Many people experience fatigue every now and then. An NIH study showed that 38% of U.S. workers reported feeling fatigued. Despite the fact that fatigue is not something you should expect to experience as you grow older, many women at midlife complain about fatigue. Most of the time fatigue is related to something that is going on in your life. When this is the case, getting a good night’s sleep, eating a well-balanced diet, and exercising can usually help you get your energy back pretty quickly.

However, constant or debilitating fatigue can be a symptom that something else is going on. For example, sometimes fatigue can be the first symptom of a medical condition such as sleep apnea, hypothyroidism, pain, arthritis, diabetes, heart disease, and even cancer. Feeling constantly run down and tired could also be due to adrenal fatigue. Plus, medications and medical treatments can cause fatigue as well.

When to See Your Doctor about Fatigue

If you have a medical condition, take medication, or are undergoing treatment for an illness, be sure to speak to your health-care provider about whether fatigue is a side effect of your condition, medication, or treatment; and ask what you can do to have more energy.

If you suspect that your fatigue is due to an undiagnosed health problem, see your doctor. Before your appointment, keep a fatigue journal so that you can accurately remember the level of fatigue you are experiencing when you typically feel tired, and any activities or circumstances that may be contributing to your fatigue.

If you are healthy and still experience fatigue on a regular basis, you still may want to check in with your health-care provider to uncover possible causes of fatigue. Often, the causes are lifestyle-related, so it may be time to make some changes.

When Fatigue Is a Symptom of Your Life

If you are constantly tired even after a good night’s sleep, it may be time to make some lifestyle changes.

Here are 9 common causes of fatigue and how you can combat them:

1. Stress. Stress can be caused by work, family, money, or feeling you have no control over your life. When you’re under stress, your cortisol levels rise, and your body goes into fight, flight, or freeze mode. When you’re chronically stressed, cortisol continuously floods your body, keeping it in overdrive. Eventually, fatigue sets in, and your immunity plummets, making you more susceptible to infections as well as cellular inflammation.

2. Lack of quality sleep. While sleep disorders, including sleep apnea, can cause fatigue, having poor sleep habits is often the main reason you can feel tired.

3. Sedentary lifestyle. Being a couch potato contributes to fatigue in several ways. People who are sedentary typically have higher levels of cortisol, which is linked to insomnia. In addition, a sedentary lifestyle can lead to an increased heart rate and lower oxygen consumption, causing fatigue. Finally, people who sit most of the time have weaker muscles, causing them to use more energy and feel more exhausted when performing daily tasks.

4. Unresolved emotions. Negative thoughts and emotions such as fear, anger, and grief, when held too long, can trigger a stress response. In excess, this stress hormone cascade can make you feel drained.

5. Too much caffeine. Drinking too much caffeine, especially late in the day, can keep you from getting a good night’s sleep and lead to next-day fatigue and the desire for more caffeine. As your body becomes accustomed to needing more and more caffeine during the day and then not sleeping well at night, the cycle can contribute to a constant low level of fatigue.

6. Poor diet. Eating highly processed foods that are high in calories and added sugar and low in nutrients spikes your blood sugar. This causes insulin to surge, leading to a quick drop in blood sugar that makes you feel tired and hungry. Over time, a poor diet can slow your metabolism and even lead to insulin resistance.

7. Menopause. Many perimenopausal and postmenopausal women complain of fatigue. Often this is due to a combination of changing hormone levels and increased life stresses that together can cause a lack of sleep with night sweats and anxiety.

8. Drinking alcohol. Alcohol has an initial sedative effect, but it can disrupt your sleep and lead to fatigue. Several hours after ingesting, alcohol stimulates your body by raising stress hormones and increasing your heart rate, leading to poor sleep quality. This is why having a couple of glasses of wine in the evening may put you to sleep only to cause you to wake up around 2:00 AM and make it hard for you to get back to sleep. Alcohol also acts as a diuretic, which can cause you to wake several times per night to urinate.

9. Energy vampire relationships. Fatigue is a common symptom of being in an energy vampire relationship and can lead to a whole array of physical ailments that do not respond well to medical treatments until the relationship is addressed.

13 Easy Ways to Combat Fatigue

1. Engage in activities you enjoy. Doing something you love on a regular basis can energize you. Think about what interests you, then participate in that activity once per week until it becomes a regular part of your routine. You may want to take a class, volunteer in your community, or join a book club or a walking group.

2. Develop a relaxation practice. Stress causes fatigue. We feel stress when we believe we must do something that contradicts our core values or when we wish that something is different from what it is. Developing a relaxation practice, such as gentle yoga, meditation, or Tai Chi, can help you tap into your true self so you are more able to notice where you might be doing too many things on a day-to-day basis that goes against what you hold important. Reading books such as Eckhart Tolle’s The Power of Now can also help.

