Mohammad T Islam (BSc, MBA, MEd)

Tiredness is a common complaint among people of all ages. It’s frustrating to feel persistently fatigued despite getting what is widely considered to be a sufficient amount of sleep. Eight hours per night is typically recommended for adults, yet many people still feel exhausted throughout the day. So, what could be the cause? This article explores the potential explanations for ongoing tiredness, drawing on medical, psychological, and lifestyle factors. Quantity vs Quality of Sleep While eight hours of sleep is generally accepted as ideal for most adults, individual sleep needs vary. Winston Churchill famously functioned on as little as four hours of nightly sleep, compensating with brief daytime naps (Robbins & Judge, 2019). However, it is not just the number of hours slept that determines how rested one feels, but the quality of sleep. Deep sleep, particularly during the first part of the night, plays a crucial role in physical and mental restoration (Walker, 2017). Poor quality sleep can be caused by several factors. Snoring, often overlooked, may significantly reduce sleep quality. Loud, persistent snoring can indicate obstructive sleep apnoea (OSA), a condition where breathing temporarily stops during sleep. This causes repeated awakenings throughout the night, often without the individual realising. OSA is more prevalent in individuals with a neck circumference over 17 inches, those who are overweight, smokers, and heavy alcohol users (NHS, 2023). In addition, environmental factors such as an overly warm or stuffy bedroom can disrupt sleep. Sleep specialists recommend a cool, well-ventilated room to promote deeper, uninterrupted rest (Chokroverty, 2017). Turning off the radiator and slightly opening a window may significantly improve your sleep environment. Could a Medical Condition Be the Cause? If sleep quality and duration are both adequate, persistent tiredness might stem from an underlying medical condition. General practitioners frequently encounter patients with what is colloquially known in the profession as “TATT” – Tired All The Time (O’Connor & Burke, 2016). One of the most common medical causes of fatigue is anaemia, particularly iron-deficiency anaemia. This condition, often due to poor dietary iron intake or blood loss (such as from heavy menstrual periods), reduces the blood’s ability to carry oxygen, resulting in constant tiredness and weakness (British Heart Foundation, 2022). Anaemia caused by vitamin B12 or folate deficiency is also common and is easily diagnosed through a blood test. Another frequent culprit is hypothyroidism, or an underactive thyroid gland. This condition slows down the body’s metabolism and is accompanied by other symptoms such as weight gain, dry skin, hair thinning, and constipation (NICE, 2020). Like anaemia, hypothyroidism can be detected through simple blood tests. Diabetes mellitus, both Type 1 and Type 2, can also lead to fatigue due to fluctuations in blood sugar levels. Patients may feel particularly drained if the condition is poorly managed (Diabetes UK, 2023). Other red flags include excessive thirst, frequent urination, and unexplained weight loss. Although rare, persistent tiredness may signal a more serious illness such as cancer. For instance, leukaemia, a cancer of the blood, often presents with fatigue, unexplained bruising, and frequent infections. However, cancer is usually accompanied by more specific symptoms, such as significant weight loss, night sweats, or a palpable lump (Cancer Research UK, 2024). Medications also warrant consideration. Many commonly prescribed drugs – such as beta-blockers, antihistamines, tranquillisers, and some sleep aids – can leave individuals feeling lethargic or mentally foggy, especially if taken at night (BNF, 2023). The Psychological Connection: Depression and Stress Fatigue is not always physical; it can also stem from psychological conditions. Feeling persistently tired, losing interest in daily activities, becoming emotionally withdrawn, or experiencing changes in sleep patterns may all point toward depression. People suffering from depression often wake early in the morning and are unable to return to sleep, feel chronically unmotivated, and lose interest in work, hobbies, or relationships (NICE, 2022). Stress, anxiety, and burnout also contribute significantly to tiredness. Working long hours without sufficient rest and recovery, juggling multiple responsibilities, or facing constant psychological pressure can lead to a state of mental exhaustion. According to the Mental Health Foundation (2023), chronic stress can impact sleep, appetite, and overall energy levels. In both depression and anxiety, individuals may confuse emotional tiredness with physical fatigue. Treatment options include counselling, lifestyle adjustments, and in some cases, antidepressant medications, which modern research shows are generally safe and non-addictive (Stahl, 2013). Lifestyle Factors Beyond sleep and health issues, lifestyle choices have a substantial impact on how energised we feel. Poor diet, lack of exercise, dehydration, excessive caffeine, and alcohol consumption can all drain our energy. A balanced diet rich in whole grains, vegetables, lean proteins, and healthy fats supports stable energy levels (British Nutrition Foundation, 2022). Regular physical activity also combats fatigue by improving cardiovascular health, boosting endorphins, and enhancing sleep quality. Even short daily walks can reduce tiredness over time (WHO, 2022). Overreliance on stimulants like caffeine may offer short-term alertness but often leads to a subsequent energy crash. Alcohol, while sedative, impairs REM sleep and can worsen fatigue the following day (Walker, 2017).   