Fatigue Syndrome

All about tiredness, by Dr. José Alegre

Dr. José Alegre, a specialist in Chronic Fatigue Syndrome and tiredness, who directs the CFS treatment unit at the Vall d’Hebrón Hospital in Barcelona, tells us about fatigue, its origin, the importance of rest, among many other things.

Why do we get tired?

Physiological fatigue is a symptom so that we understand that we have to rest and we have it introduced into our circadian rhythm. We do not go to sleep at the time we are sleepy but at a time that we have determined and when we stop connecting with external stimuli, we fall asleep. With day-to-day obligations, many times we do not sleep that much and, at first, it seems that nothing is happening. That happens the same with lunchtime, many times we don’t eat because we are hungry but because it is the time that we have stipulated. By this I mean that we have to be very aware of the importance of rest and decide to go to sleep, not when we are sleepy, but when it is best for us.

Tiredness is recovered by sleeping because in the REM phase of sleep there are elements that make you recover. The body seeks to rest, not only at night but also during the day.

Therefore, when we feel tired on a physical level, we have to rest. Tiredness in a healthy person is a sign that we should pay attention to.

Are there different types of tiredness? Is fatigue cumulative?

Yes, there is a fatigue that recovers which is what we call physiological fatigue and then there is the fatigue that even you sleep you do not recover. When students have final exams, for example, they pretend to go to bed and be fine the next day, but, in reality, do not recover from one day to the next because the rhythm is not acquired all at once, and that is why people who go to bed at 4am, or party all night frequently, have to be careful with as they are distorting the circadian rhythm. For example, it has been studied that when professionals have a child their effectiveness decreases.

Non-restorative sleep is quite common and it can be recovered, but if we make a continuous effort we will not suddenly recover our circadian cycle as it might take some time. Keep in mind that most of us think that our sleep is correct, but, how many times we wake up tired and with the feeling of not having had a restful sleep? If we add to this a whole night without sleeping, for whatever reason, recovery will not be something immediate, but will take a few days.

Society tells us that you have fun when you go out at night until the wee hours of the morning but that has nothing beneficial for the body.

When you are tired, does the brain work the same?

No, it does not work the same as if you are rested. A large number of complex mechanisms are activated in our body and some have to do with positivity and the ability to react, and when you are tired it decreases significantly.

It is important to emphasize that we are global beings and that we function as an integrative whole.

For example, in cases of chronic fatigue, it worsens markedly with menstruation and improves with pregnancy, worsens during childbirth and improves when breastfeeding. This occurs due to the influence of estrogen and prolactin, which are regulators of the immune response and that means that we are interconnected and we cannot treat pathologies or problems from a single point of view.

About the importance of movement

Physical exercise is essential for healthy and sick people, that is, movement has to be daily, almost like breathing. If you do something you don’t like, you end up not doing it, so you have to look for strategies to incorporate it into your day-to-day life.

When you do what you like you don’t usually get tired. For me it is super important that, for example, when we look for a job, there is a good atmosphere, in this way we won’t get tired. Those toxic environments end up tiring you, physically and mentally.

What is cellular energy?

Cellular energy is the energy that comes from the mitochondria and the fuel it needs to keep working is ATP, which regulates a number of functions, but is generally responsible for giving energy to the cell. When we charge the mobile we are giving it ATP. The cell must be able to recharge, otherwise it is not possible.

How to improve tiredness?

If we talk about physiological fatigue there are three fundamental things. In the first place, try to do something you like and you are passionate about. I always tell my patients that, for example, you don’t have to like medicine, you have to be passionate about it. Secondly, you have to learn to regulate the wake-sleep cycle and, finally, you have to do moderate and light exercise on a daily basis.

That is to say, we have to sleep and rest properly, try to move and not lead a sedentary life and that in our work and day to day we look for motivations that make what we do exciting. What really causes stress is doing something that you can’t find an explanation for and that doesn’t motivate you.

My mother taught me to fight for what I believed and her great virtue that, at the same time, was her great flaw was that she didn’t have a minute for herself. With this I mean that it is very important to find time for oneself, although in the current time it is very complicated.

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