The tired that sleep doesn't fix

Specialist CBT therapy for anxiety, OCD, depression and more in West London

There is a kind of tiredness that can make a full night of sleep feel insufficient. A person may wake already depleted, need much more effort for ordinary tasks, feel detached from work they once cared about, lose patience more quickly or struggle to concentrate. It can be frightening when rest does not seem to bring the expected relief. That pattern does not prove burnout, depression, anxiety or any other diagnosis. Persistent fatigue can have many causes, including physical illness, infection, anaemia, thyroid conditions, menopause, sleep disorders, medication effects, pain, nutritional issues, substance use, caring responsibilities, grief, stress and mental health difficulties. A blog cannot determine the cause of someone’s exhaustion from their description. New, severe, changing or worrying tiredness should be discussed with an appropriate medical professional. This matters particularly where there is unexplained weight change, fever, chest pain, fainting, shortness of breath, neurological symptoms, severe sleep disruption or an inability to manage basic daily needs. Physical symptoms should not automatically be attributed to stress, overwork or anxiety. Workplace pressure can be part of the picture for some people. A person may be carrying an unmanageable workload, caring for others, feeling unable to switch off, working through illness, responding to constant messages or measuring their worth through output. Another person may have the same workload but be affected differently because of their health, support, role, environment or recent events. Assessment helps avoid turning a complex experience into one label. The word burnout can be useful when it gives someone language for work related exhaustion. It can also obscure other concerns if used too quickly. A careful conversation can explore what has changed, what restores or depletes energy, the role of sleep and health, what safety or employment issues are present and what the person wants to be different. CBT may be considered where it is appropriate after assessment. It does not promise to restore energy on a timetable, replace medical care or tell someone to leave a job. In therapy, a person may examine patterns such as perfectionism, overcommitment, avoidance, self criticism, boundaries, pacing and the difficulty of resting without guilt. The work is collaborative and shaped around the person’s circumstances. Behavioural changes are not self directed instructions from an article to push through exhaustion, stop medication, cut contact with work or make a major decision. Where behavioural experiments are appropriate, they are planned with a qualified clinician, consent and attention to health, safety and practical constraints. If persistent exhaustion comes with hopelessness, thoughts of self harm, a crisis or an inability to keep yourself safe, urgent appropriate help is needed. For related information, see <a href="/therapy/burnout/">CBT support for burnout</a>, <a href="/guides/burnout comprehensive guide/">the burnout clinical guide</a> and <a href="/guides/high functioning anxiety burnout signs/">high functioning anxiety and burnout</a>. The Lyceum Clinic offers assessment led CBT online and in West London.