Feeling tired all the time, even after a long night’s rest, is more common than many realise, and in some cases, the reason is not what you think.
According to Dr. Jenipher Niyonziza, a medical doctor at Ruhengeri Referral Hospital, fatigue can stem from a range of overlooked health issues that are often mistaken for chronic conditions such as fibromyalgia or myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome.
She told Rwanda Daily that before confirming a diagnosis of these conditions, she prefers to rule out several other possibilities that could explain persistent exhaustion.
“When I see patients who have got fibromyalgia or ME, one of the first things they want to know is, has everything been ruled out,” she said.
One commonly missed cause is obstructive sleep apnea, a disorder where breathing repeatedly stops and starts during sleep. This condition is often under-diagnosed because its symptoms usually occur while the patient is asleep.
“To get a diagnosis, often someone else is needed, such as a partner who shares the same bed. People who sleep alone may be unaware they experience “weird apnoeic episodes” at night, yet these episodes can be the real reason behind their constant fatigue,” Dr. Niyonziza explained.
She has encountered many patients who were initially told they had ME or chronic fatigue syndrome, only to discover the true culprit was untreated sleep apnea.
Another possible cause is chronic Lyme disease. This tick-borne illness can produce symptoms such as muscle and joint pain, fever, fatigue, and a distinctive bullseye-shaped rash.
“However, diagnosing it is notoriously difficult. This is a very tricky one because you can’t really diagnose on a blood test,” Niyonziza said, adding that there is no single medication that can instantly resolve it.
Medical history plays a crucial role, particularly if the patient has lived in rural or wooded areas, worked with animals, or recalls having an unusual rash after feeling unwell.
A third condition to consider is mast cell activation syndrome (MCAS). In this disorder, the body releases excessive histamine in response to triggers that normally should not cause such a reaction.
The result is a wide range of symptoms, with extreme fatigue being one of the most prominent. Diagnosis often involves a safe trial of specific treatments, which can bring significant relief if MCAS is indeed the cause.
Dr. Niyonziza emphasizes that these three examples are far from the full list of reasons why someone might feel chronically tired.
“Chronic fatigue or feeling tired all the time is one of the most common things we see every single day. It can be due to so many things. These are just a few that I’ve come across recently that have been missed,” she said.
Her advice is that if exhaustion is interfering with your daily life, don’t settle for a quick diagnosis. A thorough medical evaluation could reveal an entirely different, and treatable, underlying cause.
