You wake up feeling like you have jet lag, a hangover, and the flu, all at the same time. You feel like you have fallen into quicksand, weighted down, neck deep, trying to put one foot in front of the other.

Your whole body is heavy, your legs feel like rubber, and your thinking is distorted and fuzzy. Someone is saying something that might be important, but you can’t fully understand or concentrate on what they are saying. You try so hard to focus, to be productive, but you know something is wrong.

You resolve that you will get to bed earlier tonight, in hopes that all will be better tomorrow. Still, tomorrow comes and you wake-up feeling the same way.

If the described state has persisted for several days, then you are not just tired, you have reached “the great phase of exhaustion.”

What is exhaustion?

Exhaustion is a prolonged state of feeling completely worn-out and drained. Your body, for one reason or another, starts to slow down and weaken. It can be physical exhaustion or emotional exhaustion.

Exhaustion is a slow process; it doesn’t happen overnight; in fact, it is the result of persistent and prolonged stress, whether the stress is physical or psychological. The muscles become weak and sometimes painful, your memory and concentration can feel depleted, and your thought process is foggy and slower than usual.

But one thing you should understand is that exhaustion is a normal response to stress, and it is reversible with rest.

What causes exhaustion?

Physiological causes of exhaustion: 

  1. Sleep deprivation:

The average human requires between 7.5 to 8 hours of sleep per night. Sleep loss, whether by acute total sleep deprivation (prolonged hours of wakefulness with no sleep at all), or chronic partial sleep restriction (insufficient or interrupted hours of daily sleep) can both lead to exhaustion [1].

  1. Intense exercise: 

Exhaustion can occur if you have overexerted your body during physical activity. Studies have shown that there is a direct link between excess physical exercise, serotonin levels, and exhaustion. Intense exercise can lead to a high level of serotonin and a decrease in dopamine. However, scientists are still unclear as to why these chemical changes occur.[2].

  1. Lack of exercise:

Although this sounds illogical, if you live a sedentary lifestyle, over time, your muscles will weaken, causing even the simplest tasks to become more difficult. It’s best to incorporate a minimal amount of exercise into your daily routine. Even regular stretching will help the muscles remain more pliable. After all, exercise helps the brain release endorphins, which are responsible for activating positive mood-boosting hormones, promoting happiness and energy, and therefore helping to combat exhaustion.

So, start with some low- intensity exercises for a short duration daily and increase gradually [3][4].

  1. Unhealthy habits:

Smoking, excessive drinking of alcohol, and drug abuse can all contribute to chronic fatigue and exhaustion. A rebound effect is what happens when the body tries to bring itself back into balance after drugs or excess alcohol has been consumed. This becomes a vicious cycle as your body spends considerable time trying to repair itself and restore energy. Fatigue is your body’s way of getting you to rest and recuperate.

When unhealthy habits are part of your daily lifestyle, it is not uncommon for you to feel exhausted. The good news is that most people who discontinue using drugs and alcohol regain energy, sometimes in as little as a few weeks. Having supportive connections around you may help you overcome the unhealthy habits that could be draining your energy.

Pathological causes of exhaustion:

Here is a list of physical diseases that may be directly associated with exhaustion. Although the list is very long, I think it is important that we discuss the first two illnesses (anemia and hypothyroidism) as definite contributors to exhaustion.

  1.   Anemia:

“When you hear hoofbeats, think of horses, not zebras” are words coined by Dr. Theodore Woodward in the late 1940s, and shared with his medical residents. The principle meaning is that odds are a patient has a more common diagnosis than a rare, improbable one. Every physician has heard this at least a hundred times throughout his/her training, I certainly did.

So, you are tired, everything aches, you feel dizzy, and you have no energy. No, you probably don’t have cancer, and chronic fatigue syndrome is still an appropriate diagnosis if you don’t rule out other probable causes.

This is the simplest and most common cause of exhaustion and chronic fatigue among adults, especially females during menstruation. Hemoglobin binds to oxygen and carries it to the cells. The cells use this oxygen to metabolize glucose and produce energy. The decrease of hemoglobin level leads to hypo-oxygenation of the cells with a subsequent reduction in energy level.

