Tired Beyond Relief

(By Robert Maass -- Corbis)
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By Jennifer Huget
Special to The Washington Post
Tuesday, March 4, 2008

Are you beat? Tuckered out? Dragging, flagging or just plain pooped?

Or maybe you're just tired of hearing others complain about how tired they are.

In this era of burning candles at both ends (whoever works the longest hours wins), with stops only for caregiving and a few stolen winks, most everyone gets tired now and then. Sometimes all you need to recover is a solid night's sleep or an actual vacation, sans BlackBerry. But in some instances, tiredness moves to the next realm and becomes the soul-sucking, energy-draining condition called fatigue.

And whereas sleepiness is generally remedied by sleep, fatigue can maintain its grip even when you sleep for hours on end. Fatigue makes you feel exhausted just thinking of paying the bills or walking the dog. It makes you want to bury your head under your pillow, even though you're sitting in your cubicle at work and there's no pillow in sight.

Kevin Ferentz, director of clinical operations in the University of Maryland School of Medicine's Department of Family Medicine, cites a 1994 study showing that fatigue is the primary reason for between 1 and 7 percent of all medical office visits made by adults, and another study published in 2000 that calls fatigue the seventh most common complaint in primary care.

But for a widespread complaint, fatigue can be frustrating to pin down. It can be a symptom of dozens of physical ailments, including thyroid imbalance, cancer, depression and autoimmune disease. It can be transient or chronic. It can be spurred by stress or sleep loss, a crummy diet or some medicine you take. Or it can creep into your life for no apparent reason.

One explanation for why fatigue is so fuzzy: There is no objective medical definition for the condition, says John DeLuca, editor of the 2007 research compilation "Fatigue as a Window to the Brain" (MIT Press, 2007). Nobody knows precisely where "tired" ends and "fatigued" begins; nor are experts sure how long one has to feel fagged before we start calling it fatigue, or even whether the underlying source is primarily physiological or psychological, or some combination of the two.

DeLuca notes doctors have no concrete way to assess a patient's fatigue. "It's totally nonscientific. A clinician asks the question 'Are you fatigued? Is it mild, moderate or severe?' . . . Everybody defines it the way they think. We need objective ways to measure it."

While garden-variety fatigue remains ill-defined, chronic fatigue syndrome, or CFS, is characterized by severe, disabling fatigue lasting six months or more that can't be traced to a physical cause and that is accompanied by at least four other symptoms, including headache, joint or muscle pain, lymph-node tenderness, and memory or concentration difficulties. More than a million people in the United States have CFS, according to the Centers for Disease Control and Prevention.

No matter how it's defined, "fatigue in the medical setting is incredibly important," DeLuca says. Beyond its association with myriad conditions and its being a side effect of many medications -- including beta blockers and antidepressants, which are sometimes used to treat persistent tiredness -- fatigue can be a marker of other serious disorders.

For example, DeLuca notes, a study published in the journal Stroke in 2002 shows that post-stroke fatigue is a strong predictor of death. Similarly, he says, people who have had a heart attack and who experience fatigue as their sole symptom of depression are at increased risk of another heart attack.

"People think as you grow older, you fatigue more easily," he says. "The literature shows just the opposite, except in those who have hypertension or diabetes. If you don't have fatigue and you're elderly, you're in pretty good shape. Fatigue may be a sign that something is not right."

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