This time of year always makes me feel exhausted. I find my visits to Starbucks increasing every September as the month signals the beginning of so many things starting up again.

The job, kids going back to school, board meetings, fundraisers and committee work -- it all makes me feel so fatigued. Some causes of fatigue include stress, overwork and not enough sleep. Doesn't this strike a chord with most of us? Welcome to my world.

The National Institute of Health defines fatigue as ``a feeling of weariness, tiredness or lack of energy.'' Fatigue is differentiated from drowsiness or sleepiness but fatigue is often accompanied by a desire to sleep.

Fatigue is a common symptom that fortunately is not usually serious. The experts at the Mayo Clinic note three general areas that can cause fatigue. The first is lifestyle problems such as poor health habits, sleep deprivation, poor nutrition and overwork. The second is psychological problems, including emotional stress, depression and grief. Third, fatigue can signify an underlying medical problem.

Some of the more common illnesses that are usually accompanied by fatigue include cancer, rheumatoid arthritis, lupus, thyroid disease, diabetes, kidney and liver disease and anemia.

As noted in the information that accompanies our prescription medications, some drugs like antihistamines, heart and blood pressure medications, pain medications and antidepressants may in fact be the cause of your fatigue.

Chronic fatigue syndrome (CFS) often starts with flu-like symptoms and produces extreme exhaustion that tends to last more than six months. There is no specific diagnostic test for CFS; it is diagnosed only by ruling out all of the other possible causes of the fatigue. It is totally different from common fatigue and once the diagnosis is established there are treatments to make it easier to live with.

You should seek immediate medical attention when fatigue occurs along with more serious issues such as unexplained weight loss or gain; severe headaches, abdominal, back or pelvic pain; abnormal bleeding or shortness of breath.

If your fatigue has continued for over two weeks and/or you notice new symptoms, make a doctor's appointment to explore potential causes and hopefully generate a treatment plan. Go prepared with an accurate medical history and a list of your symptoms that details when they started and what seems to make them worse or better.

Don't be surprised if your doctor asks about your lifestyle and current state of mind, exploring such issues as relationship or job problems, feelings of sadness or boredom or increased stress. It is important to answer these questions truthfully.

Get organized and try these tips to reduce your fatigue:

• Learn some relaxation techniques.

• Get on a consistent sleep schedule and shoot for eight or more hours per night.

• Consider going to a nutritionist who can recommend a well balanced, healthy diet.

• Avoid overuse of alcohol and use of nicotine and drugs.

• Exercise daily if possible.

• Analyze what is causing your stress and explore strategies to reduce those circumstances.

• Talk to your health care provider about the best vitamins for you.

• Read the accompanying patient information sheets that come with your medications to see if fatigue could be a side effect.

Lynda G. Shrager is an occupational therapist, author and professional health organizing consultant. E-mail: lshrager@

otherwisehealthy.com

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