  1. Thyroid dysfunction (Hypothyroidism):

Another disorder that is common among females is hypothyroidism. One of the earliest manifestations of hypothyroidism is persistent exhaustion and prolonged sleeping hours. Check the other symptoms of hypothyroidism from here. If you feel that you have multiple symptoms of hypothyroidism, talk to your doctor or health practitioner about having your hormone levels checked.

  1. Infection:

Infection, of any kind, provokes an inflammatory response. The mediators of this inflammatory response are chemical substances like cytokines and interleukins. These chemicals put the body in a hypermetabolic state and burn a lot of ATP, or Adenosine triphosphate (molecules responsible for energy production), leading to low energy and exhaustion.

If you have feelings of exhaustion, your doctor or health practitioner will check to see if you may have a chronic sinus infection, chronic vaginal infection, or even the flu.

  1. Addison’s disease:

With this disease, the adrenal gland secretes lower levels of cortisol than normal. The earliest symptom is extreme fatigue, hypotension, and low energy level. This disease is not common, but it is important to consider if you are feeling exhausted daily, and your lab work is normal.

Before jumping to the conclusion that depression may be the culprit, you may want to read more about the disease and have your family doctor or health practitioner, check your hormone levels.

The following is a list of diseases that are associated with exhaustion and chronic fatigue. Although these conditions have specific symptoms, extreme fatigue is considered to be a secondary symptom in most cases.

  1. Allergic rhinitis: runny nose, sneezing, itching.
  2. Arthritis: joint pain.
  3. Autoimmune diseases: varies widely.
  4. Fibromyalgia: muscle pain.
  5. Diabetes mellitus: polyuriapolydipsia, and polyphagia.
  6. Congestive heart failure: shortness of breath, and palpitations
  7. Kidney diseases: earthy look, and a change in the color of urine.
  8. Liver diseases: Jaundice.
  9. Cancer.

Chronic Fatigue Syndrome (CFS):

We can define chronic fatigue syndrome as always feeling tired with little to no underlying medical cause. The diagnosis of CFS is made by exclusion of all the other possible causes of exhaustion. CFS is common among females between the ages of 40 and 50, and the cause of CFS is relatively unknown, though there are some theories that indicate it may be linked to viral infections or just bad genes. There is no cure for CFS, but the symptoms are manageable with treatment.

Psychological causes of exhaustion:

Exhaustion may be linked to various mental illnesses, such as:

  1. Depression
  2. Bipolar disorder
  3. Insomnia
  4. Eating disorders, such as; anorexia nervosa

How can mental illness cause fatigue?

In the case of mental illness, especially depression, there is a loss of interest in daily life. Completing tasks that were once enjoyable, have simply become burdensome. You may feel exhausted, though your lab work may come back, indicating that your body is functioning normally. So, what may be the problem?

Both physical and mental illnesses can lead to physical exhaustion, though they are fundamentally different. In the case of mental illness, your brain chemistry changes. Neurotransmitters are chemical messengers within the nervous system. They are responsible for our muscle movement, heart rate, and influence our moods by producing serotonin and dopamine – chemicals that cause us to feel happy. When the body is deficient in these chemicals, as in the case of depression, this can lead to low energy and exhaustion.

Symptoms of Exhaustion:

  • Dizziness
  • Sleepiness
  • Chronic tiredness
  • Muscle ache
  • Joint pain
  • Slow reflexes
  • Poor judgment
  • Poor concentration
  • Impairment of the short memory
  • Confusion
  • Slow thinking
  • Low energy
  • Lack of motivation
  • Weakening of the immune system
  • Bad coordination
  • Moodiness

How to treat exhaustion?

It is important to note that exhaustion is not a disease; it is a symptom of an underlying condition. Proper diagnosis is critical to eradicating both problems by treating the condition and thereby curing the symptom.

However, there are some things that we can do to improve the condition and get some relief. As well, if the condition is simple, those measures may lead to the resolution of the problem completely.

  • Healthy eating habits:
    To achieve a healthier, more energetic lifestyle, it begins with a healthy diet, rich in vitamins, minerals, and a range of calories, based on your age and activity level. Regular exercise, along with positive mental health, is also a key contributor to increased energy and overall well being.

