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7 Reasons You're Always Tired

What could be causing your fatigue — and how to fight it

Older man sleeping in chair as a young child peeks at him
Jose Luis Pelaez Inc/GETTY IMAGES

David Levine feels tired — a lot — and laments how he rarely makes it to the end of a movie. The 68-year-old Manhattan journalist has a pretty good idea why: A night in the sleep lab showed he had borderline sleep apnea. “But certain medications I take, especially Lipitor, make me even more tired,” he says. “I went off it for two months, and I felt a lot better.”

Levine is in good company. Research suggests that fatigue (or anergia, in medical lingo) runs as high as 50 percent in people 65 and older, compared with rates in the general population, which range from 10 to 25 percent.

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Yet “fatigue is not a natural consequence of aging,” says Barbara Resnick, codirector of the Biology and Behavior Across the Lifespan Organized Research Center at the University of Maryland School of Nursing.  “It’s more related to the changes that occur due to age and commonly associated diseases.”

Fatigue is common when you’re fighting any kind of illness, from infections to autoimmune disorders. Some treatments, such as chemotherapy, are notoriously exhausting. And, of course, fatigue is also a symptom of COVID-19, although it’s usually accompanied by more telling signs like fever and chills, even in minor cases of the disease caused by the coronavirus.

Beyond that, “all of us feel tired some of the time,” says Suzanne Salamon, M.D., assistant professor of geriatric medicine and primary care at Beth Israel Deaconess Medical Center in Boston. “Usually, it goes away, either with sleep or time.”

But if unexplained fatigue continues for more than a few weeks, it’s time to figure out what’s causing it. Here are some of the likely suspects (keep in mind, though, that more than one culprit may be responsible).

1. Your medications are sapping your energy

“Older adults take a lot of medications, and a lot of those medications tend to make people feel tired,” explains Brenda Windemuth, director of the Adult Gerontology Primary Care Nurse Practitioner Program at the University of Maryland School of Nursing. Chief among these: certain antidepressants, antianxiety drugs, sedatives, antihistamines, steroids, and blood pressure and cholesterol medications.

Antipsychotics, pain meds, seizure drugs and chemotherapy also stir up trouble. Others, like diuretics, contribute to exhaustion by disturbing your sleep. 

“Not all drugs cause the same effects in all people,” Salamon says. “If a person has started a new medicine and they notice fatigue, they should report this to the doctor. Sometimes just moving the drug to the evening or lowering the dose can help, but sometimes you need to change to a different medicine.” She recommends always bringing all your medicines — prescription and over the counter — to your office visits so your doctor can check doses and duplicates.

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Levine was able to take a lower dose of his cholesterol drug and still get its benefits. Although he still feels somewhat tired, he’s decided to stay on it. “The trade-off is worth it,” he says. “I’m a tennis player and I don’t want to drop dead on the court.”

2. Your sleep hygiene may need improvement 

Many of us simply aren’t getting enough slumber and are paying the price the next day.

Poor sleep habits are often to blame. If you’re lying in bed and can’t fall asleep, Resnick advises, get up and do something until you feel tired, and then go back and try again. “The other really big mistake people make is that they expect to lie around all day and then be able to sleep at night,” she observes. “You only want to spend time in bed when it’s sleep time. Some people like to control the world from their bed.”

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Other advice: Maintain a regular sleep pattern, and avoid alcohol at night. Consider keeping a sleep diary to help you identify factors — foods, drinks, medicines — that may be keeping you from solid slumber. Keep in mind that as you get older you may not require the seven to nine hours you used to, Windemuth says.

Obstructive sleep apnea is another culprit. Patients experience as many as 30 awakenings an hour when the soft tissues of the throat relax and obstruct the airway during sleep; as a result, they feel exhausted the next day.

Loud snoring is a clue. Spending the night in a sleep lab can confirm the diagnosis. The standard treatment, a continuous positive air pressure (CPAP) machine, involves wearing a mask over the nose to force air into the throat and keep the airways open.

3. You’re missing key nutrients 

People over 50 are more likely to experience nutrient deficiencies — especially vitamins B12 and D, iron and folic acid — that cause fatigue. If your doctor suspects a deficiency, she’ll send you for a blood test, and you may need a supplement. 

4. You’re anemic

This means that your blood has too few red cells or those cells have too little hemoglobin, which transports oxygen through the bloodstream. The result: fatigue.

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A simple blood test provides a diagnosis, after which your physician will investigate possible reasons for the anemia and may put you on iron pills. 

There are three main reasons older adults become anemic. Kidney disease is one. If your kidneys are not working properly, they may not be able to help your body make the red blood cells it needs. “It can also be due to blood loss from somewhere, usually along the gastrointestinal tract,” Resnick says, “or it’s in the bone marrow, which could be due to a malignancy.”

5. You have a heart or pulmonary problem

Cardiac issues — including heart failure, coronary artery disease, valvular heart disease, asthma and chronic obstructive pulmonary disease (COPD) — are among the most common causes of fatigue in older people.

Heart disease can cause the heart to pump blood less efficiently and fluid to build up in the lungs. This, in turn, results in shortness of breath and less oxygen supply to the heart and lungs. So be sure to follow doctor’s orders when it comes to treatment.

6. You’re anxious or depressed

“Depression, being alone and other psychosocial issues are a huge factor in older people,” Windemuth says. “People are losing friends and spouses. They’re being uprooted from their homes or going into assisted living. That can lead to fatigue.”

Antidepressant medications are sometimes the answer. “We also encourage people to go out, become more involved and find things that they really enjoy doing,” Windemuth adds.

Paradoxically, exercise can make a huge difference. “The best thing for fatigue is physical activity — no matter what the underlying problem,” Resnick says. “The goal should be 30 minutes daily of moderate-level activity.”

Playing tennis has been a lifesaver for Levine, helping him to keep up his energy level. “If I exercise in the afternoon, I feel better,” he says.

7. COVID could be the Culprit

When COVID-19 symptoms linger long after a person’s initial illness, fatigue is a very common complaint. “Estimates of the prevalence are variable but some sources suggest that more than 50 percent of all COVID survivors are affected by persistent fatigue,” says John Baratta, M.D., founder and codirector of the UNC COVID Recovery Clinic at UNC Health in Chapel Hill, North Carolina. "In our Long COVID clinic, over 90 percent are troubled by this symptom."

Before treating the fatigue, doctors first investigate other potential factors that may be contributing to extreme tiredness, such as sleep apnea, depression and chronic pain, says Benjamin Abramoff, M.D., head of the Post-COVID Assessment and Recovery Clinic at Penn Medicine in Philadelphia. Then you may be prescribed physical therapy or a graded exercise program, where the duration and intensity of activity is gradually increased. Both can improve stamina, but it’s important to pace yourself to avoid exacerbating symptoms or risking relapse, Baratta says.

“We have also found benefits from certain medications, such as antidepressants and stimulants, in certain situations,” Baratta adds. These include certain antidepressants in the SSRI (selective serotonin reuptake inhibitor) class and stimulants like those used to treat attention deficit disorder.

If you’re suffering from fatigue related to long COVID, ask your doctor about such strategies or consider making an appointment at a post-COVID clinic. These programs typically take a multidisciplinary approach to treating the disease’s lasting symptoms, fatigue included.

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