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We’re always striving to be faster, stronger, better and more, but there are consequences of this. We have less downtime leading to us being chronically tired and fatigued which can lead having a huge impact on your entire life.

It’s normal to feel tired or even sleepy at times, however, it’s not normal to be fatigued.

But what are the differences between fatigued, sleepy, and tired?


Tired is something that we experience everyday that’s alleviated by rest and sleep. By contrast, fatigue is pathological and something that can catch up with you, which can change the way that you partake in every facet of your life. Being fatigued on the other hand, is very different from being tired. It is akin to saying to someone who is depressed, “I can feel sad too”. Depression is more than being sad, it is a feeling of hopelessness with no direction to take in life. Likewise, fatigue is more than just being tired.

Naturally, we all become tired in our day to day as we push our goals in work, rest, or play, however, a good routine and a balance of good quality rest, exercise, sleep, meals and play can lead us feeling refreshed and ready to take on the next day.

When we become very tired, we often become sleepy and differentiating between this and fatigue can sometimes be a challenge. Sleepy is having head nods, being unable to hold you head up or keep your eyes open. Although we can sometimes be sleepy it can be a challenge to get to sleep.


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If you’re having trouble sleeping, there are four areas we should always investigate. These are thoughts, environment, behaviours, and physiology.

  1. Thoughts is how we think. It does not have to be negative, it can be positive too, it can just be our minds being excited as often when going on holiday it can be hard to sleep the night before.
  2. Environment refers to whether it’s loud, a comfortable bed, too hot or cold.
  3. Behaviour is around your wind down, or sleep hygiene which is the term used for ‘clean’ sleep habits. Keeping it simple is the key and it may be reading a book or cleaning your teeth.
  4. The fourth refers to our physiology which is how our bodies react to sleep.


When it comes to sleep physiology, there are three major parts that we need to look after.


  1. Sleep rhythm. This is not how we move in our sleep but the time we go to bed and wake which is regulated by melatonin and serotonin. Generally, this is not a problem for most people, however, the most common problem with rhythm is shift work and jetlag. Often having jetlag can lead to being fatigued.
  2. The second problem that we see with sleep is a high sleep drive. Sleep drive is regulated by the amount of time you are awake and that you are asleep. For example, if you are an 8-hour sleeper, then it’s a 2:1 ratio. So the 2 hours that you are up, you create one hour of sleep drive. In addition to this, the amount of physical and mental activity that we do also increases our sleep drive. This means that no matter what we do, eventually we will fall asleep due to an increased sleep drive.
  3. The third and most common problem we see is wake drive which refers to the body being highly stimulated. Think about having five cups of coffee and trying to sleep! Often if we have played sport, have had something on our mind or had a very busy day at work then our mind and our body can be overly stimulated. This increased wake drive can make it challenging to fall asleep and can also lead to reduced quality sleep.


Oddly enough, a high wake drive is common in people with fatigue, and remember fatigue is not tired, nor sleepy. Unlike being tired or sleepy, fatigue is not alleviated by rest and it is an urgent sign that we need to take action. Fatigue is often referred to as feeling similar to jetlag, carrying an extra 20 kilos or getting off of a Velcro couch.

Now to understand fatigue, we need to think of it as a multi-system problem. This means that every system in our body can contribute towards a feeling of fatigue. Think about having a flu or a cold, the immune system can contribute to a feeling of fatigue. Likewise, our temperature regulation, hormonal changes, and inflammation can often lead to fatigue as well as pain.


If you have started to regularly feel fatigued, it’s a sign your body needs help. If fatigue persists, it’s very important to see your doctor, as there is a large range of different conditions that may contribute towards fatigue. These being thyroid function, food intolerances, immune conditions, or syndromes such as Chronic Fatigue Syndrome.

Chronic Fatigue Syndrome is a physiological disorder characterized by post exertional malaise (PEM). This refers to when a person either physically or mentally does too much activity and leads to exacerbation of their symptoms which can be fatigue, muscle or joint aches and pains, a sore throat, tender glands, unrefreshing sleep and dizziness.

So what do we do with fatigue? If you’re finding that you’re fatigued and there is not a good reason for it, then it’s essential to take care of yourself and have a balanced lifestyle.

