Fatigue Diagnosis: How The Doctor Works

The medical history gives first indications of possible causes of tiredness. This is followed by physical examinations, possibly laboratory tests and imaging procedures

If you suffer from prolonged tiredness, you should always consult a doctor. This also applies if the tiredness suddenly sets in for no apparent reason or goes well beyond what is normal. Other warning signs are additional symptoms such as fever, pain, muscle weakness, shortness of breath, night sweats, dizziness, as well as a deep feeling of exhaustion, depression, increased anxiety.

Constantly tired: what the doctor should know

For the doctor, usually first the family doctor, it is important to know

How exactly the tiredness expresses,
When and how often does it occur
Whether it is experienced as new and unusual, for example, after physical or professional activities, or
Whether it also sets in without special efforts being made.

Basic are also information on sleep behavior, whether the quality of sleep has changed, whether you or sleep partner noticed severe snoring and nocturnal breathing. And, if you even give in during the day more often.


Also, of interest are questions such as: Has something changed privately or professionally? How often do you move and how? Did you eat differently recently, and did you increase or decrease? Do you experience more mood swings? Don’t you trust yourself as much as you used to?

Another issue is dealing with pollutants and chemicals in the workplace, but also at home, for example when you are renovating the apartment. In addition, possible addictive behavior plays an essential role when it comes to tracking fatigue.

Additional physical symptoms give the doctor important information. Frequently, the family doctor knows the medical history of his patient quite well. He will be attentive to changes in already diagnosed clinical pictures or new complaints. He also checks which medications you are taking. Also, of importance may be recent or previous long-lasting infections.

Diagnosis fatigue: Which specialists can be responsible

The first steps are usually taken by the family doctor. Depending on the indications that result from this, he initiates further examinations or transfers his patient to a specialist. This can include a specialist in internal diseases (internist) or for heart disease (cardiologist), for diabetes (diabetologist), for hormone and metabolic diseases (endocrinologist) or nervous diseases (neurologist). Sometimes a rheumatologist or otherwise specialized internist is needed, such as a specialist in kidney disease (nephrologist) or liver disease (gastroenterologist / hepatologist).

Oncologists and trained staff of oncology departments in clinics care for cancer patients at various stages.

If psychological problems are in the foreground, psychiatrists and psychotherapists assume diagnosis and treatment. Addiction also requires the respective search experts.

Severe sleep disorders with severe daytime fatigue sometimes require targeted diagnosis and treatment in a specialized clinic with a sleep center.

If it is suspected that the fatigue triggers could be related to the occupational activity or environmental influences, a work or environmental doctor will answer the relevant questions.

Possible physical examinations in case of tiredness

The detailed doctor-patient interview is usually followed by a thorough physical examination. Above all, the doctor scans the abdomen, back and body areas in which abnormally altered lymph nodes can be noticed, such as armpits and groins. He also searches for arms and legs as well as for swelling and noticeable changes in the head and neck. He also checks the skin, the joints, the muscle reactions, hears the heart and lungs. He also looks at the mouth and throat area as well as the eyes. As a rule, blood pressure measurements are also part of the routine. If necessary, allergy tests and certain laboratory tests are added.

Causes of fatigue in focus: further investigations

Insightful tests in the laboratory

Blood tests often confirm a suspected diabetes or thyroid disorder, such as hypofunction (hypothyroidism). Other hormone or metabolic irregularities or inflammatory processes in the body such as rheumatism can be detected in the blood. Certain blood levels also provide information about kidney function. For liver disease, various liver tests are indicated.

Urine tests are often ordered by the doctor to help diagnose a possible kidney disease or provide early warning of kidney problems with diabetes.

Other measures, such as a nerve water test, are indicated if, for example, the doctor suspects multiple sclerosis or a serious herpes infection. Bone marrow puncture ensures the diagnosis of, for example, leukemia. Fine tissue examinations of tissue samples may sometimes be necessary for heart, muscle, metabolic or cancer diseases.

Apparative investigations

Which examinations the doctor arranges, depends on already existing illnesses or afterwards, in which direction first examination results exhibit. Further investigations may include, for example, the recording of a cardiac current waveform (electrocardiogram, ECG), a stress ECG and / or pulmonary function tests.

Imaging procedures

Ultrasound examinations of different organs are used as necessary. This can be, for example, a sonography of the heart (echocardiography), the liver, the thyroid or the abdominal cavity and internal lymph nodes.

