Aberdeen GP Rosalind Adam and her colleagues are dealing with more people than ever reporting extreme tiredness, even taking into account their increased workload. “The thing is, we are seeing so many patients a day now,” she said.
Research suggests that 5%-7% of people seeing their family doctor complain about fatigue, said Adam – already an enormous number given the 300m GP appointments in Britain each year – “but I think we are just seeing the tip of the iceberg”, given many patients will focus on other complaints first. And that doesn’t count those soldiering on at home – or the ever busier GPs having to deal with ever more patients.
Everyone, it seems, is absolutely shattered – and it’s doing us no good at all. We know we ought to be exercising and eating well to keep healthy and help us sleep, but as a survey published this week revealed, one of the main reasons Britons don’t live healthier lifestyles is because – oh the irony – they are too tired.
Tiredness matters. Economically, the cost to the UK economy of sleep deprivation has been put at £40bn a year. The number of Britons too sick to work at all is at a record high, ONS figures published this week revealed, boosted in part by those suffering from long Covid, which is often characterised by debilitating chronic fatigue. The cost of living crisis means more and more children are turning up at school tired and hungry, with almost nine in 10 teachers saying some of their poorer students are too exhausted to concentrate in class.
Personally, too, tiredness from lack of sleep can be devastating, said Lisa Artis, deputy chief executive of The Sleep Charity, which runs the national sleep helpline. “Sleep has this huge impact on physical, mental and emotional health and well being,” she said. “It impacts on relationships or relationships between partners, it can impact in families, it can impact with friends and colleagues.”
What’s going on? Part of the challenge in talking about or measuring the problem is that all tiredness is not the same. A bout of crippling sleeplessness due to acute stress is very different to months of exhaustion from lone parenting small children; neither has much in common with chronic fatigue, which is often unrelieved by rest. And yet all can be devastating to those experiencing them.
Extreme tiredness can be a symptom of many conditions including heart disease, head injuries, cancer and depression – which is why you should see your doctor if it doesn’t resolve – but in many cases lifestyle factors are important too, “and we do find that sometimes just sitting down with somebody and systematically going through things and what might be contributing can be really helpful for them”, said Adam.
And yet medically speaking, she said, fatigue is so poorly understood, doctors don’t even have an agreed definition. They also have very few options for treating a problem that, for many, will not be solved by a lavender-scented bath or going to bed an hour earlier.
For that reason, Adam is leading a major new study with Aberdeen university and others into the daily lived experience of those suffering from fatigue, in the hope it may shed light on the different types of extreme tiredness, and potentially the best ways of addressing each. “[Our patients] are just so keen to gain insight into patterns in their fatigue and what might be causing it.”
Identifying a single cause for our collective exhaustion may be impossible, but there are a few unsurprising contributors. Serious mental health problems – often associated with extreme anxiety and sleeplessness – have exploded in adults and children in recent years, with the pandemic and cost of living factors identified as key factors. Poverty is significant here – people in the poorest areas are more than twice as likely to need mental health services as those in the richest.
There is plenty of anecdotal and scientific evidence, too, of the link between the time spent on screens and increased tiredness. “The chaoticness of our daily lives, and the constant connection we have to technology does mean that we really sort of struggle to decompress at the end of the day,” said Artis.
But longer-term changes to the way we live and work also play a part. Recent research by the Resolution Foundation found that while British workers have become more positive about a range of aspects of their jobs, the proportion saying their work is always or often stressful rose sharply from 30% in 1989 to 38% in 2015. Almost a third say they now feel “used up” by the end of the working day, a proportion that increased by almost half between 1992 and 2017.
Could the pandemic-driven changes to many people’s working patterns offer a chance to mitigate workplace exhaustion? Researchers at the London School of Economics are examining how hybrid working – which relieves many workers from the need to be in an office five days a week – affects wellbeing, tiredness and levels of burnout. Even dispensing with the commute a few days a week could be significant, said PhD researcher Alexandra Kirienko.
“If somebody can go directly to a client meeting from home in the morning, instead of popping into the office for 30 minutes, it definitely cuts down on tiredness because the commute is a giant source of stress and fatigue,” she said. While some value commuting time as a buffer between home and work, studies have found the ideal duration to be just 16 minutes; increasing that by just 20 minutes brings a sharp drop in measurable standards of wellbeing.
As for what to do about our tiredness, in the absence of other significant factors, said Artis, “the advice doesn’t change, it’s quite boring”. Try to eat well, exercise during the daytime if you can, think about your alcohol and caffeine intake and your screen time, think about what helps you to relax. Ask for help if you’re struggling. Rest.
“The best sort of tip I can give to anyone is, don’t overthink sleep,” she added. “Because the more you overthink it, the more stressed and anxious you will feel at bedtime. And going to bed should be one of the loveliest things that you do.”