Feeling Tired All the Time

We understand that feeling persistently tired or lacking energy can be frustrating, worrying, and have a significant impact on your daily life. Fatigue is one of the most common reasons patients contact GP services, and we recognise how challenging and disruptive it can be.

Please be reassured that your symptoms are taken seriously. Our aim is to assess for important medical causes where appropriate, while also supporting you to address the factors that most commonly contribute to ongoing tiredness.

🧠Understanding Fatigue

Fatigue (or tiredness) is generally described as a lack of energy or a feeling of physical and/or mental exhaustion. Tiredness (Fatigue): Causes, Tests, and Treatment

It is important to recognise that:

Fatigue is very common and often part of normal life
It may be temporary (e.g. after illness, stress, or poor sleep)
It is a symptom, not a diagnosis
In many cases, no serious medical cause is found despite appropriate testing

Many people experience what is sometimes called “TATT” (Tired All The Time), which can be difficult to attribute to a single cause.

🔍Causes of Fatigue

Fatigue often has more than one contributing cause. Why Am I So Tired All The Time? Explore 5 Causes and Tips

Common causes include:

Poor sleep or sleep disorders Home – The Sleep Charity
Stress, anxiety, or low mood Talking Therapies – Liverpool
Lack of physical activity (deconditioning)
Diet and hydration issues
Recent illness or infection
Life circumstances (e.g. work, family pressures)

In many patients, no single medical cause is identified. Blood tests are often normal. This does not mean your symptoms are not real. Fatigue is frequently multifactorial (caused by several factors together)

😰Chronic Stress “Survival Mode”

A significant number of patients experiencing fatigue are affected by chronic stress, sometimes described as being in “survival mode.”

Fatigue is frequently linked to psychological and lifestyle factors, including stress, low mood, and poor sleep.

What happens in the body:

The body remains in a prolonged stress response (“fight or flight”)
Hormones such as cortisol remain elevated
Over time, this can affect:
- Energy levels
- Sleep
- Concentration
- Physical health

Common symptoms include:

Persistent tiredness
Poor sleep
Difficulty concentrating
Feeling overwhelmed or anxious

Long-term stress can contribute significantly to fatigue and overall wellbeing. How to lower cortisol levels: 10 proven ways

🚨What to Look Out For (When to Seek Urgent Help)

Please seek urgent medical advice if fatigue is associated with:

Unexplained weight loss
Persistent fever
Shortness of breath or chest pain
New neurological symptoms (e.g. weakness)

These may indicate a more serious underlying condition.

🔬Blood Tests and Medical Causes

As part of assessing fatigue, we are happy to arrange an initial set of blood tests where clinically appropriate. These are designed to identify common and treatable medical causes. Typically, this may include:

Full Blood Count (to check for anaemia or infection)
Thyroid Function Tests (to assess for underactive or overactive thyroid)
Urea & Electrolytes (kidney function and hydration status)
Liver Function Tests
HbA1c (to screen for diabetes)
Ferritin (iron levels)
Vitamin B12 and Folate

If your results are normal, this is reassuring and helps rule out many underlying conditions.

It is important to note that:

Investigations for fatigue are often normal
A clear diagnosis is not always identified
Repeating blood tests frequently is unlikely to provide new answers unless symptoms change

⚖️Hormones and Fatigue

Patients often request hormone testing when feeling tired. The NHS follows a selective and evidence-based approach:

Hormone tests are not routinely performed for general fatigue
Testing is guided by specific symptoms or clinical findings

When hormone tests may be appropriate:

Thyroid function (TSH ± T4) – routinely checked where indicated
Cortisol (adrenal function) – only if there are clear red flag features
Sex hormones – only if symptoms suggest a specific hormonal condition

What is not recommended:

“Full hormone panels” without clinical indication
Testing for “adrenal fatigue” (not a recognised diagnosis)

💊Vitamins and Supplements

The NHS advises that:

Most people should obtain nutrients through a balanced diet
Fatigue is usually not due to vitamin deficiency
Supplements are not routinely required unless deficiency is confirmed

Vitamin D – Important Update

We do not routinely check Vitamin D levels as part of standard blood tests.