X-rays of the chest or the lungs are important diagnostic tools for heart and respiratory problems, in cancer diagnostics. Computed tomography (CT) and magnetic resonance imaging (MRI) are often indicated for tumor disease. Likewise, a cardiac MRI in addition to heart ultrasound may sometimes reveal the cause of cardiac insufficiency, such as a specific myocardial disease.

Therapy of pathological tiredness: The decisive factor is the diagnosis

The treatment depends on the diagnosis and will be individually tailored to the patient. A good and trusting doctor-patient relationship helps to control even a distressing general symptom such as tiredness.

The next few chapters will give you an overview of the most important causes of tiredness and other characteristic symptoms of the underlying diseases. To many diseases there are detailed disease counselors on our pages.

Fatigue – Causes: Habits, Environment

Lack of sleep, too little exercise, and personal and professional problems are high on the cause list of fatigue. Environmental influences can also play a role

In the search for possible everyday triggers for increased fatigue comes true, which applies to so many things: both too much and too little can harm and cause fatigue in addition to other health problems. This is true for sleep, exercise, eating habits, daily needs and much more. Lack makes you tired, as well as excess. However, each individual must find the right degree individually in many areas, sometimes in consultation with his doctor.

Lack of sleep: the main reason for tiredness

Many people sleep too little, one in three to four complain of pronounced sleep disturbances, be it falling asleep or staying asleep. Those who sleep badly at night feel more tired during the day, less concentrated and less efficient, but often nervous and tense at the same time. The normal daily lows are more pronounced. Sometimes a temporary vicious cycle develops into a vicious circle: when those affected try to kill the daytime tiredness with increased coffee consumption, alcohol or even stimulants. Sleep disorder, inner restlessness and exhaustion are intensified, alcohol and drug abuse is one of the possible problematic consequences.

Disturbed night sleep has many forms and is in turn a symptom that can have numerous mental and physical causes. A whole series of illnesses leads to sleep disturbances and thus to stressful tiredness during the day. Depression or anxiety disorders as well as cardiac ailments or metabolic problems are among the underlying diseases that reduce wakefulness and daytime performance.

People who suffer from sleep apnea syndrome often do not feel disturbed while sleeping. However, your sleep quality suffers considerably from the nocturnal breathing mishaps. Increased daytime sleepiness and serious health problems are the result.

Conversations with the doctor, possibly a diagnosis in a sleep laboratory help to get the triggers of a sleep disorder on track and to treat them consistently.

Not to be confused is the symptom of tiredness with the so-called somnolence of the day, narcolepsy. In this chronic illness suffer the victims of real sleep attacks, often in completely inappropriate everyday situations.

In-depth information on the forms, causes and treatment options for sleep disorders as well as helpful tips for a restful night’s sleep can be found in the guide “Sleep Disorders“.

Lack of exercise makes you tired

Those who want to get to the bottom of their tiredness should, in addition to their sleeping habits, also take a close look at their physical activities. Too little exercise is one of the main causes of many ailments and numerous studies prove this at different levels impressively. If the circulation, blood circulation and metabolism are not stimulated, joints and muscles are not required, many bodily functions go limp. Movement conveys elementary stimuli and thus directly influences the performance of all organs and body systems. Increased fatigue is the result of multiple inter-meshing disorders. This can also turn into a vicious circle. “I’m too tired” becomes an excuse to be even less active. The problems only increase.

Doing sports regularly and being physically active is not only important for healthy people. Adapted exercise programs accompany the therapeutic measures for most clinical pictures, be it heart disease, cancer or mental disorders.

However, in return, physical overwork can also be exhausted. The fatigue that spreads after an activity is usually a good gauge along with pain and other ailments here. She demands the necessary rest. Anyone who reaches the limits every now and then, but allows the body rest and gentle balancing activities, can gradually increase his fitness and ability. If a first pleasant tiredness does not result in the feeling of being fresher and more efficient than before, and if unpleasant heaviness remains in the limbs, mind and head, this usually indicates excessive demands. Then it’s time to relax, to relax, to give the strained limbs and muscles time to repair, gradually rebuild their activity and build it into their everyday lives in a modest, adapted way.

Tiredness triggers: Unilateral diet, overweight and underweight, lack of fluids

Everyone knows tiredness after lunch, especially when it was luscious, with lots of meat, potatoes and cream sauce. The sweet cream dessert as a dessert puts the heaviness on top of it. For the body then, hard digestive work is announced, he needs rest short term. This also indicates the tiredness. Only a little break and a little later the walk, then the senses are fresh and powerful again. People who like to eat a lot, rich in fat and calories often feel tired.


