Being tired all the time is a recognised symptom with its own acronym, TATT. Factors can be health related, both physical and mental, as well as environmental.9

Insufficient good quality sleep is perhaps the most common reason for tiredness. This can often be addressed by improving sleep hygiene €“ keeping regular bedtime hours, not napping in the day, avoiding stimulation (eg television/social media) and stimulants (such as caffeine) before bed, having a suitable mattress, cutting out light and noises in the bedroom, and having the bedroom at the right temperature.6

Tiredness can also be a symptom of a medical condition. Among the conditions that commonly cause tiredness are coeliac disease, anaemia, chronic fatigue syndrome, underactive thyroid, glandular fever, restless legs syndrome, diabetes and obstructive sleep apnoea (see panel). Tiredness is also associated with depression and anxiety, and cancer-related fatigue may arise from the cancer itself, treatment, or symptoms and side effects, such as appetite loss.10,11,12

Sleep disturbance is linked to over 600 drugs. Drug classes noted especially for adversely affecting ability to sleep and/or sleep quality include:13

·       antiarrhythmics;

·       beta blockers;

·       caffeine, theophylline and other xanthines;

·       clonidine;

·       CNS stimulants and ADHD treatments eg methylphenidate;

·       corticosteroids;

·       diuretics (due to the need to get up to urinate, or from causing cramps);

·       hypothyroidism treatments;

·       nicotine replacement products;

·       SSRIs.