I am soooooooo tired and I don't know how to fix it.

[Topoftherange]

Admittedly, I have been really quite stressed for a long time and it's getting worse and sadly not currently something 'fixable' but everything combined is having such a detrimental effect on my energy levels and I just want to sleep all the time.

I am 53 next month and have been in peri for many years. I also have endometriosis, adenomyosis, IBS, adhd and a history of depression and anxiety so I know that I struggle but no matter what I do to help myself I just can not fix this overwhelming exhaustion and it is really punching the life out of me.

I go to bed exhausted, my sleep is either really deep and satisfying or the complete opposite and restless as hell (although, tbh it has been the latter for a while now). I wake every day with high anxiety for the day ahead, I do not wake refreshed at all and feel like a zombie until around midday. I will get a few hours in the early afternoon when I may feel a little more human-like then crash again towards the end of the day (I only work a few hours a week and then it's not until the afternoon). I constantly battle the urge to fall into a deep sleep around 7pm, if I do this then I can't sleep when I do go to bed but often I am just too knackered to fight it so that becomes a no-win situation.

What can I do? Obviously everything is a million times worse at this time of year but do try to be healthy, I eat as well as I can (although can be a bit difficult with daily digestive issues), make sure I avoid any known trigger foods, I have protein with every meal and I only drink water. I walk for around an hour a day (split into two smaller walks) with my dog over fields and woodland and have to really push myself most days as I feel wobbly and drained. I am not overweight. I don't take any meds which could leave me so tired, in fact I currently take no meds only co-codamol or paracetamol a few times a month for my endo/adeno pain and peppermint oil sometimes for my gut issues. I try to combat my stress with daily relaxation techniques, hypnotherapy and have just finished my last counselling session (I have had quite a bit of counselling over the last few years) but none of this helps.

I was anaemic for many years but following iron infusions and a gynae op to stop my bleeding 4 years ago my iron levels have now returned to normal, including ferritin which had previously been at 3 for years. I had a full blood panel taken at the end of summer last year and all results returned as normal. Normal levels for iron, vitamin D, B12, folate, FBC etc. Thyroid levels are all normal too.

I honestly don't know what else I can do for myself to combat this exhaustion? Alongside the restrictions of my current chronic health issues I am finding this exhaustion and malaise just too much.

Any suggestions? I know there is little I can do about some of my chronic health issues and certainly not with my source of current stress sadly (my mum is terminally ill with advanced dementia) but I just want to be able to get through the day without desperately wanting to go to bed.

Are you taking medical treatment for the perimenopause, adhd or depression/anxiety? If not can you consider these?

I have trialled hrt but it worsened my endo pain so had to come off. I have also tried lots of anti d's (Escitalopram, Sertraline, Fluoxetine and Amitriptyline) but they all made my gut issues worse. It's so frustrating because I am desperate for something to stick and work/help.

‘Normal’ blood test results aren’t always optimal. Could you post your actual figures here and that might shed some light?

exactly this! The range of "normal" is huge and at the bottom end of the scale it's often not enough to stop people feeling crap, particularly if a couple of measures are low or you've other health conditions. I spent years with heavy bleeding and being told my iron levels were normal but have only recently got my hands on the numbers and they were completely at the bottom end of normal while I was trying to exercise 6 days a week and marathon train!

Are you overweight?
Do you exercise hard regularly?
How much sleep do you actually get and do you have a regular bedtime, and wake up time?
What is your diet like?
What is your social support like?
Do you have something to look forward to this week, and month, and year?

Do you do exercise? I'd start with finding a good restorative yoga class and having a walk in the daylight for 20 minutes a day if you can. Yoga and mediation, breathwork, anything like that reduces cortisol and the fight and flight response, getting the parasympathetic nervous system going. I started in earnest at 42 when my dad was very ill and I was very stressed about that. It has helped me MASSIVELY through losing both my parents in the last eight years. The app Headspace also helped me before I did yoga regularly.

Also if you can have just one session with a good dietician they could probably help with some supplements and look at your your food diary. Nutracheck I'd also recommend to record your food and have a look at your macros. Sleepstation who sorted me out with their sleep course when I was desperate and hardly sleepng at all. Also do you have a partner of could record yourself sleeping at some point? You may be having sleep apnoea for similar.