If they add too much weight to the scale, several factors contribute to the fact that even less effort leads to fatigue and drowsiness in the short term. Shortness of breath, increased sweating are other common complaints. Significant obesity puts a strain on the heart and circulation, the vessels, the blood composition, the joints, the metabolic and endocrine systems. There are also long-term consequences such as high blood pressure, diabetes, coronary heart disease, joint diseases, mental health problems – all diseases that can aggravate the symptoms of tiredness. Like sleep apnea syndrome, obese people often suffer from it.

Vitamin and mineral deficiencies

A one-sided diet often leads to a lack of important nutrients. These include vitamins, minerals and trace elements. For example, lack of magnesium or B vitamins such as vitamin B12, muscles and nervous system underneath and thus fitness and performance. Potassium deficiency may also have an effect here, as occurs in chronic diarrhea or vomiting.


Not only people with overweight, even those who eat too little food, lose more and more of physical and mental energy. Fatigue coupled with irritability and lack of concentration is an annoying companion, especially radical weight loss diets and a clear indication, but to switch to healthier weight loss. Practical suggestions can be found in the special “Healthy weight loss”.

If eating a little food becomes a cult, a mania that dominates life, it hides a serious mental illness behind it. Eating disorders such as anorexia and bulimia (Ess-Brech-Addiction) lead to life-threatening deficiencies. Creeping exhaustion and tiredness are only a sign of it (see chapter “psyche, nerves”).


Our body consists of over two-thirds of water. The body water is located inside and outside the cells and in the bloodstream. Our organism needs daily a sufficient amount of liquid, so that the water balance is balanced. If the body excretes more fluid than it absorbs, it not only loses essential salts and nutrients, but also the body cells can no longer fulfill many of the required functions. The blood becomes more and more viscous and thus the circulation gets worse, the blood pressure drops. The brain gets too little oxygen. Fatigue, difficulty concentrating, headaches, memory problems, dizziness, dry, “wrinkled” skin are among the many consequences if we drink too little.

Professionals recommend healthy people to drink at least one and a half liters daily. Suitable drinks are mineral waters, juice spritzers, herbal teas. The ideal amount of drinking, however, varies individually. Athletes lose more fluids and should therefore drink significantly more. People with heart problems or kidney disease need to discuss with their doctor how much they can drink daily.

Cold, heat, weather conditions increase tiredness

The alternation of light and darkness affects wakefulness, fatigue and sleep. Likewise, air pressure and temperature play a role. The body temperature itself is an important factor: it sinks in the evening at bed-time so we get tired. It rises again in the morning to wake us up. On long, bright summer days, many people stay longer in the evening, in the morning they find it easier to get out of bed. Dark, gray rain clouds tend to depress the mind and increase the need for sleep.

But even with the outside temperatures, it is usually the extremes and opposites that can affect our physical condition: frosty cold, brooding heat. If you are feeling cold, you are often tired, nervous and unfocused. In hypothermia, such as in the snow, the urge to fall asleep is life-threatening.

High temperatures slow our pace, the body sweats, thereby losing more fluid. That makes you tired and weak. Strong sunlight also irritates the meninges and sets in motion inflammatory reactions throughout the body. Tiredness, nausea, dizziness, headache occur in a sunstroke either immediately or only a few hours later. Then it says, “Get out of the sun,” lie down, raise your head and cool, for example, with damp cloths.

Weather influences: In which form the weather influences on health and well-being and thus on our wakefulness, is a much-discussed question. Not a few people complain about the weather and alleged fatigue. However, even with extreme weather changes, this can always have manifold and very individual causes.

Tiring stress in everyday life

Even the soul can become tired when worries and demands get out of hand. Increased need for sleep, listlessness, depressive mood are then clear signs that it has become too much at work or in private life.

As well as our bodily functions, mental processes also take place via the activity of neurotransmitters and hormones. The centers in the brain, in which experiences are emotionally processed, are closely networked with other areas of the brain. A mental depression changes certain nerve impulses’ in the brain and influences hormone secretion and immune system. This in turn affects different body functions. Oppressive tiredness reflects our emotional state.