Daily Average of Calories Required:

Gender Age Activity level
    Sedentary Moderately active Active
Female 4-8 1200 1400- 1600 1400- 1800
  9-13 1600 1800- 2000 1800- 2200
  14-18 1800 2000 2400
  19-30 2000 2000- 2200 2400
  31-50 1800 2000 2200
  51+ 1600 1800 2000- 2200
Male 4-8 1400 1400- 1600 1600- 2000
  9-13 1800 1800- 2200 2000- 2600
  14-18 2200 2400- 2800 2800- 3200
  19-30 2400 2600- 2800 3000
  31-50 2200 2400- 2600 2800- 3000
  51+ 2000 2200- 2400 2400- 2800

Daily Average of Vitamins and Nutrients Required:

Nutrient Daily requirement

1.8 gm/ kg


18% of the total caloric intake.

fat 44% of the total caloric intake
carb 41% of the total caloric intake
Calcium (Ca) 1000 mg
Sodium (Na) 1-2 mEq/ kg
Potassium (K) 1-2 mEq/ kg
Magnesium (Mg) 410 mg
Iron (Fe) 8 mg
Vit A 3000 IU
Vit E 15 mg
Vit D 600 IU
Vit K 0.12 mg
Vit B6 1.3 mg
Vit B12 2.4 microgram
Vit C 90 mg
  • Avoid fast and processed food
  • Limit caffeine such as; coffee, tea, cola and energy drinks
  • Limit your alcohol intake, or abstain altogether
  • Drink plenty of water to avoid dehydration.

A note about water consumption: Although I am a firm believer, and highly recommend drinking 8 glasses of water, or 2 litres per day, I don’t want you to spend the rest of your life in the bathroom. I feel that drinking gallons of water per day is overestimated on all counts and is not a magic theriac. As long as your body is hydrated, overconsumption is not going to increase your energy, nor restore your youth. It is necessary that you keep your body hydrated, though drinking excessive amounts of water will not fix exhaustion.

  • Maintain a healthy body:
    To help combat chronic fatigue, it is important that you:

– Exercise more, and
– Get more rest

Confusing, right? But it is not, really.
If you are an athlete, feeling exhausted and extremely fatigued, daily, you need to pay attention to your body. Slow down and get some rest. If you are working out 7 days a week, perhaps reduce your sessions to 5. This way, it will allow your body time to rest and regain strength and energy. On the other hand, if you live a sedentary lifestyle, then you need to start exercising. Start slow and increase the intensity of the exercises over time.

Look after you:

  • Get a good night’s sleep: As we mentioned before, our bodies need 7.5 to 8 hours of sleep per night to function normally. Disturbed sleeping habits will lead to exhaustion and chronic fatigue.
  • Try and avoid stress: We all deal with some type of the stress, though it’s how we handle stress that can have a negative impact on our overall health. Try to listen to relaxing music, do some yoga, go for a walk, or talk to someone, which may help ease your stress levels.
  • Take deep breaths to increase the oxygen level in the blood. Remember to do this frequently throughout the day.
  • Don’t be afraid to ask for help. If exhaustion is impacting your life, and you no longer have the energy or desire for things you once used to enjoy, make an appointment and see your doctor.

When to visit a doctor?

I genuinely believe that you should consult with your doctor from the onset of your symptoms. However, most people delay calling their physicians until symptoms have escalated. Below are instances when you should make an appointment with your physician without delay.

When your symptoms are compound or complex

If you are chronically tired, exhausted, with other presenting issues, such as hair loss, tingling, and numbness in your feet, or hands, severe headache, or any other symptom. In this case, it is important you seek medical attention immediately to avoid any underlying disease.

When you don’t get better, even though you have tried all of the recommended steps

Those who believe they may be suffering from exhaustion and have tried the recommended steps, and do not feel better within a short amount of time, should speak with their doctor to rule out any underlying condition, or disease.

When the symptoms of fatigue start soon after you wake up

Typically, if you had a good night’s sleep, you are supposed to wake up feeling refreshed and energetic. Waking up exhausted may be a sign of depression.

When your exhaustion worsens quickly or lasts more than 2 weeks

On the appearance of alarming symptoms
If your fatigue is combined with alarming symptoms, call 911 immediately [5]:
· Shortness of breath
· Chest pain
· Left shoulder pain
· Abdominal/pelvic pain
· Fainting

In possible signs of infection
Such as:
· Low-grade fever
· Lymph node enlargement
· Pain at the site of infection


What should you do when you are exhausted, but can’t sleep?