This is because in the UK, due to our climate and limited sunlight, it is assumed that a large proportion of the population will have lower Vitamin D levels, particularly during autumn and winter.

Where does Vitamin D come from?

The main source is sunlight exposure on the skin
Smaller amounts come from foods such as oily fish, eggs, and fortified products

In the UK:

Sunlight is generally only strong enough to produce Vitamin D between April and September
During these months, short periods of sunlight exposure (e.g. 10–30 minutes to face and arms, depending on skin type) can help maintain levels
From October to March, sunlight is insufficient for Vitamin D production

NHS recommendation:

Adults should consider taking 10 micrograms (400 IU) of Vitamin D daily, particularly during autumn and winter
Some individuals (e.g. those with limited sun exposure, darker skin, or who cover their skin) may benefit from year-round supplementation

For this reason, routine testing is usually not necessary, as supplementation is considered safe and appropriate for most people.

When supplements are appropriate:

Vitamin D – recommended seasonally in the UK
Iron – if deficiency confirmed
Vitamin B12 / Folate – if deficiency confirmed

A pragmatic, balanced approach

Some research suggests symptoms may occur at the lower end of “normal” levels. Therefore, if tests are normal but symptoms persist, it may be reasonable to try a short-term (6 month) trial of a standard multivitamin containing:

Iron/ Ferritin
Vitamin B12
Vitamin D

There is no need to purchase expensive brands—standard supermarket or pharmacy products are sufficient.

📝Patient Self-Check: Fatigue

This questionnaire is not a validated medical tool and has not been formally assessed for diagnostic use. It has been developed by the practice as a supportive guide to help patients reflect on common lifestyle and wellbeing factors that may contribute to fatigue. Its purpose is to highlight areas that may be worth focusing on in day-to-day life to improve overall symptoms, rather than to provide a diagnosis or replace medical assessment.

For each statement, score:

0 = Rarely / Never 1 = Sometimes 2 = Often / Most of the time

🛌Sleep

I get less than 6–7 hours of sleep most nights
My sleep schedule is irregular
I wake feeling unrefreshed
I use screens (phone/tablet/TV) late at night

Sleep subtotal: ____ / 8

😰Stress & Mental Wellbeing

I feel frequently overwhelmed or under pressure
I find it difficult to switch off or relax
I worry a lot or feel anxious
I feel low, irritable, or mentally drained

Stress subtotal: ____ / 8

🏋️Physical Activity

I am inactive most days (little walking/exercise)
I sit for long periods without breaks
I feel deconditioned or low in stamina

Activity subtotal: ____ / 6

🥗Diet & Hydration

I skip meals or eat irregularly
My diet is low in balanced/nutritious foods
I rely on caffeine or sugary foods for energy
I drink insufficient fluids

Diet subtotal: ____ / 8

📺Daily Habits & Screen Time

I spend prolonged periods on screens each day
I do not take regular breaks from work/study
My evening routine is not conducive to winding down

Habits subtotal: ____ / 6

🌿Lifestyle Balance

I have little time for rest or recovery
I rarely engage in enjoyable or relaxing activities
My work/life balance feels poor

Balance subtotal: ____ / 6

Interpreting Your Score

Add your subtotals for a Total Score: ____ / 42

0–10 (Low impact): Lifestyle factors are less likely to be the main cause. Monitor symptoms and seek review if persistent.
11–20 (Mild–moderate impact): Some lifestyle contributors present. Focus on 1–2 key areas for improvement.
21–30 (Moderate–high impact): Several contributing factors identified. Target structured changes in sleep, stress, and activity.
31–42 (High impact): Lifestyle factors are likely playing a significant role. Prioritise gradual but consistent changes and consider additional support.

👉 Key principle: Focus on small, sustainable changes in the areas where your scores are highest. Improvements over time are more effective than sudden, drastic changes.

We are here to support you, while also ensuring that investigations are used appropriately and effectively for all patients.

Yours Sincerely,

Priory Medical Centre