Exhausted? Feeling down? You may have hyper-fatigue

The chronic low-level stresses of everyday life can knock you sideways. From diet to exercise, here’s what the experts recommend you can do.

Chronic low-level stresses could lead to hyper-fatigue, according to a new study.

In its annual forecast of global consumer trends for 2023, the market research agency Mintel predicted a wave of what it called “hyper-fatigue”, a crushing weariness with everyday life that would leave many of us flat-out exhausted. If my own experience is anything to go by, its forecast doesn’t seem far wrong.

I’m the least likely person to slump with an energy crash, but in recent weeks I’ve been hit by unexpected bouts of the heavy-limbed, low-mood lethargy that is hard to overcome. It’s taken more than the usual effort to haul myself through the day. I am not alone. When I ask other people how they are, an increasing number respond with “shattered”. I don’t think sleep is the issue for me - I get plenty - but there is nothing I can put my finger on, no identifiable trigger, that is causing the waves of lethargy.

Experts say that hyper-fatigue is neither the extreme debilitating chronic fatigue associated with fluctuating hormones or underlying illness nor the everyday tiredness that passes with a few good nights’ sleep, but a mid-point of exhaustion, the consequence of unprecedented drains on our energy levels.

Matthew Apps, associate professor in the school of psychology at the University of Birmingham, where he is researching fatigue and its effects, says it’s a consequence of being stretched and strained in so many directions with pressures such as the cost of living crisis and the difficulty of maintaining a work-life balance, not to mention the impact of what has seemed like a never-ending winter extending into spring.

“We are now in this post-pandemic bounce-back phase and, even over the last two months, there seems to have been a big upswing in people taking on more tasks, requests and invitations for work and social events than they have over the past couple of years,” Apps says. “It can result in a kind of chronic low-level stress that leads to feelings of fatigue and can impact our motivation to do things so that we feel even more lethargic. It is often assumed that a lack of sleep is the reason but fatigue is impacted by lots of different things and sleep is just one of them.”

It’s also difficult to quantify, even for scientists. “The problem with fatigue is that it’s a slippery concept,” says Derek Hill, professor of medical imaging science at University College London (UCL) and part of a team at UCL and the University of Aberdeen working on an ongoing fatigue study. “Doctors don’t yet have a way of accurately assessing it, which means as yet it is hard to distinguish when people are just tired as part of everyday life or when fatigue is something more serious.”

Hill’s team have recently embarked on a new study that will monitor fatigue patterns in different people using wrist-worn trackers and strategically placed movement sensors in their homes. “We are looking at a group of people with problematic fatigue and those without fatigue to see how and when they move when their fatigue symptoms are at their worst,” he says. “Our aim is to better understand fatigue by looking for clues about why it happens so that we can identify patterns in how it affects different people.”

It’s part of a swell in scientific interest in tiredness that could result in new treatments and different ways to deal with it. “Twenty years ago no researchers were thinking about finding ways to help people deal with fatigue,” he says. “But it can become an issue that impacts people’s lives and it is now being taken seriously.” In the meantime, what do we know about hyper-fatigue and what can be done to overcome it?

Experts say fatigue is a ‘slippery’ concept and could lead to major problems.

HOW DO YOU KNOW WHEN YOU ARE HYPER-FATIGUED?

Tiredness is highly subjective - one person’s mild weariness is another’s hyper-fatigue. Psychologists use screening tools such as the Epworth Sleepiness Scale to assess concerning levels of fatigue and completing it yourself can give you an idea of your tiredness rating, although it won’t tell the whole story. “Nobody’s experience of fatigue can be neatly quantified in a 20-question survey,” Hill says. With only rudimentary measurements to assess fatigue available, it comes down to brutal self-scrutiny.

“I tell people that if the things they would normally do to reboot their energy levels - such as massage, sleep, exercise, socialising - are no longer working, then it is a sign you are overtired,” Apps says. “For example, I am generally a poor sleeper so I am used to feeling a little bit groggy most mornings, but if I were to feel beyond that level of exhaustion for a prolonged period I would start to feel concerned.”

WHEN SHOULD YOU MAKE AN APPOINTMENT TO SEE A DOCTOR?

If tiredness persists for several weeks and starts to impact your life, you should speak to your GP because it could be telling you something important about body or brain. Hill suggests that should happen “when fatigue interferes with everyday living and it isn’t just waking up feeling exhausted for a couple of days in a row, but for a few weeks”.