When to See a Doctor If you’ve addressed lifestyle and environmental factors and still feel tired every day, it is important to consult your GP. Fatigue can be a complex symptom with multiple causes, and early diagnosis of underlying issues can significantly improve quality of life. Blood tests, medication reviews, and a holistic assessment of your mental and physical health will allow healthcare professionals to determine the root cause. Most conditions associated with fatigue – whether physical or mental – are treatable with the right approach. Tiredness despite sufficient sleep is a common issue with many potential explanations. While poor sleep quality, medical conditions, and psychological distress are common culprits, lifestyle habits and environmental factors also play a role. Persistent tiredness should never be ignored. Through a combination of personal reflection and professional medical advice, most people can regain their energy and quality of life. References British Heart Foundation. (2022). Iron deficiency anaemia. [Online] Available at: https://www.bhf.org.uk British Nutrition Foundation. (2022). Healthy eating to … Read more

Type 2 diabetis is a chronic metabolic disorder characterised by insulin resistance and relative insulin deficiency. Unlike Type 1 diabetis, which is autoimmune in nature, Type 2 diabetis is primarily linked to modifiable risk factors such as poor diet, physical inactivity, and obesity. As its prevalence continues to rise globally—especially in low- and middle-income countries—it has become a significant public health concern. Lifestyle interventions, including diet, physical activity, and behavioural changes, are widely recognised as the cornerstone of Type 2 diabetis prevention and management (World Health Organization, 2023). Understanding Type 2 Diabetis Type 2 diabetis occurs when the body becomes resistant to insulin or when the pancreas does not produce enough insulin to maintain normal blood glucose levels. Symptoms often develop slowly and may include increased thirst, frequent urination, fatigue, and blurred vision. Unlike Type 1 diabetis, which typically manifests in childhood or adolescence, Type 2 is more common in adults, though its incidence in children is increasing due to rising obesity rates (American Diabetes Association, 2022). Risk factors include age, genetic predisposition, obesity (particularly central obesity), a sedentary lifestyle, and poor dietary habits. According to the National Institute for Health and Care Excellence (NICE, 2022), early identification and intervention are crucial to delay or prevent the onset of complications such as cardiovascular disease, kidney failure, and neuropathy. The Role of Diet Dietary modification is one of the most effective lifestyle interventions for preventing and managing Type 2 diabetis. A balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats can help control blood glucose levels, reduce insulin resistance, and support weight loss. The Mediterranean diet, characterised by high consumption of olive oil, nuts, legumes, and fish, has been shown to be particularly beneficial. A study by Esposito et al. (2014) demonstrated that adherence to the Mediterranean diet led to a significant reduction in the risk of developing Type 2 diabetis among high-risk individuals. Reducing the intake of processed foods, sugary drinks, and refined carbohydrates is also critical. The NHS (2023) recommends choosing foods with a low glycaemic index (GI), as these release glucose more slowly into the bloodstream, thereby preventing spikes in blood sugar levels. Physical Activity and Exercise Regular physical activity improves insulin sensitivity, aids weight control, and enhances overall metabolic health. The World Health Organization (2023) advises at least 150 minutes of moderate-intensity aerobic physical activity per week for adults, or 75 minutes of vigorous-intensity activity. Structured exercise programmes, including both aerobic and resistance training, have shown positive outcomes in managing Type 2 diabetis. Umpierre et al. (2011) conducted a meta-analysis that found significant improvements in glycaemic control and reduced HbA1c levels among individuals engaging in structured exercise programmes. Moreover, lifestyle physical activity—such as walking, cycling, and using stairs—can be easily integrated into daily routines, making it a sustainable intervention for many people. Weight Management Obesity is a major risk factor for Type 2 diabetis. Losing even a modest amount of weight—5% to 10% of body weight—can significantly improve insulin sensitivity and glycaemic control (Lean et al., 2019). The DiRECT trial, a landmark study conducted in the UK, showed that intensive weight management through a low-calorie diet led to remission of Type 2 diabetis in