How much fatigue is normal?

Are you dozing at your desk after lunch? Sleeping for 8 hours or more, but it’s never enough? Stuck in an endless battle of snoozing your alarm?

Perhaps you feel like you don’t have a ‘reason’ to be tired. You dismiss the messages your body is sending, and push on, telling yourself that you just need to try harder.

“Fatigue is so common that people often dismiss debilitating symptoms as ‘just life’. While it’s normal to feel tired after poor sleep or physical exertion, your energy and mood should improve with rest,” says Dr Monica Xu.

“It’s a common complaint among my patients,” agrees Dr Ji Woon Min. “It’s often overlooked because it’s intertwined with louder symptoms which feel more troubling to patients, like diarrhoea, hair loss, weight gain or period cramps.”

Experts recommend between seven and nine hours of sleep a night, but there are more factors which influence your sleep requirements. “Individual needs vary widely based on accumulated sleep debt, stress levels and specific health concerns,” says Ji Woon.

But when you’re sleeping for 10 hours a night, and still tired? For Dr Ji Woon, this is a clear red flag – and a sign that further investigation is needed.

“If low energy persists for longer than two weeks, or doesn’t respond to rest, you should seek some support,” Monica confirms.

Sally and Anna came to IMI battling with low energy throughout the day, even though they were getting plenty of sleep at night.

Sally’s story

It took Sally (aged 42) more than 5 snoozes in the morning to get up before 10am. Sometimes, she forgot to bring important things with her to work. She had put on weight, felt puffy, was losing her hair, and each month experienced rage during her premenstrual phase. Her profound fatigue was unexplained by traditional medicine pathways. A family member who had been treated for the same issue by IMI referred her to Naturopathic Doctor Monica Xu.

The first thing that Monica did was take a thorough case history – checking Sally’s current medications, recent unresolved illnesses, prolonged stress, traumatic events and menstrual cycle patterns. This information determined which labs were needed to uncover the root cause.

Dr Monica tested Sally’s thyroid health, ferritin levels, blood sugar levels (which checked her fasting insulin and glucose levels), adrenal hormones (testing her cortisol wakening response), vitamin D levels and a complete blood count to check for anaemia.

The tests revealed that Sally had very low salivary cortisol levels in the morning, and throughout the day, suggesting severe burnout and hypoactivity of the HPA axis. This is common among women in perimenopause, usually as the result of chronic stress, accumulated over years.

Sally’s tests also showed that her iron and vitamin D levels were low. Depleted iron is one of the major causes of fatigue among women, and 50% of women are estimated to have low levels. Scientists estimate that around two thirds of the world’s population have low vitamin D: a key characteristic of which is fatigue.

Her fasting insulin was also very high, indicating insulin resistance syndrome, which can negatively impact how well your body uses glucose as an energy source.

Dr Monica prescribed herbal remedies, including Rhodiola, ginseng and ashwagandha to boost Sally’s energy levels and ease her stress. She also added fish oil for better quality sleep and vitamin D and iron to raise Sally’s depleted nutrient stores.

Additional lifestyle changes were incorporated to support the findings of the tests. Dr Monica recommended Sally double her protein intake and halve her intake of refined carbohydrates like white bread, rice and pasta, snacks, sugary drinks and sweet treats. This helped stabilise blood sugar levels, preventing spikes and crashes which can drain energy.

Sally had a tendency to fall asleep straight after dinner, which would trigger her acid reflux and decrease her sleep quality, so Monica recommended she eat 3 hours before bed.

Monica also helped Sally incorporate short forms of physical exercise like 5 to 15 minute walks into her weekly habits, which can help increase energy, as shown by a 2022 systematic review of 81 studies and 7,050 participants which found that physical activity decreases fatigue.

Slowly, over the course of 3-6 months, Sally started noticing a difference in her energy as her iron levels and vitamin D levels increased. It took another 3 months for her energy levels to remain stable throughout the day. Her mood swings during the PMS phase became less volatile, her cravings for unhealthy foods reduced, she moved down one dress size and it only took her one or two snoozes to get up in the morning.