Blood tests might be conducted to determine if there is a nutrient deficiency or other underlying problems potentially causing the fatigue. Unexplained fatigue is a symptom of depression but could also be associated with alcohol intake, undiagnosed sleep apnoea or a more serious long-term illness.

A 2020 study at the University of Massachusetts Amherst revealed that fatigue is a symptom for 40 to 74 per cent of people living with chronic illness such as heart disease, cancer, rheumatoid arthritis and neurological illnesses. “It might be none, one or more of these, or related to a chronic build-up of stress,” Apps says. Don’t ignore it. If fatigue in your fifties and sixties results in lower activity levels, there is a risk of speedy deconditioning and muscle loss. Researchers have shown that, left unaddressed, fatigue is the main underlying reason for restricted and reduced physical activity in people aged 70 and above.

IS MORE SLEEP THE ANSWER?

Sleep is restorative and, governed by our body’s circadian rhythms, allows us to replenish energy stores. It is a no-brainer that you should get more sleep if you regularly fall well below seven hours a night and feel tired. “We know that in people who sleep less than optimally there are changes in patterns of parts of the brain that make you feel more fatigued,” Apps says.

However, for people with longer-lasting fatigue, a lack of sleep is rarely the single root cause of their tiredness.

“Not everyone who feels tired needs more sleep,” Apps says. Too much sleep can even interfere with the body’s circadian rhythms and make you feel even more tired.

“This can happen if you have long lie-ins to try and overcome fatigue,” Stanley says. “The body clock gets confused and thinks it’s on holiday, and you just come crashing down when you revert to normal sleep times.”

A power nap won’t make up for a lack of sleep but might help to restore alertness temporarily. “A short nap of 20 to 30 minutes can help you to feel more energised for a few hours,” Stanley says, “but nap for longer and you are likely to suffer sleep inertia, that horrible grogginess on waking that makes you feel more tired, which can persist for up to two hours.”

Exercise is a helpful way to relieve stress, but over-exercising could have the reverse effect.

WILL EXERCISE HELP?

Sedentary lifestyles are certainly implicated in rising levels of fatigue partly because of their links to chronic, low-level inflammation in the body that researchers have suggested contributes to people feeling tired all the time and is exacerbated by stress and poor diet. “There’s also the general lethargy effect of feeling tired because you are not doing as much as you should,” Apps says. “And the more tired you feel, the less motivated you are to do anything.”

Apathy breeds fatigue and if you are not active enough, moving more is likely to leave you feeling less tired. On the flip side are regular exercisers who might need to scale back. “When people think about fatigue they think exercise will help to raise energy levels,” Hill says. “That’s certainly the case for some people, but for others more physical activity can make things worse.”

In Apps’s studies he has shown that the brain processes physical and mental fatigue in the same way and that both result in a downturn in motivation. “Too much exercise with too little recovery will adversely impact how tired you feel,” Apps says. “If you are too exhausted to do anything else, you are exercising too much.”

IS YOUR DIET TO BLAME?

Eating too much sugar and salt, as well as too many ultra-processed, refined foods, are likely to affect energy levels over time.

“It won’t necessarily impact fatigue levels directly, but a generally unhealthy diet can affect your health and general sense of wellbeing,” Apps says. “It can lower your mood, which affects motivation to do things, and that brings about fatigue.”

Low levels of some specific vitamins and minerals could be a reason you are tired. Too little vitamin D, for example, can lead to “unexplained fatigue” in some people, according to researchers from the University of Florida College of Medicine. The body produces vitamin D when skin is exposed to sunlight and there are few natural food sources, although dairy products, oily fish, cod liver oil and eggs contain some.

If you didn’t take the 10mcg vitamin D supplement recommended by the government from September to April you might have low stores, which can be established from a blood test provided by your GP or a registered dietician. If so, supplementation could significantly improve tiredness levels.

Check iron levels too. Iron is found in red meat, poultry, seafood and fish, eggs, bread, beans, pulses and green, leafy vegetables and seeds, but too little can leave you feeling overwhelmingly tired.

“A blood test by your GP will identify iron-deficiency anaemia, which can leave you with low energy and feeling breathless on the slightest exertion,” says Dr Linia Patel, a registered dietician. “You may be prescribed a course of supplements to rectify iron levels.”

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