Here are some tips to help you with falling asleep:

  • Listen to calm relaxing music.
  • Read for 3 minutes before going to bed, nothing complicated, just a simple, fun novel.
  • Exercise no more than 3 hours before going to bed. Exercising immediately before going to bed may cause your energy levels to increase, thereby preventing you from getting a good night’s sleep.
  • Turn off your mobile phone and laptop. Just relax.
  • Avoid noise and disturbing sounds.
  • Don’t work in your bedroom. Your subconscious mind may not be able to turn off at night knowing that your work desk is 2 feet away, and you may be tempted to complete tasks left from earlier in the day.
  • Don’t take long naps. 15 to 20 minutes daily is enough to refresh your mind.
  • Drink relaxing herbs, like mint, before going to bed. There are a lot of herbs that can help you with insomnia.
  • Eat food that is rich in magnesium and B vitamins, such as:
    Halibut, spinach, cashews, and almond are all rich in magnesium.
    Nuts, leafy green vegetables, and Legumes are all rich in the vitamin B complex.
  • Try to do some breathing exercises; it will help your body to relax. Watch this video to learn more about breathing and relaxation practices.
  • Get help from a professional psychotherapist or psychiatrist.

My personal experience with exhaustion:

For me, it was depression. At the end of my final year in med school and the beginning of my internship, everything was so exhausting and painful for me. There was far too much pain for me to handle, and I had great difficulty processing it all. I went into this profession because I wanted to help people. Still, more often than not, I felt that I didn’t have the energy, nor the mental clarity to perform effectively.

I saw people dying all around me, and it was very depressing. I slowly slipped into a dark hole, and I couldn’t find my way out.

I didn’t even realize I was depressed and thought it might be anemia, but my test results for my hemoglobin were 12.5. Then, I considered it might be hypothyroidism, especially given the fact that I have a strong family history of hypothyroidism. But, once again, all of my tests came back normal.

It drove me crazy! I questioned so many things. If my test results are normal and I have no disease, then why can’t I get out of bed? Why can’t I breathe normally? Why do I feel this heaviness when I wake up? And, why was I so exhausted all the time?

It took having an in-depth conversation with a friend to realize that I was no longer the happy, outgoing person I once was. I felt an overwhelming sense of sadness consume my whole body, and I couldn’t believe that I was dealing with so much pain.

At that moment, I realized that something was seriously wrong.

I booked an appointment with a psychiatrist, and I was diagnosed with mild to moderate depression. It took me a while to start to feel like myself again and learn how to cope with death, loss, and pain. I still don’t take loss very well, but I learned to give dying children one last chocolate and a big laugh, rather than mourning their pain, illness, and death.

My point is that it is okay to feel tired, sad, and exhausted.

Don’t beat yourself up about it. And seek help when you need to. There are people who love you, and there are doctors who can help you. Don’t wait until you feel like you are in the depths of despair before you seek the help you need.


Exhaustion means underperformance both physically and mentally. Exhaustion may be a result of a faulty lifestyle, unhealthy eating, and sleeping habits, or perhaps due to mental illness.

Some symptoms of exhaustion are: dizziness, sleepiness, headache, inability to focus, poor judgment, forgetfulness, irritability, anger management issues, and sometimes fainting.

If you are feeling exhausted for more than 2 weeks, see your doctor. Please keep in mind that anemia and hypothyroidism may be the cause of exhaustion and chronic fatigue, especially in females.

To overcome exhaustion, you may try to eat healthier foods, exercise more, and avoid undue stress.

You may also want to consider mental health issues when thinking about exhaustion and chronic fatigue.

And remember, exhaustion is a symptom, not a disease. Find the root of your problem and work hard to solve it so that you may, once again, enjoy a happy, healthy, productive life.

Dr. Ethar Alagha was born in Minia, Egypt and is a graduate of the Faculty of Medicine at Minia University, where she obtained her Medical Degree.  Dr. Alagha currently works as a General Practitioner at the University Hospital.  Her original plan was to become a computer engineer, or even an astronaut, though, through the tragic death of a loved one, she decided to enter the medical field to help those in need.  Dr. Alagha has a compassionate heart, loves writing and her hope is to help those around the world in need through the written word.