'Why am I so tired?' Recognizing and dealing with fatigue

"Why am I so tired?"

Fatigue is a very common complaint and affects athletes of all ages, sizes and abilities. It is one of the most common complaints in the physician's office, with one in every four patients stating that fatigue is disrupting his or her life.

What is fatigue?
Fatigue is a subjective condition in which a person feels tired before beginning an activity, lacks the energy to accomplish tasks requiring sustained effort and attention, and becomes unduly exhausted after normal activities.

It can range from pervasive and overwhelming to subtle, felt only during all-out competition. Fatigue, as a symptom, is vague and can be wide-ranging in its implications.

What are the most common causes of fatigue? For the friends and family in our lives, we might be tired for obvious reasons such as a virtuous effort to get up at 4:30 in the morning to exercise strenuously prior to starting the workday. But why does this have an impact?

It is important to remember that the human body requires 7 - 10 hours of sleep in a 24-hour period. When we don't have enough time, the first place we typically cut back is sleep time.

If you are getting up early to exercise, or staying up late, it is important to adjust your sleep time accordingly. If continuous sleep is not possible, a 20- to 40-minute nap during the day may help.

Insomnia
Sometimes the problem isn't lack of sleep, but the inability to fall asleep. Everyone has problems with insomnia at some time, typically associated with a change in the daily routine such as travel or a new job. Others have more persistent trouble sleeping.

There are a variety of causes for insomnia. These include illness, medications, or depression, and should be discussed with a physician. Many times the exact cause of the insomnia cannot be identified. However, there are a variety of things to try in order to improve sleep.

It is important to go to bed at the same time each night and to get up at the same time each morning. Napping in the middle of the day should be avoided. A regular exercise routine should be followed, and it may be of benefit to exercise in the late afternoon or early evening. At bedtime, the room should be dark and quiet, and extremes of temperature should be avoided.

If you find yourself unable to fall asleep, after 30 minutes get up, do some quiet activity, and return to bed when you are sleepy. Avoid caffeinated foods or beverages after 4 p.m., and remember that although alcohol is a sedative, it also prevents deep, restful sleep and should be avoided if sleeping is a problem.

Overtraining
An overlooked cause of fatigue in the athletic adult is overtraining. One of the hardest things for an athlete to do is rest. The mindset is to push harder to get stronger and faster.

We forget that it is possible to get too much of a good thing, even exercise, and that rest is an important part of training.

Rest and recovery
What is rest? Rest can be the time when no strenuous activity is performed, such as in sleep time or days off. It can also be more active and involve low-intensity exercise, allowing a small amount of increased blood flow to reach the muscles. Both types of rest allow recovery to occur.

Recovery is what the body does during rest periods to repair the damage to muscle cells after strenuous activity. If the body is given enough rest to allow adequate recovery, the body will completely repair the broken-down muscle cells and even build them up a little stronger, resulting in a stronger and faster athlete.

Balancing act
Exercise needs to have a balance between training and recovery. If an imbalance occurs and is allowed to persist, overtraining results. Athletes, and those around them, will notice lingering fatigue, mood changes, irritability, altered sleep and persistent soreness. Performance in workouts or competition may deteriorate. Frequent respiratory illnesses or even an overuse injury may occur.

The cure for overtraining is rest. The more severe the problem, the more rest needed to fix it. This can be very difficult to do until illness or injury forces the rest to occur. Prevention can help the adult athlete avoid this problem.

Programming rest into the training can help. It is also important to be aware of how the body is responding to training. Some -- particularly those who are prone to overdoing it -- find it beneficial to keep a fatigue score, ranking the cumulative feel during the day from 1 - 5. If this score goes up over days to weeks, it may be time to decrease the intensity of training.

Another way to track overtraining is to measure morning heart rate. If the measured pulse increases progressively, it may be a sign that the body has not had ample time for recovery. Both the fatigue scale and the morning heart rate can be recorded in a training log.

It is also important for the adult athlete to factor in the outside stresses of real life, job and family. Anticipate times of increased stress and adjust the workout schedule accordingly.

There are many causes of fatigue in the athletic adult. It is important to listen to your body and heed your body's warning signs. It is also important to remember that unrelenting fatigue may be a sign of underlying illness, and you should consult with your physician if this occurs.


Jody Welborn is a cardiologist from Portland, Ore. Her medical experience includes a B.A. from the University of Oregon, an M.D. from Oregon Health Sciences University, an internal medicine residency at University of Texas, San Antonio, and a Cardiology fellowship at the University of Alabama, Birmingham. Jody is a member of three United States Masters Swimming national committees, including Sports Medicine, Fitness and Planning. She is also a Masters swimmer who swims with the Metro YMCA Masters in Portland.

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