Tired All the Time? Your Brain Might Be Trying to Tell You Something

“Tired All the Time? Your Brain Might Be Trying to Tell You Something,” by Dr. Rege, a psychiatrist and educator, explores the misunderstood symptom of fatigue, particularly when it’s not resolved by rest. The video challenges the common perception of fatigue, suggesting it’s not merely a lack of sleep but potentially a sign that the brain is not truly resting.

Highlights:

• Types of Fatigue: Dr. Rege differentiates between cognitive fatigue (brain fog, trouble concentrating, forgetfulness) and physical fatigue (body heaviness, pain, stiffness).
• Disrupted Sleep Architecture: Even if you’re sleeping, your brain might not be resting due to disrupted non-REM sleep, often caused by REM hyperarousal, which prevents deep restorative sleep.
• Inflammation and Dopamine: Chronic low-grade inflammation can reduce dopamine transmission in the brain, impacting motivation, clarity, and the ability to switch tasks, contributing to cognitive fatigue.
• Fatigue as a Form of Pain: The video proposes that fatigue activates the same brain regions as physical and emotional pain, suggesting it’s a protective signal from the brain to regulate effort.
• Psychiatric Disorders and Fatigue: Several mental health conditions are associated with or can amplify fatigue, including melancholic depression, ADHD, PTSD and trauma histories, and generalized anxiety.
• Dysregulated Arousal: Some individuals with fatigue experience restlessness, agitation, and irritability, indicating a nervous system swinging between fight, flight, and collapse modes.
• Fatigue as a Protective Mechanism: The brain may enter an energy conservation mode in response to perceived threats from stress, trauma, or inflammation, reducing dopamine and motivation to prioritize safety over action.
• Clinical Approach to Fatigue: Dr. Rege advises clinicians to assess sleep architecture, screen for psychiatric disorders, rule out organic, inflammatory, neuroimmune, and endocrine causes, and validate the patient’s experience of fatigue even when lab results are normal.

The video concludes by reframing fatigue not as a weakness, but as a signal that the brain might be stuck in survival mode, emphasizing that the goal isn’t just more sleep, but understanding what the brain is trying to protect you from.