I felt like this in my late 30s/40s. Work stress was also a huge factor for me and changing my job helped no end. If it helps, I don't now feel like that at 50.

MiddleAgedDread WhisperingJesse

Thyroid
Serum TSH 1.47 range 0.27-4.2
Serum Free T4 13.6 range 12-22

B12 326 range 197-771
Folate 3 no range given
Vit D 61 no range given
Ferritin 61 range 30-200

I had questioned if my B12 might need boosting and if the folate was low but GP said all was fine.

I had a couple of sessions with this lady in 2017- she's based in London but does online consultations.

https://www.carolinefarrell.com/

I wasn't going that wrong with diet but it really helped.

I am 5 foot 6 and weigh 9 stone so normal weight
I can only manange the hour dog walk per day
I go to bed at 10.30 and wake at 7.30am but I dream a lot and wake a lot also
Diet is good, due to my gut issues I usually make my own food
I have a dh, dc, dsis and a best friend who are there for me - I help care for my parents as mum is in advanced dementia and dad struggles but we do have carers in daily

I have nothing to look forward to tbh, I find life difficult atm as I have been in this 6 year long linbo land with living grief for my mum as is the case with most dementia cases, I won't lie, it's my biggest source of stress in my life atm.

OP, if you are in UK, NHS 'normal' levels of lots of nutrients are really substandard. I would definitely try adding Vit D, B complex and iron supplements to your daily food. Go for a veg-based iron supplement in liquid form or those grains in capsules - it's gentler on the stomach than the pills which caused constipation.

If you are already diagnosed with ADHD, consider getting medication for it. My exhaustion has gone. I used to drag around, ready to fall asleep at any moment. Since finding the right dose of ADHD meds, tiredness is never an issue any more. It makes such a difference.

Also, IME, all those years of antidepressants (when i should have been taking ADHD medication - wrong diagnosis) really play havoc with your fatigue. Citalopram left me happy but completely doped up and sleepy all day long. And even after coming off it, the after effects lasted.

As I've mentioned in my OP, I walk my dog over fields and woodland every day.

I used to do a lot of yoga and really need to take it up again. I do meditate with the Calm app every day, I do find it very relaxing but it sadly hasn't had much impact on my issues throughout the day but I still do it as I very much enjoy it.

Sadly, as I am on carers allowance and only work minimal hours atm I can not afford to see anyone privately, I have to rely on the NHS and my GP.

Oh love, that sounds so tough. Can you try to squeeze some micro-pleasures into each day. Put on your favourite music when prepping food or when you are in the bath, or when you wake up and do those morning jobs of emptying dishwasher, prepping breakfast etc? I find everything from Bach or soothing piano music to the rock and pop I loved in my teens is a real mood booster.

Can you take five minutes several times a day. Make coffee or tea but instead of swigging it while rushing to do other things, sit and savour it. Maybe read a poem or do a 5 minute meditation.

First thing in the morning, go out, feed the birds, take a deep breath and a couple of stretches, whatever the weather, just connecting with nature.
Try to catch a moment at sunset to watch the sky.
Last thing at night take a minute to look at the moon and stars.
Take 2 minutes to play with the dog.
Make a list of uplifting TV shows, films, podcasts, comedians stand up routines and watch these instead of the endless volume of terrifying news and grim crime dramas. Same with books. Find mood-boosting comic or feel good novels and memoirs, poems and self-help books.

I used to do these things all the time and thought they had no effect. But i stopped and last year realised I was really mentally run down. I am starting to do these again and the difference is noticeable.

You say that your diet is good, but what does that look like? What are you eating/drinking each day? And what sort of quantities?

Sleep apnea?

What is your carb intake like? Can you request a HbA1c test?

Thank you. I will have to look into getting some supplements as it really is knocking me down right now. I will have a look online.

I was only diagnosed with ADHD last year and was put on Elvanse but it gave me awful migraines and diarrhoea so the assessor advised me to come off it. She never offered me an alternative so not sure what others are available, as it was via right to choose I'm not sure if my GP can advise me?

I adore music and currently have Classic FM playing on my Alexa, I do find it very soothing. I swap between that and Greatest Hits as I do love my 80's music too.

I bought myself a gratitude journal last year, I really need to dig that out and start writing some positives every day, I will admit that I have a tendency to dwell on the bad and gloss over the good things I have going on.

