Imagine you plug your phone in overnight and wake to 100 per cent. By ten past eleven it is in the red. You have not streamed anything or played a game. You have only done the ordinary things a Tuesday asks of you. Now picture yourself at the kitchen table with a cold tea, reading the same line of the same email for the third time. The charger is still in the wall, the cable is still in the phone, and the number will not climb. You are not sleepy in the heavy-eyelid way a long walk leaves you. You are flat, and eight hours in bed has not changed it.
Maybe you have been told it is just stress, or just age, or just a busy season. Maybe someone has suggested an earlier night, and you have tried that too. You may be reading this while you wait for a GP appointment, or with a blood test form in your bag that you have not yet taken to the lab. Or you may have come out of the surgery last week with the words “everything looks normal” and a tiredness that had not moved an inch.
This post rests on two sources that are worth knowing. One is the NHS guidance on why you might be tired all the time. The other is the World Health Organization’s definition of burn-out, published on 28 May 2019 as part of the eleventh International Classification of Diseases (ICD-11). Between them they explain a lot about where to look, and about where not to look.
Tired is a symptom, not a verdict
The first thing the NHS makes plain is that tiredness is a signal. It is not a diagnosis, and it has no single cause. The guidance sorts the possible reasons into three families. Before you settle on one explanation, it is worth reading down all three.
The first family is lifestyle. That means not getting enough sleep or finding it hard to get to sleep, an unhealthy diet, and a lack of exercise.
The second is psychological. It covers stress and depression, along with the life events that drain anybody, such as bereavement or a new baby in the house.
The third is medical, and it is the longest. It includes hormonal changes in puberty, pregnancy or the menopause. It includes illnesses such as glandular fever and COVID-19, and the effects of medicines and treatments such as chemotherapy. It also includes sleep apnoea (a condition that affects your breathing while you sleep), iron deficiency anaemia (too little iron to make healthy red blood cells), diabetes, an overactive thyroid (hyperthyroidism) and ME/CFS (myalgic encephalomyelitis, also called chronic fatigue syndrome).
Look at that third list again. If you assume your job is the cause, you may spend six months rearranging your job. If the cause turns out to be something a blood test can find, no rearranging will touch it. That is why the medical family deserves a place on your list from the start, however much the workplace or the weather seems the obvious culprit.
The aim is not to frighten you. It is to make sure you are looking in all the places where the answer might be.
When the NHS says to see a GP
The NHS is specific here, and it helps to have the wording in front of you before you ring the surgery. It advises seeing a GP if you have been tired for a few weeks and you are not sure why. It also advises it if the tiredness is getting in the way of your daily life, or if it comes with other symptoms such as weight loss, changes in mood, or noises when you breathe at night.
That last one is easy to miss, because you are asleep when it happens. If somebody who shares your home has mentioned strange sounds when you breathe at night, say so at the appointment. Sleep apnoea is on the NHS list of causes, and it is the kind of problem that eight hours in bed cannot fix.
If you already have an appointment booked, you have done the hard part. If you do not, what is stopping you ringing this week?
What if the tests come back normal?
Picture the car park afterwards. The results are in, the thyroid is fine, the iron is fine, the sugar is fine, and you were told kindly that all looks normal. You sit with your keys in your hand feeling oddly worse. The tiredness has not moved, and now it has lost its explanation as well.
A normal result does not mean you are imagining it. It means some medical causes have been ruled out. The lifestyle and psychological families are still on the table, and so is a word that gets used very loosely.
What the WHO actually says about burn-out
Burnout gets used for everything from a bad Monday to a breakdown, so it helps to know what the WHO wrote. In ICD-11, burn-out is defined as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” It names three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy.
Read those slowly, because only the first is about being tired. The second is when work you once cared about starts to feel like somebody else’s problem. The third is the creeping sense that you are no longer any good at it. So ask yourself something. Are you tired, and also dreading a job you once did without thinking, and also quietly worried you are slipping? If so, that cluster has a name, and the name is worth bringing to your GP and, if you feel able, to your employer.
Here I want to slow down, because the WHO is careful and you should be too. The same statement says burn-out is not classified as a medical condition. It also says the term refers specifically to the occupational context. It should not be used to describe experiences in other areas of life.
