Why am I so Tired? I Haven’t Done Anything
The quiet costs of chronic stress and why pushing through doesn't work
Stress has become almost synonymous with adulthood and, as a result, we can minimize it rather than acknowledge and respond to it in ways that actually facilitate stronger and healthier functioning.
Western culture is goal-oriented, so much so that at times it can dominate our thoughts and discussions. Often, when meeting someone new, our conversations pivot around: What do you do for work? What are you studying in school? Or something else directed at our goals and aspirations.
While there is nothing inherently wrong with this type of interaction, it can quietly create a culture where what we can produce becomes intertwined with our sense of self-worth, confidence, and self-esteem. As a byproduct of these unspoken narratives, rest can become a prize we earn instead of the necessary requirement for maintaining basic functioning.
The costs of chronic stress and how it hides
In my clinical practice, I often see clients who share an inability to fall asleep, stay asleep, allow themselves guilt-free rest, or quiet the never-ending stream of thoughts overloading their brains the moment they try to relax.
The skills involved with slowing down are not nearly as recognized as the skills it takes to be productive, so much so that slowing down can actually become anxiety-provoking.
A certain amount of stress is adaptive and even healthy. It's what makes sure we wake up on time, make the kids' lunches, and respond to our boss's email that feels rather unimportant on a larger scale. It's what keeps us doing the things we need to do to maintain our lives.
Our physiological stress response is designed to help us adapt to demands. The problem is that repeated or chronic activation without adequate recovery can create cumulative wear and tear, a concept described as allostatic load (McEwen & Stellar, 1993; McEwen, 1998).
But how does it creep up on us so fast?
The truth is, most of us aren't tracking how much stress we actually carry on a day-to-day basis.
Some stress is not tangible: the nagging thought about the 12-hour workday, the dinner you have to cook when you get home, children fighting, the one thing you asked your spouse to help with that you're already bracing for not being done, the bill you keep forgetting to pay, the dog you need to walk, the weekend houseguests you need to prep for, and the guilt we feel when we fall short.
The tabs in our brain don't always close just because our bodies are no longer in motion.
The repeated demands that sit in your brain all day get little consideration because often it just "is what it is!" This is a common statement I hear in therapy. The reality is often much more stark: unless the stressor is impacting your day-to-day functioning in a substantial way, it can be easy to dismiss.
Small everyday stressors that often get dismissed can cumulatively take a significant toll, particularly when they happen repeatedly without adequate opportunities for recovery (McEwen, 1998).
The cycle might look something like this:
First, you might notice a change in your thoughts. They might suddenly become more negative or harder to shut off. Next, we might see changes in behaviour and emotion: irritability, feelings of apathy, becoming more easily overwhelmed, or social isolation. At the same time, our stress-response systems kick in, releasing hormones such as cortisol and creating physiological changes throughout the body.
Then come the physical changes. Sleep patterns might deteriorate, headaches become more frequent, eating habits change, and we attribute it all to being "busy," along with an undeniable urge to snap at our co-worker for scheduling a meeting that should have been an email. The truth is, that excuse is believable because it's not completely wrong. We've already established that our culture is very, VERY busy.
Then the tradeoffs of the extra weight start rearing their ugly heads, with some less than glamorous changes behind the scenes: forgetfulness, difficulty focusing, and decision fatigue. Chronic stress can affect brain systems involved in memory, attention, and executive functioning, while mental exhaustion can make sustained attention and effort increasingly harder, requiring more and more adaptation (McEwen, 1998; Boksem & Tops, 2008).
The challenging part is that we can't necessarily see these changes from the outside. We insidiously adapt as stress builds. As being stressed becomes our baseline, recognizing changes in ourselves can become harder, making it easier to bypass the warning signs.
Mental health and physical health aren't separate
So often we try to separate our mental health from our physical health as if we have two separate bodies, ignoring the fact that the same brain involved in creating the stress response that acts on our body is also involved in the mental reasons we might feel sad, hurt, overwhelmed, or angry (McEwen, 1998).
That does not mean every physical symptom is caused by stress. Persistent or unexplained fatigue, changes in sleep, headaches, gastrointestinal symptoms, or other physical changes can have medical causes and deserve appropriate medical assessment.
But it does mean that our mental and physical health aren't as separate as we sometimes treat them.
I remember one of the most shocking things I learned in my undergraduate studies was, in very simple terms, pain is pain. While physical and emotional pain aren't identical in our brain, there is meaningful overlap in the systems involved in processing both (Eisenberger, 2012; Kross et al., 2011).
What stuck with me wasn't simply that emotional pain can hurt. It was that our brains aren't assigning these experiences a hierarchy of which pain is legitimate and which isn't. We do that. We attach subjective meaning to different types of pain and then decide which ones justify rest, attention, or care and which ones we should be able to tolerate.
Why pushing through doesn't work
Cumulative load is real. What's often lacking is our ability to identify it, respond to it, and sometimes even accept its legitimacy.
Pushing through, white-knuckling it, or shoving everything down isn't a sustainable answer to chronic stress. People can function through enormous amounts of stress, sometimes for surprisingly long periods of time, but functioning through stress doesn't mean that stress isn't having an effect (McEwen & Stellar, 1993; McEwen, 1998).
Forcing ourselves through another day isn't necessarily evidence that what we're doing is working (Boksem & Tops, 2008).
Sometimes the question isn't:
"Why am I so tired when I haven't done anything?"
Maybe the better question is:
"How much have I been carrying that I've stopped counting?"
Start counting, energy is finite.
Amber
References
Boksem, M. A. S., & Tops, M. (2008). Mental fatigue: Costs and benefits. Brain Research Reviews, 59(1), 125–139. https://doi.org/10.1016/j.brainresrev.2008.07.001
Eisenberger, N. I. (2012). The pain of social disconnection: Examining the shared neural underpinnings of physical and social pain. Nature Reviews Neuroscience, 13, 421–434. https://doi.org/10.1038/nrn3231
Kross, E., Berman, M. G., Mischel, W., Smith, E. E., & Wager, T. D. (2011). Social rejection shares somatosensory representations with physical pain. Proceedings of the National Academy of Sciences, 108(15), 6270–6275. https://doi.org/10.1073/pnas.1102693108
McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338(3), 171–179. https://doi.org/10.1056/NEJM199801153380307
McEwen, B. S., & Stellar, E. (1993). Stress and the individual: Mechanisms leading to disease. Archives of Internal Medicine, 153(18), 2093–2101. https://doi.org/10.1001/archinte.1993.00410180039004