Tired all the time

Question 1

HPC exploring questions

Answer 1

Sleep pattern, quality and length
Activity levels

Have things changed recently that may have triggered this? E.g. recent illnesses?
Stress?
Impact on life/work

Had this problem before?

How is your diet? Eating lots of vegetables/fruit?

Any changes to urinary habits (e.g. prostate Ca, polyuria in DM) or bowel habits (constipation in hypothyroid, blood in stool in GI cancer)

Question 2

Questions to rule out a cause

Answer 2

Malignancy - any unexplained weight loss or night sweats

Depression - any low mood

Anaemia - any breathlessness, heavy periods, blood in stool or melaena (black stools)

Hypothyroidism - feeling the cold, weight gain, hair loss

DM - polyuria, polydipsia

(Lumps in breast in woman (breast Ca) or History of productive cough or coughing up blood (potential lung cancer))

Question 3

If low mood is a feature - ask these questions

Answer 3

Risk of self-harm/suicide
Thoughts vs plans
Protective factors

Question 4

PMH questions

Answer 4

Problems with tiredness before
Previous mental health conditions
Previous thyroid problems - particularly low thyroid
Previous anaemia

Question 5

DH

Answer 5

Regular medications

Recent medication changes (e.g. just started steroids)

Question 6

FH

Answer 6

Problems with low mood/depression
Hypothyroid
Anaemia

Question 7

SH

Answer 7

Smoking
Alcohol
Occupation
Living arrangements

Question 8

Examination in tired all the time

Answer 8

Obs: HR, RR, BP, BMI, temperature

o Auscultate chest / heart
o Cervical lymphadenopathy

• Eyes - conjunctival pallor
• Assess for goitre

Question 9

Investigations in tired all the time

Answer 9

Bloods - FBC (for Hb), CRP, TFTs, (also could do HbA1c if suspect diabetes)

Question 10

Management of insomnia

Answer 10

Encourage sleep hygiene -

• Fixed times for going to bed and waking up
• Avoid caffeine, smoking and alcohol from late afternoon onwards
• Dark quiet room
• Only use the bedroom for sleeping
• Avoid screens e.g. phone before sleeping
• Better if exercise earlier in the day and restful activities for 30m before sleep

PIL on sleep hygiene

OTC medications - e.g. Nytol - an antihistamine

Try not to prescribe but options include:

• Benzodiazepine/Z drug e.g. temazepam or zopiclone
• Only used if there is day time impairment
• Addictive nature, less than 2w treatment, avoid driving

Question 11

SN for insomnia and follow up

Answer 11

If experience night sweats, loss of appetite, unexplained weight loss then come back to the GP

If experiencing low mood come back to the GP

Follow up in 2-3 weeks