Bad sleep habits — like watching late movies and dozing off with the television on — can contribute to extreme fatigue.

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Extreme fatigue causes you to be less alert and more forgetful. You also may feel indecisive, irritable, and moody. If you feel too fatigued to engage with other people, you may even withdraw socially.

These side effects can throw a wrench into daily life, so it’s important to work out your personal extreme fatigue causes. Keep in mind that extreme fatigue may be a symptom of a serious underlying condition.

Often, though, you can take steps to avoid or compensate—steps that may be as simple as eating more foods that give energy, or improving your sleep.

Potential causes of extreme fatigue include:

• Bad sleep habits. You may sleep poorly due to insomnia, jet lag, restless legs syndrome, or pain from a chronic condition such as arthritis. In many cases, simple sleep hygiene measures (for example, a bath last thing at night, a set routine for bedtime and a consistent waking time, keeping your bedroom as dark as possible, and wearing earplugs to keep out noise) can help improve poor sleep. A short course of sleeping pills may also help; see your physician.
• Sleep apnea is another frequent cause of fatigue, particularly in overweight and obese people. The condition causes the muscles at the back of your throat to relax to the extent that the airway is narrowed and you can’t inhale sufficient breath, which lowers the level of oxygen in your blood. Your brain senses this inability to breathe and briefly rouses you. Most people with sleep apnea don’t remember these mini-awakenings,which can occur hundreds of times during the night. Snoring is a common sign of sleep apnea; another is that you’ll feel excessively tired after what was apparently a full night’s sleep. If you have a bed partner, he or she may be disturbed from sleep by hearing you gasp for breath.

Worried that you may have sleep apnea? Consult a sleep specialist, since sleep apnea has been associated with an increased risk for cardiovascular problems, including high blood pressure and stroke.

• Infections like hepatitis and tuberculosis. Hepatitis A is usually mild and clears up by itself. Hepatitis B and C (the most common blood-borne infection in the U.S.) are more severe and can damage the liver if they are not treated. Tuberculosis is a potential cause of fatigue that is frequently missed—it can lie dormant in the body, and older adults are at high risk for a reactivation of old disease.
• Poor diet. Fatigue can set in for as simple a reason as not eating enough; this is one of the biggest extreme fatigue causes in older adults. A 2014 study found that more than half of the seniors who visit emergency departments are either malnourished or at risk for malnutrition. See our post on foods that give energy for information on how you can ensure that you’re eating the right energy-boosting foods.
• Underlying disease. Heart disease, chronic obstructive pulmonary disease (COPD), thyroid disorders, kidney disease, liver disease, and multiple sclerosis can all manifest as fatigue. So can cancer; since cancer cells grow rapidly, they use up energy and resources needed for other cellular processes.
• Chronic pain from diseases like arthritis is another frequent contributing factor—it saps your energy, leaving you feeling constantly tired.
• Medications. Add the medications you may be taking to treat physical conditions to the list of possible extreme fatigue causes. Drugs associated with fatigue include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn); tetracycline, an antibiotic that is frequently prescribed to treat urinary tract infections; and the antipsychotics that may be used to help manage dementia symptoms, antidepressants, sleep medications, and pain medications.
• Emotional issues. If you constantly feel sad and have lost pleasure in activities you used to enjoy, you may be suffering from depression. This is a treatable illness, so discuss your symptoms with your doctor. With proper management, most people with depression can regain their normal energy levels. Your emotions also can be affected by stress and anxiety, bereavement and grief, and life events such as moving house or divorcing your partner.

Originally published in June 2016 and updated.