3. Keep a journal. Writing down your daily routines and when you feel tired can help you discover patterns throughout the day including anything that you are doing or not doing that might be associated with your fatigue.

4. Say “no” to empty calories. You are what you eat. Nourish yourself with real food, and avoid highly processed foods and sweets, which have few nutrients and are high in fat and sugars. Be careful of fad diets that can leave you feeling tired. And don’t deprive yourself. Use the 80-20 rule so you can stick with a healthy diet long-term.

5. Avoid long naps. Short naps can sometimes make you feel energized. But if you regularly take long naps (30 minutes or longer)—especially late in the day—it can leave you feeling groggy. Long naps can also make it harder to fall and stay asleep during the night.

6. Ask for help. Feeling overwhelmed can lead to stress and fatigue. One of the most empowering ways to break free from overwhelm is to ask someone for help. Plus, when you allow others to help you, you are able to get things done faster and even have fun.

7. Exercise regularly. Regular exercise can increase energy levels, even among people suffering from medical conditions that cause fatigue. Plus, exercise can help improve your mood and make you feel mentally more energized. In addition, low- to moderate-intensity exercise helps decrease stress hormones, which can help you sleep better so you feel more refreshed the next day. Choose activities that you enjoy. For example, you can take a short walk during your lunch break or try a yoga class. The important thing is to find something that you can do regularly. Just don’t overexercise, which can tax your adrenals. Listen to your body.

8. Remove clutter. Clutter literally increases your cortisol level! When we have a lot of clutter in our homes, it has the effect of distracting us and can even cause chronic restlessness, weigh you down emotionally, and cause fatigue. While I’m a huge fan of the KonMari method of tidying, I realize that sometimes this method is not feasible for everyone. If you are not able to discard clutter and organize your space in one session, try cleaning up a small cluttered area, then notice your mood and energy level. I personally make sure that my kitchen and sink area are clean and organized before going to bed even when I haven’t managed to clear clutter in the rest of the house. That one focus of order does me a world of good!

9. Resolve unhealthy emotions. There are many ways to release negative emotions. Some techniques you can try include tapping (EFT), energy-clearing modalities, and using Divine Love Establishing a mindfulness practice, such as RAIN, can also be a great way to acknowledge and release difficult emotions. RAIN stands for: (R) recognition of the negative thoughts arising; (A) acceptance of their existence; (I) inquiry into their underlying nature (The inquiry is a contemplative process. You can inquire into how you are experiencing the emotions in your body or what these emotions are causing in your life.); and (N) nourishment of self, where you detach from, or stop identifying with, the negative emotion. Another great tool is cognitive-behavioral therapy (CBT). One of the very best ways to off-load stress is to express how you feel creatively. You can try writing, singing, dancing, painting, or acting out your fatigue and emotions. This takes the energy out of your body and leaves you feeling much more energized. I did something called “process painting” for about a year. There is nothing like putting on soothing music and simply putting paint on canvas or paper with no prior plan. It’s very therapeutic. I even sold one of the paintings!

10. Develop a bedtime ritual. Establishing a bedtime ritual can help you combat fatigue caused by lack of quality sleep. Some things you can do as part of your sleep ritual include turning off all electronics at least an hour before you go to sleep, taking an Epsom salt bath with lavender essential oil, avoiding difficult conversations, going to bed and waking up at the same time every day including weekends, avoiding caffeine and alcohol close to bedtime, and making sure your bedroom is the right temperature.

11. Do a short detox. If your liver isn’t functioning well—whether due to medications, dietary stress, alcohol use, or everyday low-level toxin buildup—you can experience fatigue. Along with eating a healthy diet, you may consider trying a short detox cleanse.

12. Balance your hormones. At perimenopause, skipping ovulations and having progesterone levels that are very low and estrogen levels that are high can cause your body to convert estrogen into stress hormones. Hormone support—either via prescription or herbs like Pueraria mirifica—can help while you work on the other aspects of your life that may be contributing to fatigue.

13. Get out in the sun. Sunshine in a nutrient and can help fight fatigue in a couple of ways. Sunshine increases serotonin Higher serotonin levels are associated with improved mood. When you are happy, you typically feel more energetic. Regular sun exposure also helps in maintaining a normal circadian rhythm, so you are more likely to experience restful sleep and have more energy when you awake. If you are using a full spectrum light, be sure to avoid excess exposure and don’t use it at night. This could suppress melatonin production and disrupt your sleep.

Do you experience fatigue? If so, what are you doing to improve your energy levels?