues.

That said, why would anyone want to look tired as a fashion statement? Never the less people who suffer from fatigue or chronic fatigue are often overlooked in society and medicine in general. This is because the exact causes of the illness are hard to pinpoint. There is no basic diagnosis specific to fatigue syndrome. Doctors invariably start elsewhere.

Most of the time we know the reason why we are tired: we slept too little. Short or restless nights are the simplest and most common cause of daytime tiredness. But even those who start well-rested in the morning know phases during the day in which they are overcome by that leaden feeling that weighs heavily on the eyes, slows down thinking and movements and demands a break. This can be a brief midday dip, compounded by a large meal. It has the same effect if we eat too little and, above all, drink too little. Sitting for long periods in a poorly ventilated room can also make your brain and legs go limp.

People who work intensively for a long time without a break will at some point be overcome by acute fatigue, but also those who have spent the whole day inactive on the sofa. Turning your thumbs makes you just as tired as prolonged stress, too little physical exercise as well as excessive training. And finally, an incipient infection, a cold for example, announces itself not only through an itchy nose, but also through an indefinite feeling of tiredness.

What fatigue means

So fatigue is usually an indication that we are missing something – sleep, oxygen, fluids, exercise. Sometimes the leaden state also shows that our body is actively defending itself against something – against germs, for example – and therefore mobilizes more defenses. That makes you tired. Very often everyday problems that weigh on the mind and body cloud the mood, the inner drive and the performance.

It is a consolation that such phases of tiredness, which are often perceived as unpleasant, pass again or can be resolved quickly: the open window, a short walk in the fresh air, a glass of mineral water or relaxation exercises drive away stressful sagging. The deep sleep of a cold or flu supports the organism in its recovery work.

In certain situations, we even experience tiredness as pleasant, for example after a long hike in a beautiful landscape or after concentrated, successful work at the desk. The limbs feel heavy, the head is pumped out, but a calming satisfaction spreads. Those who then get enough sleep and take the necessary break will feel awake, fit and productive again afterwards.

Take persistent fatigue seriously

Unusual, persistent or constant tiredness, on the other hand, is often the first sign that something is wrong in the body or in the mental state. Fatigue is a general symptom of illness, such as fever or sweating. It announces disease processes of all kinds or accompanies them to a greater or lesser extent. Often, tiredness also has an effect later, for example when the infection is over and the disease has already healed.

Fatigue: When should you pay attention?

Here advice and help from the doctor are called for:

  • Sleep is not restful for a long time
  • A phase of tiredness is not replaced by awake, active times
  • Sleep, rest, and exercise do not remedy the inner heaviness
  • The tiredness lasts longer than you normally expect
  • You suddenly become extremely tired without exerting yourself excessively
  • Being tired puts a noticeable burden on your everyday life
  • The performance drops significantly as a result
  • There are other complaints, like fever, exhaustion, pain, swelling, nausea, dizziness, night sweats, muscle weakness, shortness of breath, depressive mood, anxiety, memory disorders

For example, if the tiredness is related to severe sleep disorders, it is important to talk to your doctor about it in order to specifically address the cause.

The first point of contact is usually the family doctor, who usually knows the patient’s medical history and living environment. The family doctor either makes the diagnosis himself or calls in a specialist for further examinations.

In search of the causes of fatigue

The question of why we get tired has not yet been answered. The sequence of wakefulness, being tired and sleeping follows the body’s own rhythm, the internal clock. Under her direction, certain neurotransmitters in the brain, certain hormones and proteins of the immune system are produced and released in different amounts as required. Body temperature also changes during the day and night to encourage wakefulness or fatigue. The times of day, light and darkness are essential external clocks, as are social requirements in everyday life. The personal lifestyle, the professional and private situation can bring restlessness and shifts in the internal processes, which often result in inappropriate tiredness.

Inside the body, a number of factors affect the ups and downs of alertness and fatigue. Basically, the brain and other organs must be adequately supplied with oxygen and nutrients, i.e. have a good blood supply. Blood circulation, cardiac function, metabolism, hormone production, nerve activities and immune defense must interlock smoothly. Disorders and illnesses in all these areas can impair the level of wakefulness during the day and lead to increased fatigue. They also directly reduce the quality of sleep.

The psyche also influences nerve functions, hormones and the body’s defenses. Mental disorders such as depression and anxiety play an important role in persistent, stressful fatigue.

Fatigue is an undesirable side effect of a number of drugs that affect blood pressure, brain metabolism, and various nerve functions. Alcohol abuse and drug consumption also have far-reaching consequences. Feeling exhausted and tired is just one expression of the damage that addictions can do to the body. This also applies to eating disorders such as anorexia or pathological obesity.

Chronic fatigue syndrome (CFS) is a disease that is often cited, but from a medical point of view rather rare. Those affected feel constantly tired and exhausted for months for an as yet unexplained cause. In addition, there are usually other characteristic complaints such as concentration disorders, muscle and/or joint pain, sore throat and headache, sleep disorders.

Unusual fatigue can also be an early symptom of some tumors and blood disorders, such as lymphoma or leukemia. Cancer patients sometimes experience persistent states of exhaustion (fatigue) – on the one hand, due to the disease process itself, on the other hand as a result of the treatment.

