What I Would Tell My Best Friend: When She's Tired All the Time

What I Would Tell My Best Friend, a Valivera Health series

If you told me you were tired, I'd probably nod. Most of us are. But if you told me you were tired all the time, tired in a way that sleep doesn't fix, I'd put down whatever I was doing and start asking questions. How long has this been going on? Is it new, or has it been building? Is it sleepiness, weakness, or more of a heavy, flat feeling? And what else has changed? Most fatigue has an ordinary explanation, and usually more than one. But if you were my best friend, I'd start with the things I'd never want you to brush off.

The Signs I'd Never Want You to Brush Off

I'd want you to see a doctor promptly if your fatigue comes with chest pain, shortness of breath, fainting, or a racing or irregular heartbeat. The same goes for unexplained weight loss, fevers or drenching night sweats, black or bloody stools, very heavy menstrual bleeding, new severe headaches, vision changes, weakness or numbness, trouble speaking, or swelling in your legs or feet. And if your low energy comes with a mood that keeps sinking, or any thoughts of harming yourself, please don't wait. Call or text 988, and reach out to someone you trust today.

The Everyday Reasons We Don't Always Connect

Once the red flags are off the table, I'd want to know what else has been going on. How are you sleeping? Are you eating regularly and getting enough protein? Are you going through perimenopause or menopause, with night sweats, 3am anxiety, or restless nights? What has stress looked like over the past several years? Maybe you've been caring for aging parents while raising teenagers. Maybe work has been relentless. Maybe you're sleeping six hours a night and calling it good because that's what you've gotten used to. And maybe you've stopped moving as much because you're too tired, which can leave you even more tired.

Any of these can drain your energy, and so can things we don't always link to fatigue: sleep apnea (loud snoring, gasping at night, or morning headaches are worth mentioning), low iron, B12, or vitamin D, thyroid problems, blood sugar changes, anxiety or depression, certain medications, and alcohol.

"Normal" Labs Don't Always Mean Nothing's Going On

Not everyone needs every test. But depending on your history, I might look at blood counts, ferritin, thyroid function, blood sugar, or vitamin levels, or consider a sleep study. And if your labs come back "normal" but you still feel terrible, that doesn't mean it's in your head. It means we keep looking at the bigger picture, without rushing to give you a label.

The Right Plan Starts With What's Getting in the Way

Say you're exhausted, you're sleeping poorly, and you've been skipping meals or fasting because it's "the thing to do." I wouldn't tell you to exercise more or sleep more. Your body may be in survival mode because of how you're eating. So we'd start with nutrition, work on the sleep disruption, and once the fatigue begins to lift, we'd bring in movement and strength. Other times, labs point to something like a thyroid problem or a hormone deficiency, and even the best nutrition and exercise plan won't get you far until that's treated. So we'd treat that first.

The point isn't to change everything at once. For the next week or two, I'd ask you to jot down your sleep, meals, energy, stress, and any hot flashes or cycle changes. It gives us something concrete to work with.

You're Not Lazy, and You're Not Just Tired

So if you were my best friend and you told me, "I'm just tired," I'd take it seriously. Because sometimes the question isn't simply, "How do we get you more energy?" It's, "What is your body telling us?"

You're not lazy. You're not a to-do list. You're a whole person. And sometimes the best way to get your energy back is to understand what's been draining it.

Dr. Liz Dulaney-Cripe

This post is part of a series where I share what I'd tell a friend. Have a question you'd like me to tackle? Send it my way.