nearly half of the participants at one year (Lean et al., 2018). Weight management strategies should include dietary counselling, regular exercise, and behavioural support. Importantly, these interventions should be tailored to the individual’s needs, preferences, and cultural context to improve adherence and outcomes. Behavioural and Psychological Support Changing long-standing lifestyle habits can be challenging. Psychological and behavioural support plays a vital role in helping individuals make and sustain healthy changes. Interventions such as cognitive behavioural therapy (CBT), motivational interviewing, and self-monitoring have shown efficacy in promoting healthy behaviours and improving glycaemic control (NICE, 2022). Peer support groups and diabetes education programmes also provide valuable social support and practical knowledge, empowering individuals to take control of their health. The NHS Diabetes Prevention Programme is one such initiative in the UK that offers lifestyle coaching and group-based interventions for individuals at high risk (NHS, 2023). Technology and Lifestyle Management The use of digital health tools, such as mobile apps, wearable devices, and telehealth services, is increasingly popular in supporting lifestyle changes. These tools allow for continuous monitoring of diet, physical activity, and blood glucose levels, thereby enhancing self-management and clinician-patient communication. A study by Bonoto et al. (2017) found that mobile health interventions improved medication adherence and glycaemic outcomes in patients with Type 2 diabetis. However, accessibility and digital literacy remain potential barriers, particularly among older populations and those in underserved areas. Barriers to Lifestyle Intervention Despite clear evidence supporting lifestyle interventions, several barriers can hinder their adoption. These include socioeconomic challenges, lack of access to healthy food and safe exercise spaces, time constraints, and cultural beliefs. Health inequities can exacerbate the risk and impact of Type 2 diabetis among disadvantaged groups. Addressing these social determinants of health requires multi-sectoral collaboration, including policy interventions that promote health equity, urban planning for active living, and subsidies for healthy foods (Marmot, 2020). Type 2 diabetis is a preventable and manageable condition. Lifestyle interventions—particularly those targeting diet, physical activity, and weight management—are highly effective tools in reducing its prevalence and improving quality of life for those affected. To be successful, interventions must be evidence-based, person-centred, and supported by appropriate healthcare systems and policies. Empowering individuals with knowledge and resources, coupled with supportive environments and behavioural strategies, can make a significant difference in the fight against Type 2 diabetis. As the burden of this condition continues to grow, prioritising lifestyle-based approaches remains a crucial component of public health strategy. References American Diabetes Association (2022) Standards of Medical Care in Diabetes—2022. [Online] Available at: https://diabetesjournals.org [Accessed 15 May 2025]. Bonoto, B.C. et al. (2017) ‘Efficacy of mobile apps to support the care of patients with diabetes mellitus: a systematic review and meta-analysis of randomised controlled trials’, JMIR mHealth and uHealth, 5(3), p.e4. Esposito, K. et al. (2014) ‘Mediterranean diet and prevention of Type 2 diabetes … Read more

1.0 What is Blood Pressure and How is it Measured? Blood pressure (BP) is the force exerted by circulating blood upon the walls of the arteries. It is an essential indicator of cardiovascular health and is measured in millimetres of mercury (mmHg). Two values are recorded: systolic pressure (pressure when the heart beats) and diastolic pressure (pressure when the heart rests between beats) (Porth, 2011). BP is typically measured using a sphygmomanometer, either manually with a stethoscope or digitally. The cuff is placed around the upper arm and inflated to constrict blood flow. As air is released, the practitioner listens for the Korotkoff sounds – the first sound indicates systolic pressure, and the point at which sounds disappear marks the diastolic pressure (Bickley & Szilagyi, 2017). Modern automatic monitors use oscillometric methods to detect fluctuations in arterial wall pressure, providing systolic and diastolic readings, and often pulse rate (Pickering et al., 2005). Proper measurement requires the patient to be relaxed, seated, and supported, with the arm at heart level and no recent physical activity or caffeine intake (National Institute for Health and Care Excellence [NICE], 2019). 2.0 Normal vs. High or Low Blood Pressure The American Heart Association (AHA) and NICE categorize BP as follows (Whelton et al., 2018; NICE, 2019): Normal: Systolic <120 mmHg and Diastolic <80 mmHg Elevated: Systolic 120–129 mmHg and Diastolic <80 mmHg Hypertension Stage 1: Systolic 130–139 mmHg or Diastolic 80–89 mmHg Hypertension Stage 2: Systolic ≥140 mmHg or Diastolic ≥90 mmHg Hypertensive Crisis: Systolic >180 mmHg and/or Diastolic >120 mmHg Hypotension: Systolic <90 mmHg or Diastolic <60 mmHg High blood pressure (hypertension) increases the risk of heart disease, stroke, kidney damage, and vision loss. It is often asymptomatic, earning the name “silent killer” (Carretero & Oparil, 2000). In contrast, low blood pressure (hypotension), while less common, can cause dizziness, fatigue, and fainting. In some individuals, particularly young adults or athletes, it may be normal if asymptomatic (Mayo Clinic, 2023). 