Exhausting and Tiring
Too much sun can be exhausting and tiring

Overview of possible causes of fatigue

Living conditions

  • Lack of sleep (also due to illness-related sleep disorders, sleep apnea, narcolepsy or other causes)
  • Sedentary lifestyle
  • High fat and high-calorie food, slimming diets
  • Dehydration
  • Overweight, underweight
  • Magnesium deficiency
  • Weather influences, strong sun exposure (up to heatstroke), hypothermia
  • Stress, overwork, insufficient demands
  • Grief, worries in work and personal life
  • Growth, phases of physical development in children and adolescents, premenstrual syndrome in women, menopause

Pollutants, environmental factors

  • Stay in poorly ventilated rooms, the air is too dry
  • Working with toxins (wood preservatives, insecticides, lead, aniline, benzene)
Alcohol: harm on installments

Mental illnesses, nervous disorders

  • Burnout syndrome
  • depressions
  • Anxiety disorders
  • Eating disorders (anorexia, binge eating)
  • Psycho-vegetative, somatoform disorders (disorders with diverse physical symptoms for which there are no verifiable organic triggers)
  • Alcohol abuse, alcohol withdrawal, drug use, drug withdrawal, drug addiction
  • Neurological diseases (diseases of the central nervous system in the brain with disorders in the autonomic nervous system: Parkinson’s, multiple sclerosis, dementia, migraines)
The heart also has a say in tiredness

Acute and chronic internal diseases

  • Cold flu
  • Pfeiffer’s glandular fever (symptoms of tiredness sometimes persist long after the illness has been overcome)
  • Chronic sinus infections
  • Facial rose (herpes zoster infection)
  • Anemia: vitamin B12 deficiency anemia and other forms of anemia
  • Fluctuations and changes in blood pressure: low blood pressure, high blood pressure
  • Heart diseases: heart failure, cardiac arrhythmias, heart muscle inflammation, AV block
  • Lung diseases: Chronic bronchitis, COPD, exogenous allergic alveolitis (lung disease caused by regular inhalation of organic, allergenic substances and tiny particles), pulmonary hypertension (pulmonary hypertension)
  • Kidney diseases: kidney inflammation, chronic kidney failure
  • Liver diseases: hepatitis A, B, C, alcoholic hepatitis, alcoholic fatty liver, Meulengracht disease (familial jaundice)
  • Gastrointestinal diseases: irritable stomach, stomach ulcers, food intolerance; Malassimilation syndrome (impaired absorption of nutrients via the intestine with deficiency symptoms) Crohn’s disease
  • Hormonal disorders: hypothyroidism, hyperthyroidism, adrenal insufficiency (Addison’s disease)
  • Type 1, type 2 diabetes mellitus and secondary diseases such as diabetic nephropathy (damage to kidney vessels that can lead to kidney failure with corresponding symptoms)
  • Autoimmune diseases: rheumatoid arthritis, Sjogren’s syndrome, lupus erythematosus, allergies
Malignant blood diseases: Rather rare, but be aware of when you are tired

Tumors, cancers, fatigue

  • Lymphoma (cancer of the lymphatic system, lymph gland cancer): Hodgkin disease, non-Hodgkin lymphoma, chronic lymphocytic leukemia)
  • Acute leukemia, chronic myeloid leukemia (“blood cancer”)
  • Colon cancer and rectal cancer (colon and rectal cancer)
  • Fatigue in many forms of cancer in advanced stages, during and after cancer treatments
A drug as a cause of fatigue? Quite possible


  • Selection: antihypertensive drugs, sleeping pills and sedatives, psychotropic drugs, antidepressants, migraine drugs such as triptans, acne drugs, antihistamines, pain relievers (opiates), immunostimulating drugs (interferons), drugs against cardiac arrhythmias (antiarrhythmics), cancer drugs
A wide variety of pains are possible with chronic fatigue syndrome

Chronic fatigue syndrome, fibromyalgia

  • Chronic fatigue or exhaustion syndrome (cronic, CFS)
  • Fibromyalgia syndrome (still largely unexplained clinical picture with pain in different parts of the body as well as physical and mental complaints)
Yoga & Co .: Moving consciously can strengthen body and mind

Therapy: What helps against frequent tiredness

Improve lifestyle

Anyone who has identified everyday stress and unfavorable living conditions as the cause of frequent, pronounced fatigue should also consistently start here. Changing established habits and behavior patterns is often difficult, but it is absolutely worthwhile for in-depth wellbeing. For healthy people who often feel weak and tired, this usually means:

  • move more physically,
  • find a healthy normal weight,
  • improve sleep,
  • Reduce stress,
  • relax regularly.

Sometimes this is only possible with professional help. Often the family doctor, health center or psychotherapist can give specific advice or name appropriate support facilities.

Occupational and environmental physicians, as well as professional associations, are the points of contact when it comes to exposure to toxins and pollutants at work.

Treat existing underlying diseases sustainably

If the tiredness is caused by a certain illness, the treatment is based on it. Exercise therapies adapted to the illness usually support the medical measures. Because with various heart diseases, for example, or during and after cancer therapy, physical activity in the right form helps you feel fresher and more productive again. This also applies to mental illness.

Moderate physical training and a well-dosed use of available energies are also effective measures to overcome permanent fatigue in a chronic fatigue syndrome. In addition to a generally healthy lifestyle, psychotherapeutic support, for example with behavioral therapy, plays an important role here.

Doing various detoxes to rid the body of toxins and heavy metals often helps, so does a thorough parasite cleanse and supporting the kidney and liver.

Many people have found that regular colonics help keep their immune systems strong by promoting good gut health.


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