Jaime Lewis (Host): It's an unfortunate fact of modern life that so many of us go through our days exhausted. According to research by the National Sleep Foundation, about half of all Americans say they feel sleepy during the day anywhere from 3 to 7 times a week. But sometimes the exhaustion isn't so much sleepiness, as it is fatigue, which can come in many guises and can be hard to pin down.

So what are the different types of fatigue and why do they matter? We're going to find out today in a discussion with Dr. Ben Kermani, a Concierge Internal Medicine Physician with expertise in addressing fatigue. This is Health Talk with the Valley Health System, presented by the Valley Health System. I'm your host, Jaime Lewis. Hello, Dr. Kermani. Thank you for being on the podcast.

Let's start with some basics. How do you define fatigue?

Ben Kermani, MD: Fatigue is basically a lack of energy or motivation, be it secondary to physical or just psychological exhaustion.

Host: And why is fatigue an important point of discussion?

Ben Kermani, MD: That's actually a very interesting question. To put this in perspective, there was a study that showed loss to the gross national product of this country due to fatigue adds up to about four percent. And if you put that in comparison with natural gas and oil production, which is 8%, the loss from fatigue is half of that production, which is immense.

Host: Well, what are the different types of fatigue that you see among your patients in your practice?

Ben Kermani, MD: There are two general types, and I'm not going to talk about just normal physiologic fatigue say an athlete or somebody working very hard. There are two general classes. There is medical biological, and there is psychological. These are the two general types.

Host: As a physician, how do you deduce between those two types of fatigue?

Ben Kermani, MD: The clinical presentation and the patient's history helps quite a bit, but we start by doing some comprehensive labs and ruling out reversible medical conditions such as thyroid disorders, hypothyroidism, metabolic cases like diabetes or other endocrine conditions such as adrenal insufficiencies and these are just a few examples.

Once everything is ruled out then there are two other classes that I am very keen on screening patients for and one is of course, the big psychological causes, the number one that brings many to the doctor's office to get diagnosed with depression is the big quote, Doc, I'm tired. So depression is a major category, but another soft spot here is an entity called sleep apnea.

And that is also a cause of fatigue. That can kind fill in its own category between general medical and psychological.

Host: Can you discuss a little bit about what sleep apnea is?

Ben Kermani, MD: Yes. So sleep apnea is an entity where the airway closes and collapses during the night and patient comes out of deep sleep because the oxygen saturation drops. Well, one of the complications of untreated sleep apnea is fatigue and depression, and I'll explain that to you in just a minute.

Imagine if somebody calls you at 2 o'clock in the morning, and you answer the phone and tell them it's the wrong number. If that happens a second time, you raise your voice, the third time you cuss the person out, and fourth, fifth time you are just exhausted. Well, the apneic person, because this cycle repeats itself, airway closes, brain gets the message, there's no oxygen, you come out of deep sleep, airway opens, okay, go back to sleep.

This happens between, at least 40, up to some patients I've seen 80 times. So you can see how exhausted the next day the person is, you know, getting sleepy behind the wheel, constantly having to drink coffee, and so on and so forth. So they cannot focus on their work. They are just plain exhausted. So that's a big cause of fatigue.

Host: Well, let's say I come into your office and I say, Doc, I'm tired and I'm concerned about what feels like it might be fatigue. What does it take for you or for the patient to initiate a lab workup?

Ben Kermani, MD: So taking a good history, social history as well as medications. I have patients, geriatrics who are on polypharmacy and they don't know it. So that, you know, that can have some complications and side effects. So with a fine tooth comb going through their meds, and also taking a good history, social history, family history, what are their sleep, habits, uh, what kind of sleep hygiene they have. And then after an exam, you know, proceeding with a full laboratory evaluation, and proceeding from there.

Host: Well, thank you, Dr. Kermani, for being on the podcast and for bringing this important subject to light.

Ben Kermani, MD: Thank you very much. I appreciate the opportunity.

Host: For more information about fatigue or the Valley Health System, visit valleyhealthsystemlv.com. And if you found this podcast helpful, please share it on your social channels and be sure to visit the episode library for more topics of interest to you. I'm Jaime Lewis. Thanks for joining me on this episode of Health Talk with the Valley Health System presented by the Valley Health System. Thanks for listening.

Physicians are independent practitioners who are not employees or agents of the Valley Health System. The system shall not be liable for actions or treatments provided by physicians.