3.0 How to Manage or Improve Blood Pressure Lifestyle modifications are the first line of intervention for managing both elevated and high BP. The following strategies are widely supported: Weight management: A reduction of even 5–10% of body weight can significantly lower BP (Appel et al., 2003). Regular exercise: Aerobic activities such as walking, swimming, and cycling for at least 150 minutes per week help lower systolic BP by an average of 5–8 mmHg (Pescatello et al., 2015). Dietary changes: The DASH diet (Dietary Approaches to Stop Hypertension) emphasizes fruits, vegetables, whole grains, low-fat dairy, and reduced saturated fat. It has shown BP reductions of up to 11 mmHg (Sacks et al., 2001). Salt restriction: Reducing sodium intake to <2,300 mg/day (ideally 1,500 mg) significantly lowers BP (He & MacGregor, 2009). Limiting alcohol: No more than two drinks per day for men and one for women (AHA, 2024). Smoking cessation: Smoking damages blood vessels and raises BP. Quitting improves cardiovascular outcomes (Benowitz, 2010). Stress management: Techniques such as mindfulness, deep breathing, and cognitive behavioural therapy can aid BP control (Chobanian et al., 2003). 4.0 Medications and Lifestyle Tips When lifestyle changes are insufficient, pharmacological treatment becomes necessary. Common antihypertensive medications include: Diuretics (e.g., thiazides): Promote sodium and water excretion, reducing blood volume. ACE inhibitors (e.g., enalapril): Block the renin-angiotensin system to lower vascular resistance. Calcium channel blockers (e.g., amlodipine): Relax blood vessels by inhibiting calcium flow into muscle cells. Beta-blockers (e.g., metoprolol): Reduce heart rate and output, lowering BP. The choice of drug depends on patient factors such as age, ethnicity, comorbidities (e.g., diabetes), and tolerance to side effects (Whelton et al., 2018; NICE, 2019). Even when on medication, continuing healthy lifestyle habits enhances treatment effectiveness and may reduce the required dosage. 5.0 Reading a Blood Pressure Monitor and Understanding Results Blood pressure monitors typically display: Systolic pressure (top number) Diastolic pressure (bottom number) Pulse rate (optional) For example, a reading of 135/85 mmHg indicates: Systolic: 135 mmHg (borderline high) Diastolic: 85 mmHg (high-normal) May be considered Stage 1 hypertension, especially if consistent across readings. Home monitoring is encouraged, especially for individuals with “white coat hypertension” (elevated readings in clinical settings only). To ensure accuracy: Take readings at the same time daily Sit calmly for 5 minutes before measurement Record multiple readings and average them (Stergiou et al., 2018) Understanding these numbers helps individuals monitor trends, adjust lifestyle habits, and seek timely medical intervention. Blood pressure is a vital sign that reflects cardiovascular health and demands careful attention. With accurate measurement, awareness of normal and abnormal ranges, and appropriate lifestyle or medical interventions, individuals can significantly reduce the risk of serious conditions like heart disease and stroke. Understanding how to interpret BP readings empowers patients to take proactive control of their health. References American Heart Association (2024) What is High Blood Pressure? Available at: https://www.heart.org/en/health-topics/high-blood-pressure (Accessed: 21 May 2025). Appel, L.J., Moore, T.J., Obarzanek, E., et al. (2003) ‘A clinical trial of the effects of dietary patterns on blood pressure’, New England Journal of Medicine, 336(16), pp. 1117–1124. Benowitz, N.L. (2010) ‘Nicotine addiction’, New England Journal of Medicine, 362(24), pp. 2295–2303. Bickley, L.S. and Szilagyi, P.G. (2017) Bates’ Guide to Physical Examination and History Taking. 12th edn. Philadelphia: Wolters Kluwer. Carretero, O.A. and Oparil, S. (2000) ‘Essential hypertension: Part I: definition and etiology’, Circulation, 101(3), pp. 329–335. Chobanian, A.V. et al. (2003) ‘Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure’, Hypertension, 42(6), pp. 1206–1252. He, F.J. and MacGregor, G.A. (2009) ‘A comprehensive review on salt and health and current experience of worldwide salt reduction programmes’, Journal of Human Hypertension, 23(6), pp. 363–384. Mayo Clinic (2023) Low blood pressure (hypotension). Available at: https://www.mayoclinic.org/diseases-conditions/low-blood-pressure (Accessed: 21 May 2025). National Institute for Health and Care Excellence (NICE) (2019) Hypertension in adults: diagnosis and management (NG136). Available at: https://www.nice.org.uk/guidance/ng136 (Accessed: 21 May 2025). Pescatello, L.S., MacDonald, H.V., Lamberti, L. and Johnson, B.T. (2015) ‘Exercise for hypertension: a prescription update integrating existing recommendations with emerging research’, Current Hypertension Reports, 17(11), … Read more