Tired all the time, but your blood tests are normal

“Your results are fine.”

You hear it with relief, and then with something close to disappointment. Because if nothing is wrong, why do you wake up already tired? Why does the afternoon feel like walking through wet sand? Why does answering one more message feel like climbing stairs?

“I’m tired all the time, even after sleeping.”

It is one of the sentences I hear most often in a first conversation. Usually from a woman who is doing well on paper. Work gets done. The children get to school. Nobody around her would call her exhausted, because she doesn’t look it.

So I don’t ask women whether they are tired. Almost every one of them says “a bit, like everyone”. I ask: for how long? And very often there is a silence. Because the honest answer is: I can’t remember when it was any different.

First, the medical part

Normal results are good news, but check with your doctor that the basics were covered: iron and ferritin, thyroid, vitamin D and B12, blood sugar. Poor sleep quality, sleep apnoea, perimenopause and some medications can also leave you drained without showing up on a standard panel. Rule those out properly. This article is about what is left when they have been.

Functioning is not the same as feeling well

We carry a very misleading picture of an overloaded person: someone crying in the bathroom, unable to get out of bed, visibly falling apart. In reality you can be deeply exhausted and still work brilliantly. Run the meeting, deliver the presentation, pick up the children, buy a present for your daughter’s friend’s birthday, and still reply at 10 pm: “Sure, I’ll take care of it.”

As I said in an interview for Onet, the fact that you are still functioning tells you about your ability to mobilise. It tells you nothing about what that costs, or how long you can keep it up.

It is a bit like judging a car by the fact that it drives. It does. But if a warning light has been on for a month, “it still drives” is not a very good reason not to look.

Your brain is always preparing

Our brain does not sit and wait for things to happen. Most of the time it predicts: what is about to happen, and what the body will need for it. Neuroscientist Lisa Feldman Barrett describes this as the brain running a “body budget”, spending resources in advance of what it expects.

You can feel it on a staircase in the dark. You are sure there is one more step, and your leg is already set for it: tense, positioned, ready. When the step isn’t there, your whole body jolts. Nothing happened. Your brain simply invested in a prediction that didn’t come true.

Now think of a woman who predicts all day long. What the children will need. What could go wrong in the project. Whether her partner is quiet because he is tired or because something is wrong. What has to be ready tonight so the morning doesn’t fall apart. Her brain keeps preparing her body for scenarios, most of which never happen.

And the body pays for that preparation. When what we anticipate feels like a threat, a conflict or something we are responsible for, parts of the stress response can switch on: more tension in the muscles, most often the shoulders, neck and jaw; changes in breathing and heart rate; with stronger stress, changes in cortisol. Digestion moves down the list, because the body assumes it will need to act soon, not digest.

Each of these changes on its own is tiny. None of them is a breakdown. The point is that they can last for hours. Every day. For years.

Why you stop noticing

If you live on a busy street, after three months you no longer hear the cars. Not because they stopped driving, but because your brain decided the sound was background and stopped reporting it. Switch on a drill and you hear it immediately. Tension works the same way. At some point it stops being a signal and becomes background, and from then on you have nothing to compare it with.

There is a second side to this. How the brain reads signals from inside the body (hunger, tiredness, tension, a racing heart) is called interoception. It is not a fixed receiver. It is closer to a skill that sharpens or dulls depending on how you use it. If for years you have learned to keep going despite hunger, tiredness or tension, you may notice those signals later and later, or treat them as normal.

That is why the most tired women I know honestly say they are not tired. They are not lying, and they are not in denial. They may simply no longer get the message as early or as clearly as they used to.

It shows in the negotiations. “Just this one email.” You are hungry, but first you’ll finish. You need a break, but in a minute. Your head hurts, but you’ll push through until the evening. Neck tension used to mean “take a break”. Now it takes a migraine to stop you.

What it looks like instead

The cost is very real. It just doesn’t look like stress. It looks like life.

For some people, long-term overload goes together with poorer sleep, muscle tension, stomach and gut trouble, slower recovery after an infection, changes in blood pressure, or catching every cold going. You sleep seven hours and wake up as if you hadn’t. You wake at three in the morning with a ready-made to-do list. You clench your jaw so hard that your dentist mentions it.

None of these looks like stress. Each of them goes to a different specialist. And none of those specialists sees the whole picture.

Research also describes pathways through which inflammatory signals from the immune system can affect the brain systems involved in motivation, mood and behaviour. That is exactly what women describe most often: no energy, nothing is as enjoyable as it used to be, everything irritates them, ordinary things suddenly feel hard. I won’t tell you that this is where your tiredness comes from; science can’t say that about one person. But the practical conclusion stands: the body is one system, and the line between “psychological” and “physical” is much blurrier than we were taught.

Why sleep stopped working

After a hard week you need sleep, and sleep helps. After five years of running like this, sleep is no longer enough. The stress researcher Bruce McEwen called this allostatic load: the wear that comes from the body constantly adjusting (stress, sleep, metabolism, immunity, the heart) to keep things in balance under pressure. It is not a debt you could count. It is the cost of never getting fully back to baseline.

And then I hear the sentence I hear more often than any other: “But I slept, so why am I still so tired?”

Rest refills what you have used. It does not change how you lose it. Think of a phone with twenty apps running in the background. You can charge it to one hundred per cent, but by evening you will be looking for the charger again. (If rest itself has stopped working for you, this article goes deeper.)

Not every “a lot” costs the same

Two women can have almost identical calendars and be in completely different states by the evening, because different things drain them.

• Analysing. One goes back over conversations, checks how she sounded, rewrites sentences that were said days ago.
• Anticipating. Another is always three steps ahead, scanning for what could go wrong.
• Picking up other people’s emotions. For a third it is enough that someone nearby is quieter than usual, and her nervous system is already working.
• Taking responsibility instantly. The fourth sees a problem and, before she has had time to think, she is already plugged into it.

These are four completely different ways of losing energy, and each needs something different. “Rest more” helps none of them, because none of them is tired from a lack of rest.

A better question

That is why “I’m tired” on its own tells me very little. I don’t even ask “what tired you today?”, because the answer is always the same: work, children, cooking. True, and it changes nothing.

I ask something else: what switches on in you before you have time to think? Which mechanism starts by itself, without your permission? That is your personal way of losing energy, and it is different from your neighbour’s, even if you are both equally finished by the evening.

For one week, notice the moments you feel most drained. Not the busiest moments, the most draining ones. They are often not the same.

Your blood tests measured what is in your body. They were never going to show what your mind has been carrying.

Further reading: Lisa Feldman Barrett, How Emotions Are Made (2017), on prediction and the body budget. Bruce S. McEwen, “Protective and damaging effects of stress mediators”, New England Journal of Medicine (1998), on allostatic load. Sahib Khalsa and colleagues, “Interoception and mental health: a roadmap”, Biological Psychiatry: CNNI (2018).

Kasia Biernacka is an organisational psychologist and leadership advisor based in Belgium, with more than 20 years in HR and leadership development. She has talked about the hidden cost of living in “I’ll manage” mode in interviews for Onet and iKobiece.pl (both in Polish).