We often talk about building your temple. A space where your body can heal and recover. The foundation of any building must be strong and it’s very important that we pace our days. Pacing refers to the balance of rest and activity, but having good quality rest can sometimes be a challenge. A focus on single tasking where the outcome doesn’t matter is key. That may be watching Netflix, watching sports, or even cooking, as long as it is restful. We need to have these activities within our day to allow our bodies to recover and decrease our wake drive, which can lead to better sleep. So pacing is creating a strong foundation of time on and time off that is sustainable over your day and week.


Good quality rest is a must...


Once your foundation is established, the structure or four pillars that hold your roof on are the management of exercise, diet, sleep, and stress.


  1. Exercise is essential for our good health with positive impacts on energy, sleep and mood. Exercise does not have to be complicated so make sure you don’t hate it! Think about vegetables, they’re all good for you but you’ve got to make sure that it tastes good otherwise you won’t eat them regularly. Walking for 180 minutes per week, whether it be in 5 to 30 minute blocks significantly decrease risk factors for heart disease, diabetes and even cancer. So whether it be a simple walk in your day or maybe moderate or high intensity activity, it’s finding something that works for you.
  2. Managing sleep is important as discussed previously. Finding a good rhythm, wind down and allowing your body to have the appropriate amount of sleep. Tip: The appropriate amount of sleep can be calculated simply by averaging how much sleep you’ve had over a fortnight.
  3. Diet is important and unless you have any food sensitivities or intolerances, maintaining a healthy diet as per the Australian Dietary Guidelines is enough.
  4. The fourth pillar, managing emotional stress is also very important. Focusing on what you can control and trying to let go of what you can’t is an easy strategy to practice. As I always say, “there is no point in yelling at the rain.”


Now, we have discussed a strong foundation and the pillars, the roof can be put in place. Now the roof is made of DIM SIMs. That may sound strange and I’m not talking about the tasty late-night snack.

DIM SIMs stand for: Danger In Me and Safety In Me and our levels of fatigue or pain are regulated by these.


An example of this is that if you stub your toe when you’re playing sport or even with your children, this can lead to pain, however, we often shake it off and keep going. Whereas if we stub our toe in the middle of the night, it also hurts but it tends to hurt more.

This is due to DIM SIMs. When we’re having a good time, we have all these safety or SIMs coming into our bodies, the body doesn’t feel that we need that much pain. Whereas in the middle of the night, you would have lost those SIMs and there are more DIMs, such as you really needing to go to the toilet and it’s dark so the body responds with more pain to protect you by getting you safely to the toilet. Now, safety messages or SIMs are very important. SIMs are all around us such as your favorite music, having a cup of tea, fresh air, and it’s important to do these things to bring joy and create a balance. This can help turn down the volume of our feelings or symptoms and allow us to take a healthy lifestyle.

In modern society, we tend to be very busy and tend to just accept that life is hard. However, we shouldn’t accept ‘ordinary’ and if you find that you’re fatigued, it’s extremely important that you reach out to your health care team.

Speak with your GP and have a look at the resources at the Active Health Clinic – Wellness Tribe on Facebook to have more knowledge on what fatigue is and how to manage it.

Being balanced will lead to being able to do more and not being forced to rest. We can choose to rest and this allows us to have more fun in life. I always like to say, that “knowledge is knowing tomato is a fruit, and wisdom is knowing that it doesn’t go in fruit salad.”

So make choices that allow you to be efficient and do more in life, and make sure that you talk with your team whether that be health professionals, family or friends but always ask questions which is normal. If in doubt, drop us a line and look at joining the Active Health – Wellness Tribe for more tips on fatigue and managing lifestyles.



Nathan Butler Photo

Nathan Butler is the founder of Active Health Clinic and worked as an Accredited Exercise Physiologist for 20 years treating and educating people with invisible illnesses that others can’t help. Nathan and his Team at Active Health Clinic focus on increasing awareness and management of complex health conditions that are challenging to treat, such as chronic fatigue syndrome, chronic pain, orthostatic intolerance/POTS and sleep disorders.


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