Anna’s story

Anna, aged 35, initially sought Naturopathic Doctor Ji Woon Min’s help with her chronic gut issues, which had plagued her for years. She experienced daily bloating after every meal, accompanied with abdominal pain, and occasional diarrhoea.

Where chronic digestive symptoms go, fatigue often follows. Anna often struggled to get out of bed in the mornings and felt the need to nap in the afternoons, despite getting around 8 hours of sleep each night.

It was clear Anna was suffering with an imbalance of gut bacteria - Dr Ji Woon recommended a comprehensive stool analysis and SIBO breath test to identify the type of dysbiosis Anna was experiencing, which would help guide treatment. A series of blood tests were also advised to rule out other common causes of fatigue, like iron, B vitamins and thyroid health.

“Gut dysbiosis inhibits the absorption of nutrients, like iron and B vitamins, which play a pivotal role in energy production,” says Dr Ji Woon Min. “Iron and B vitamins are found primarily in animal products which means that those following plant-based diets are at higher risk of low levels. Carrying out a complete blood count (CBC) alongside testing ferritin levels provides valuable insight into total iron storage,” she says.

Anna had low levels of ferritin (your body’s stores of iron) and B12, despite eating meat. Her carb-heavy diet consisted of cereal for breakfast, sandwiches or noodles for lunch and some protein at dinner – where she avoided red meat (which is rich in iron) in her effort to stay healthy.

Dr Ji Woon recommended Anna focus on eating enough protein including red meat (one gram per kilogram of your body weight, more when you’re physically active), vegetables, complex carbohydrates (like brown rice, steel-cut oats and quinoa), and healthy fats like eggs, oily fish, yoghurt and avocados.

“Learning to fuel our body better is critical for vibrant energy and a healthy gut”, says Ji Woon.

Dr Ji Woon also prescribed supplements to boost the nutrients Anna was lacking, and support gut health. After a month, Anna noticed it was easier to get up in the morning and she had sustained energy throughout the day, “Fatigue is the first thing to improve when we begin to address the root cause of health concerns,” says Dr Ji Woon. After a few months of treatment, her gut issues resolved. “Not only did her symptoms stop ruling her life, but Anna finally felt like herself again,” Ji Woon adds.

In summary

“You don’t have to accept debilitating fatigue as normal for your age, just stress, or part of being a mom,” says Dr Monica.

“Duration and persistence are key indicators that you need extra help. If you’ve been tired for two weeks or more – get checked. Additional symptoms like pain, brain fog and mood changes are common, and often one of the first signs for women entering perimenopause. Getting professional help can bring ease to this transition,” she adds.

Some symptoms add to fatigue.

“Chronic bloating, diarrhoea and constipation can rob people of their energy,” says Ji Woon. “Addressing gut health can restore vitality which has been missing for too long. Many people who come to me have been struggling with chronic gut symptoms for years.”

For those people, a comprehensive stool analysis can reveal imbalances in the gut, guiding treatment to relieve their gut symptoms and fatigue.

The final marker to look out for is timing. “Do you always feel worse after a specific event? Was there a turning point in the year where you suddenly felt very tired? These are signals that your body is out of balance. Listening to that and investigating the root cause is the first step towards reclaiming it,” says Monica.

“You shouldn’t have to rely on multiple cups of coffee to get through the day,” says Dr Ji Woon.

Fatigue isn’t a symptom you simply have to endure as a staple of adult life. When you’re sleeping plenty and still tired, it’s a clear indicator to seek some extra support. Our naturopathic doctors are here to help you get the answers you deserve.

Together we can find the ‘why’ and define a treatment plan that will guide you back to wellbeing.

References 
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University of Georgia, Low-intensity exercise reduces fatigue symptoms by 65 percent, study finds, 2008
M A Alnawwar et al, The effect of physical activity on sleep quality and sleep disorder: a systematic review, 2023.
K Shimizu, Y Kuramochi, K Hayamizu, Effect of omega-3 fatty acids on sleep: a systematic review and meta-analysis of randomized controlled trials, 2024.
Y Yanagisawa, How dietary amino acids and high protein diets influence insulin secretion, 2023.
Harvard Health Publishing, Does exercise give you energy?, 2025.
NHS, Self-help tips to fight tiredness