10 health issues that could be the real reason you feel tired all the time

It could be one of so many things
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Between work, your social calendar, trying to exercise regularly, and just life in general, it's not surprising that you feel tired all the time. That's just part of being an adult who (unfortunately) doesn't get to take regular naps like you did as a kid. But there's a difference between feeling tired because of all the things going on and feeling consistently wiped out.

Normal fatigue gets better with proper rest, but it's not normal to feel persistent fatigue for more than a week, miss work and social engagements because you're tired, or need excessive caffeine to get you through the day, Jenepher Piper, M.S.N., a certified registered nurse practitioner practicing family medicine at Hunt Valley Family Health, an affiliate of Mercy Personal Physicians, tells SELF. If you're experiencing those symptoms, you need to flag your fatigue to your doctor.

There's also a difference between being sleepy and being excessively fatigued. “Sleepiness is simply the drive to sleep. Falling asleep during concerts, sales meetings, or intercourse are sure signs of excessive sleepiness,” board-certified sleep medicine doctor and neurologist W. Christopher Winter, M.D., of Charlottesville Neurology and Sleep Medicine and author of the upcoming book, The Sleep Solution: Why Your Sleep Is Broken and How to Fix It, tells SELF. And, of course, there's also fatigue that falls somewhere in between, like feeling totally wiped even though you know you got enough sleep.

If any of this describes you, don't freak out and assume you're seriously ill—there are a bunch of different reasons why you could be dragging ass lately, some more serious than others. Here are some fatigue-causing health issues that should be on your radar:

  1. It could be PMS.

You probably associate premenstrual syndrome with crankiness and bloating, but fatigue is also a big part of the symptoms. “Feeling tired, even to the point of fatigue is a common symptom of PMS,” says women's health expert Jennifer Wider, M.D. The fatigue part is caused by a few different factors that create the perfect storm of tiredness, she says, including hormonal fluctuations, bloating, and sleep disturbances.

  1. You have seasonal allergies.

When you have seasonal allergies, you're constantly trying to keep wheezing, coughing, and a runny nose at bay—all of which suck. But that requires your immune system to be in high gear to fend off allergens, Piper explains, and can leave you feeling wiped as a result.

  1. You're still getting over a virus.

When you start to feel better after having a virus, it makes sense that your energy levels should rebound at the same time, too. But unfortunately, it can take a little time. Your immune system works really hard to fend off an infection and that requires energy, Piper points out. As a result, you can still feel a little run down, even as the rest of you is feeling better post-sickness.

  1. You might be depressed.

A huge part of depression is feeling helpless and hopeless, and that can drain your energy, licensed clinical psychologist Alicia H. Clark, Psy.D., tells SELF. Depression is often associated with changes to your sleep patterns, including sleeping more or experiencing insomnia (which can also make you tired). “If you aren't sleeping well then you may be more tired, and in turn have more trouble sleeping,” Clark says. “Insomnia and mental health challenges are closely related and can exacerbate each other.” If you're feeling fatigue alone, don't assume it's depression, but if you're also having persistent feelings of sadness, low self-esteem, changes in appetite, and difficulty concentrating, talk to your doctor.

  1. It could be celiac disease.

You probably already know that people with celiac disease can get diarrhea, gas, and vomiting if they ingest gluten, but it can also cause people to feel weak or fatigued even without gastrointestinal issues, according to the Mayo Clinic. If you notice you don't feel great after having wheat, barley, or rye products, talk to your doctor about getting tested for celiac disease.

  1. You could have sleep apnea.

If you stayed up all night watching OITNB, it makes sense that you'd be tired the next day. But if you got nine hours of sleep and are still struggling, it could be a sign of sleep apnea, says Dr. Wider, which is a potentially serious sleep disorder where your breathing stops and starts during the night. “Sleep apnea upsets the restorative nature of sleep, so fatigue is often seen with poor quality sleep,” Dr. Wider says. Unfortunately, since you're sleeping when you experience sleep apnea, it can be tough for you to know if you're actually suffering from it. But if you're feeling fatigued and are still getting a ton of sleep, this should be on your radar.

  1. You could be suffering from anxiety.

Sure, everyone experiences some degree of anxiety on a regular basis, but clinical anxiety is persistent. And, according to the National Institute of Mental Health, it can leave you exhausted and plagued with sleep disturbances. “Anxiety in particular can be draining,” Clark says. If you suspect that you're suffering from anxiety, it's a good idea to reach out to a mental health professional for help.

  1. It could be chronic fatigue syndrome.

Chronic fatigue syndrome is a complicated disorder that causes extreme and unexplained fatigue. It may get worse with physical activity but it doesn't get better when you rest, according to the Mayo Clinic. There's no test to diagnose this, but doctors typically reach a diagnosis once other medical conditions like depression and sleep disorders have been ruled out.

  1. You could have a thyroid condition.

Your thyroid helps impact several important functions of your body, including how fast or slow your heart beats and how well your bodily movements flow, Piper says. Having an underactive thyroid, a condition known as hypothyroidism, can slow down your bodily functions and leave you feeling tired, she says. On the flip side, hyperthyroidism, which is when your thyroid is overactive, speeds everything up and can cause insomnia and an inner restlessness that makes it tough to relax—leaving you wiped out as a result.

  1. It might be anemia.

Anemia happens when you don't have enough healthy red blood cells to carry adequate oxygen to your body's tissues—and having anemia can leave you feeling tired and weak, according to the Mayo Clinic. Other symptoms can include pale or yellowish skin, shortness of breath, and cold hands and feet. If you have one or several of these symptoms together, talk to your doctor. Anemia can often be resolved by taking an iron supplement, but a medical professional can guide you on next steps.

This article originally appeared on Self.com