That matters if your exhaustion comes from somewhere other than a job. Perhaps you are caring for a parent, or you have a newborn, or you live in a house that never stops asking things of you. The WHO definition is not describing you. The NHS names the psychological causes, and a new baby and bereavement are on that list. Using the word burnout for your situation is understandable. It can still point you away from the help that fits, which might be a GP conversation or more support at home.
How to tell which tired you have
You cannot diagnose yourself from the sofa, and nobody expects you to. You can gather something useful before you see anyone, though. The table below pairs what you might notice with what to raise. The medical causes come from the NHS list. The workplace rows borrow the WHO’s three dimensions as a guide to what is worth saying out loud.
| What you notice | Worth raising with your GP or employer |
|---|---|
| Tired every day for a few weeks, whatever you do at the weekend | Book a GP appointment and ask about tests; the NHS lists anaemia, thyroid problems and diabetes among the causes |
| Noises when you breathe at night, or waking unrefreshed | Tell the GP exactly this; sleep apnoea is on the NHS list |
| Flat mood, or tiredness that arrives with low spirits | Tell the GP about the mood as well as the tiredness; depression is one of the psychological causes the NHS names |
| Exhaustion that is tied to work, with dread of the job or a growing cynicism | These match the WHO’s dimensions of burn-out; raise it with your GP, and with your employer if you can, asking whether the workload or role can change and not only whether you can cope better |
| A sense of not being any good at a job you used to do well | This is the WHO’s third dimension, reduced professional efficacy; write down when it began and what changed around then |
Small, practical things the NHS recommends
The NHS self-help advice is plain, and plain things done steadily are what tend to help. The two-week trial below is a suggestion of this post rather than the NHS’s, so give these a fortnight before you judge them. If any of the warning signs above apply to you, do not wait for them to work before seeing your GP.
- Keep the same sleep times. The NHS suggests going to bed and getting up at the same times, and aiming for 6 to 9 hours. Pick a wake-up time you can hold on a Sunday as well as a Tuesday.
- Make the hour before bed boring. The NHS advises relaxing before bed and keeping screens out of the last hour. It also advises avoiding caffeine, heavy food and exercise close to bedtime.
- Move on purpose. The NHS lists a lack of exercise among the lifestyle causes of tiredness, so a regular walk is a fair place to start.
- Cut back on smoking and alcohol. The NHS advises avoiding smoking and drinking too much alcohol.
- Keep a one-line energy diary. Each evening, write one score out of ten and one sentence about what the day held. After two weeks you will have something concrete to show a GP, which beats “I’m just tired”.
What this cannot tell you
The limits of this post are there to protect you, so here they are plainly. The NHS page is general guidance. It is not an assessment of you. The WHO definition tells you what the word burn-out is meant to cover, and it explicitly leaves it outside the medical conditions. Neither can tell you whether your tiredness comes from your blood, your sleep, your mood, your workplace or some mix of these.
If you hear that a supplement, a detox or a single habit change will fix tiredness for everyone, be wary. Nothing in this material says so, and nothing here should stand in for a proper conversation with your GP.
If tiredness ever comes with thoughts of harming yourself or not wanting to be here, please do not wait for a routine appointment. Call Samaritans free on 116 123 at any hour, or speak to your GP urgently.
You are allowed to take it seriously
Long tiredness does a lot of its damage through the story you tell yourself about it. You may think you are lazy, or that everybody else copes, or that you ought to have more discipline. None of that appears in the NHS list of causes. It lists sleep, stress, illness, hormones, medicines and life events. It does not list weakness.
So treat your tiredness the way you would treat a warning light on the dashboard, with attention and without panic. Book the appointment this week. Write your first line in the diary tonight. If the tests come back clear and the diary keeps pointing at Monday to Friday, take that evidence to whoever shapes your work.
You have spent long enough asking whether you are the problem. The better question is what, exactly, is draining the battery. You are allowed to go and find out.
Source: NHS, “Why am I tired all the time?” (nhs.uk, Live Well: sleep and tiredness); World Health Organization, “Burn-out an ‘occupational phenomenon’: International Classification of Diseases”, 28 May 2019. This article is for general information and is not a substitute for advice from your GP.
Leave a comment