When patients ask me, “Why am I so tired?” my response is often cancer-related fatigue.
Feeling tired all the time has often been considered an inevitable side effect of cancer and its treatment. Even though most physicians have historically thought of pain as their patients’ biggest concern, studies show that patients report fatigue affects their lives to a greater degree. Often, cancer survivors describe their fatigue as feeling “restless at night and then tired all day,” “constant sleepiness,” “mind-numbing, down-to-your-bones exhaustion.”
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If you can identify with these feelings, you’re not alone. Up to 90 percent of cancer survivors report profound fatigue at some point during their treatment and recovery.
What causes cancer-related fatigue?
- Low blood counts
- Loss of muscle
- Chronic stress response
- Disrupted sleep
- Hormonal changes
- Cancer therapies such as chemotherapy, radiation or surgery
The medications you take could also be contributing to your fatigue. Some make fatigue worse, including:
- Nausea medications
- Allergy medications
- Pain medications
- Beta blockers (often used for high blood pressure)
- Other drug interactions
Other times, fatigue can be caused by nutritional, metabolic, or hormonal changes, such as:
- Menopause or low testosterone
- Adrenal insufficiency
- Poor diet
- Metabolic problems
What can you do about it?
If fatigue affects your quality of life, talk with your doctor. There may be some simple, reversible things you can do.
I like to review medications first because there are often adjustments that can be made. Next, I look at nutrition and vitamin deficiencies as well as hypothyroidism, all of which can be common in cancer survivors. It is also important to assess your sleep to determine whether that is contributing to your fatigue. Sleep disorders are more prevalent in cancer survivors. In fact, it is estimated that 30 percent of cancer survivors who report fatigue actually have sleep apnea.
Some steps you can take:
- As difficult as it is, try to limit daytime sleep to a single half-hour nap.
- Avoid alcohol, chocolate, caffeine and nicotine late in the day. (Everyone’s cut-off time is different.) I have found that I can’t have caffeine after noon or I will have a restless night. Remember that caffeine is a long-acting “drug.”
- Turn off your television and other electronics one hour before bedtime.
- Write all your tasks and worries on a list before bed.
- Turn your clock away from your line of vision.
- Silence all your electronics.
- Create a bedtime routine like you would with a small child.
- If you can’t fall asleep or wake frequently during the night, try moving to another room and reading.
It might be helpful to meet with a sleep specialist if you have tried these steps and found no relief, or if you answer yes to one or more of the questions on this sleep quiz.
The bottom line is that there are many reasons you may feel tired. It may be just the treatment, but often times there are other contributors. The first step is to identify and treat any other fixable causes.
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