Constant stress

In stress situations, all important processes in the body are prepared for the challenge. The mind is wide awake, fully focused on the task, ready to action. Stress hormones are released, the heart beats faster, the blood pressure rises. That makes sense for a limited time. If the tension persists, the hormone position postponed, certain bodily functions remain stimulated, others are throttled, which results in exhaustion on several levels. Physical and emotional symptoms are the expression of a harmful imbalance. Paralyzing fatigue, concentration and memory problems, dizziness, malaise, depression, and increased irritability indicate that body and soul desperately need a period of relaxation.


However, pronounced or subliminal tiredness does not always express that someone is overwhelmed. Even under-demand paralyzes the energies. Anyone sitting at a desk or spending hours in front of the TV without any stimulating tasks during the whole day is just as exhausted in the evening as someone who has worked for many hours under pressure but with dedication. The difference is often clearly in the quality of tiredness. Too little required, bored people often feel knocked off, dull tired, impotent and irritable. The others are tired but satisfied. They also often consciously use necessary recovery times.

Developmental and life phases in which fatigue occurs more frequently

Just as mental processes influence the secretion of hormones; biological changes have an effect on body sensation and mood. Teenagers are often tired during periods of growth. Women sometimes experience increased feelings of tiredness a few days before their menstrual period, which can be accompanied by headaches, increased irritability and, at the same time, depression. During menopause, some women feel tired and tired more often. But even older men sometimes feel the slight decline of male sex hormones. Among other symptoms, mild fatigue may be a sign of this.

Tired of environmental influences, pollutants and toxins in the workplace

Spent air

Fresh air and the oxygen it provides, among other things, are well-known pick-me-ups. Oxygen deficiency plays a role in fatigue, but it does not affect the so-called used air in enclosed spaces. Here it is rather too much carbon dioxide. We exhale carbon dioxide as the end product of the oxygen change. This is why it increasingly accumulates in un-ventilated, closed rooms. If we breathe in too much of it, symptoms such as tiredness, dizziness, headache, shortness of breath show up. It is dangerous if there are more gases and dusts in the room air, especially carbon monoxide. Then it can lead to serious, life-threatening poisoning, for example in flue gas development.

In order for us to feel fresh and efficient, the right humidity is also important. Dry air irritates the mucous membranes of the respiratory organs and dries them out. They can no longer effectively catch irritants and pathogens. A weakened defense makes you more tired and leads to more infections. Excessive humidity puts a strain on the organism, especially in the heat. Fatigue is just a sign (see above).

Toxic substances in the home and at work

Strong cleaners or solvents often contain hydrocarbons. People who work with it frequently must take special precautions. Hydrocarbons are also the basis of many paints and adhesives, wood preservatives or insecticides. They can lead to intoxication, for example, when people inhale solvent fumes, causing increased fatigue, headache, dizziness, and drowsiness. Skin contact may cause skin damage and inflammation.

The highly toxic benzene belongs to the hydrocarbons and is found in crude oil and its products, in car exhaust, but also in tobacco smoke. It is carcinogenic and damages the kidneys and liver in increased concentrations.

The highly toxic substances include carbon monoxide. It can escape from open fireplaces with poor smoke extraction or poorly insulated gas stoves, even in a private home. Possible symptoms of poisoning include fatigue, nausea, headache, dizziness (see above).

Sustainable damage sometimes causes a long-term use of lead and lead-based funds. It is inhaled or enters the body via contaminated food and hands. Lead attacks, among other things, the nervous system and blood formation, as well as stomach, intestine and kidneys. In addition, it can damage the embryo during the first weeks of pregnancy. Colonic abdominal pain, intestinal spasms, headache, nausea, vomiting are typical symptoms. Anemia caused by lead often indicates pale skin, persistent fatigue and fatigue.

Other pollutants that may be responsible for dizziness and headaches as well as fatigue are substances containing heavy metals. They are sometimes considered carcinogenic. If the aniline used as a dye enters the blood, it damages the blood pigment hemoglobin and hinders the transport of oxygen in the blood. Bluish skin and fingernails, dizziness, severe fatigue and headache may be signs of acute toxicity. The person concerned must be examined and treated promptly in a toxicology department (usually in a university hospital).

There is controversy among professionals and amateurs over how amalgam can be responsible for increased fatigue and performance degradation. Since there is no clear scientific evidence for this, physicians consider, among other existing complaints, other influencing factors in the environment of affected patients.

If there is evidence that ongoing fatigue is due to occupational injury, those affected should contact their doctor at an early stage. This will involve the professional association or occupational physicians and initiate appropriate diagnostic steps.

Recent Content