These 7 Medical Reasons Could Explain Why You’re Tired all the Time

Sometimes, getting to the bottom of your fatigue is about way more than simply getting enough sleep at night.

Raise your hand if you sometimes feel like you could happily take a nap at any point in the day, feel tired even after getting a decent night’s sleep, or like you have to muster up the energy at the end of a long day to get through household chores, a workout, or a “second work shift” at home. Yeah—you’re tired. I’m tired. We’re all tired.

But while occasional tiredness is normal—maybe you’re having a rough week at work, or your kid’s going through a bad sleep phase—when fatigue becomes more frequent than not (persisting even when certain work or home stressors subside), that may mean underlying health conditions could be a factor. And women are particularly vulnerable: A Centers for Disease Control and Prevention study found that women are almost twice as likely than men to feel tired or exhausted.

Pay attention to these possible medical explanations for your being tired all the time, and talk to your doctor if you’re concerned.

1. You might be at risk of a heart attack

Though it sounds scary, fatigue among women in their thirties to fifties can certainly be an indication of heart disease or a heart attack, says Mary Ann McLaughlin, MD, a senior cardiologist and an associate professor of cardiology at the Icahn School of Medicine at Mount Sinai. Many women who have had a heart attack have said that in retrospect, they “were really tired the last two weeks” in addition to experiencing discomfort upon exertion, she notes. Accompanying pain can include discomfort radiating in your jaw and/or either arm.

Think a heart attack could never happen to you? You may have more heart disease risk factors than you realize. “Woman ages 30 to 50 need to know their family history of heart disease, especially if anyone in their immediate family developed a heart condition under the age of 60,” she says. “This includes a heart attack, a stent, or any kind of heart surgery.” It’s also necessary to consider additional heart risk factors including, smoking, high cholesterol levels, sleep apnea, PCOS, and high blood pressure.

Bottom line: If you have any unusual symptoms, such as fatigue or shortness of breath, call your doctor. Many women don’t have stereotypical chest pain when they’re having a heart attack, and for this reason, may not seek medical attention as quickly as they should.

2. You could have sleep apnea

Clearly, getting enough shut-eye plays a critical role in feeling rested. But sleep apnea can rob you from the steady level of sleep necessary to make you feel refreshed come morning. Sleep apnea occurs when muscles in the back of your throat relax, causing a narrowing of your airways that makes it hard to draw in enough breath. This may cause snoring and quick periods of awakening that you may not even recall, but which can still severely disrupt sleep quality. Sleep apnea is linked with serious health issues, but getting diagnosed and properly treated can help you snooze better and reduce those risks. These sleep apnea symptoms often go overlooked.

3. You could be anemic

“When young women in their twenties and thirties start feeling tired all the time, it’s important to look for things like thyroid problems and anemia,” Dr. McLaughlin says. Premenopausal women who experience heavy periods can lower the levels of iron in their body and lead to anemia, a blood disorder that the American Society of Hematology says affects over 3 million Americans. In the case of iron-deficiency anemia, eating more iron-rich foods such as spinach may help. People with anemia also tend to feel cold all the time. You can talk to your doctor about your risk factors for anemia; a blood test can determine your iron levels and whether eating an iron-rich diet or taking supplements is right for you.

4. You could have an underactive thyroid

The American Thyroid Association notes that “one woman in eight will develop a thyroid disorder during her lifetime.” Hypothyroidism—a condition in which your thyroid gland isn’t working effectively—can cause extreme fatigue. Additionally, you may also notice a harder time zipping up your favorite jeans if your thyroid is out of whack; weight gain may also accompany your tiredness, as can foggy memory and depression. If your doctor determines that you have hypothyroidism based on your symptoms and bloodwork, the problem can be treated with thyroid hormone medicine.

5. You might have irritable bowel disease

If your fatigue is occurring along with symptoms such as abdominal pain, diarrhea, and weight loss, it could be irritable bowel disease (IBD), which is an umbrella term for health conditions such as ulcerative colitis and Crohn’s disease. IBD is considered an autoimmune disease, which occurs when the immune system can’t easily distinguish between what is normal in your body and what doesn’t belong. In turn, it mistakenly attacks healthy cells, unleashing a cascade of effects that can damage various organs and systems in the body. In IBD, it’s the digestive tract that’s under attack.

Some people with IBD notice that fatigue is among their symptoms, which may also include mouth ulcers and painful bowel movements. (Learn more here about the difference between IBD and IBS.)

6. You may have rheumatoid arthritis

In addition to being tired often, do you ever feel stiffness in your joints, mainly first thing when you wake up? Or do you find it challenging to grab or pinch items? If so, it could be rheumatoid arthritis is an autoimmune disease in which the immune system mistakenly attacks the joints, causing pain and swelling, along with pretty significant fatigue. Without treatment, RA can progress and cause permanent joint damage over time, but disease-modifying treatments can significantly reduce this risk.

7. You could have diabetes

“Fatigue is a very common complaint among people with diabetes,” says Kathleen Dungan, MD, an endocrinologist at The Ohio State University Wexner Medical Center. Having very high blood sugar levels can cause fatigue because the body is not metabolizing glucose, your main source of fuel, efficiently. If fatigue is related to having high blood sugar, it will tend to get better once you start making lifestyle changes or taking medication to lower your blood sugar levels, Dr. Dungan notes. But sometimes fatigue in diabetes can also be due to related health issues, such as obesity or depression. If you’re being treated for diabetes and are still experiencing fatigue, it’s important to let your doctor know.