Thank you for the great tips x

Put blood results into Chat GPT - it showed me that although a few of mine were in the normal range they were below optimal for energy for a woman of my age. Melatonin and magnesium at night help with sleep.

So, breakfast is usually around 10am (can not face anything before as my IBS is at it's worse in the mornings), I usually have either home made gf potatoe farls and some left over meat from dinner or homemade gf toast with peanut butter and avo (I follow the low fodmap diet).

Lunch is often a homemade soup or a gf orzo pasta salad with turkey or salmon and dinner will be fish, turkey, beef and potatoes and veg. Nothing over the top as I have to be very careful with my digestive issues.

I try to drink lots of water throughout the day and will occasionally have a mint or green tea in the evening or more mint tea is my tummy is very bad.

I don't over eat either as I get full quickly but try to eat every 3-4 hours. If I go any longer then I will suffer from weird low blood sugar type symptoms where I will get really shaky, light headed, burp loads (??) and feel very anxious.

That's not something I have ever considered, how would I go about finding out? What are the symptoms? Off to google!

I do have a fairly high carb intake I suppose but as I can not tolerate dairy, eggs, chicken, legumes or too much red meat I can't go too low carb as I would end up eating very little.

I had my HbA1c test last July it was 5.2% with the range being 4-5.9% so came back as normal.

Thank you, I will ask Chat GPT.

That folate level is shockingly low. The range is usually 3-17. It needs to be at LEAST 7 for your body to be able to utilise the B12 you get from your diet. Optional is upper quartile of the lab range (unusual yours doesn’t have a range in it, never ever seen that on folate or vitamin D - D can be toxic if too high so there should be a range on it). Your B12 could be a false high due to the low folate. Ideally you want to take 5mg folic acid daily for a month, then retest B12 and folate.

Had you taken any supplements containing B12 in the 4-6 months prior to that blood test? Even a single multivitamin 4 months before can cause you to get a false high result.

Your vitamin D isn’t the worst I’ve seen but it isn’t optimal either. In the UK, pretty much everyone should supplement vitamin D on the winter months as a minimum as you won’t be getting enough.

Ferritin looks good, although not optimal - but certainly not low enough to make you feel rough.

Are those results from last summer? If so, all if your levels could have dropped further. Ideally you need a new panel of bloods taking.

I felt like you did a few years ago. Although I was falling asleep at my desk whilst working, I was sleeping 16-19 hours a day. I could barely make it through work. Luckily I discovered B12 injections. I went onto every other day injections and after 3 weeks (plus full cofactors) I was like a different person. It took a few months to start to feel normal, and I stayed on them for over 2 years as I was still seeing an improvement in my symptoms. My B12 was in range at two hundred and something - I didn’t know supplements affected the results - luckily my doctor was prepared to try me on injections. When I saw they were helping a little, I bought my own from Germany to self inject. When my doctor saw me after those 3 weeks, she couldn’t believe I was the same woman in her office and immediately prescribed them for me to continue. My folate was showing as <3, my vitamin D was also showing as less than the bottom of the range, my ferritin was dead on the bottom of the range, and my thyroid levels showed i likely had an under active thyroid (with a family history of under active thyroid too). It seems my body is just crap at absorbing vitamins from my diet. So I now supplement regularly. I’ve just restarted iron tablets though as I stopped when my levels got to around 300 - but I’ve noticed I’m exhausted again so I’ve started taking it all once more.

Good luck. I felt like I was dying and that I must be really ill. To find it was “just” vitamin deficiencies was shocking as I genuinely didn’t think they could make you that unwell.

Long covid? Or other post viral thing?

OP, you are saying:

”I don't over eat either as I get full quickly but try to eat every 3-4 hours. If I go any longer then I will suffer from weird low blood sugar type symptoms where I will get really shaky, light headed, burp loads (??) and feel very anxious.”

This reminds me very much of myself, especially the burping (do you feel better after it?) and I subsequently got diagnosed with a hiatus hernia, via gastroscopy.

It can cause all sorts of really weird symptoms, I still get some, but I know what’s causing it and therefore can handle it (it is purely mechanical, so to speak), so the anxiety has gone. At times I felt so bad and weird that I was close to panic attacks. I was put on a low dose PPI, and that keeps it mostly at bay.

Maybe something to look into - even though I’m not sure if it would help with your fatigue.

Good luck!

(edited for spelling.)