Sleepy Boomers in for Rude Awakening?
'Frequent Fatigue Often a Clue to Treatable Illness'
PHILADELPHIA, August 18, 1999 - If you're over 40 and feeling tired much of the time, your body could be trying to tell you something: You could have an underlying illness that can be treated if caught early - or can ruin your retirement if left undiagnosed - according to America's doctors of internal medicine (internists).
"Many fatigued baby boomers are sick and don't know it," says Sandra A. Fryhofer, MD, an Atlanta internist and president-elect of the American College of Physicians-American Society of Internal Medicine (ACP-ASIM). "They just think they're rundown from the lifestyle of the 90s - stress at work, aging parents and kids. We want to tell everyone over 40: Your fatigue could be wake-up call for a condition we can treat - like thyroid disease, sleep apnea, or mild depression."
A common culprit often posing as fatigue - especially in women over 50 - is hypothyroidism. It occurs when the thyroid gland at the base of the throat fails to produce enough hormone and metabolism runs low. The symptoms often mimic those of normal aging.
Untreated, an underactive thyroid leads to weight gain, hair coarsening and high cholesterol. "Because of changes in liver metabolism, the body is less efficient in clearing cholesterol from the blood," explained Fryhofer. "You could well be on your way to heart disease and not know it," she cautioned, citing evidence that high cholesterol levels are risk factors for cardiovascular disease.
There's a blood test for hypothyroidism, and the organization representing America's 120,000 doctors of internal medicine - the American College of Physicians-American Society of Internal Medicine - recommends women over age 50 be tested.
Hypothyroidism is easily treated with a daily pill which boosts hormone levels. "Patients continue taking it for the rest of their lives," said Fryhofer. "We can check them about every six months to make sure the dosage is right."
While hypothyroidism is more prevalent in female baby boomers, male boomers with constant fatigue are more likely to be suspects of sleep apnea - although 80 to 90 percent of those who are go undiagnosed. As many as three million middle-aged men don't know they have this chronic upper airway obstruction during sleep, usually associated with loud snoring. This condition repeatedly disrupts their sleep when they gasp for breath. "Breathing actually stops, changing oxygen levels and ultimately damaging blood vessels and the cardiovascular system," says Fryhofer. "If not treated, sleep apnea can lead to heart disease, high blood pressure, even stroke, especially in men under age 60."
While there are appliances that can be worn during sleep to prevent sleep apnea, the treatment of choice is modifying lifestyle, since there is often a link between the disease and excessive weight as well as too much evening alcohol use. Fatty tissue narrows the windpipe, and alcohol use decreases muscle tone.
Another common condition often posing as fatigue is depression. "We doctors for adults see it all the time," says Fryhofer. "In fact, most of our fatigued patients are depressed, and sadly, they are the last to know it. And the problem is further compounded by the stigma of depression - the misconception that it stems from personal weakness, rather than a suspected biochemical imbalance in the brain."
"We internists prescribe medications to correct imbalances - reversing the course of depression and enabling patients to get outside and see the sun, instead of the clouds," Fryhofer said. These antidepressants are effective in more than two-thirds of cases.
In addition to the potential consequences of major depression, including suicide and domestic violence, there is evidence depression can lead to heart disease - especially in baby boomers, according to Fryhofer. "People who suffer two or more weeks of mild depression are about twice as likely to have a heart attack down the road, compared to patients with no episodes."
It is suspected that depression activates the autonomic nervous system, increasing the heart rate, constricting blood vessels and raising blood pressure. "When we are young, we can usually take this strain," Fryhofer said, "but as we grow older, the cardiovascular strain can precipitate more serious chronic disease - heart disease or stroke."
"We want to urge boomers who feel fatigued to consider seeing a primary care physician and I recommend an internist. We want baby boomers to think about their retirement health now, before it's too late, just as they have to plan for their retirement nest egg."
Fryhofer is national spokesperson for the ACP-ASIM "Doctors for Adults" public education campaign to help baby boomers prepare for a healthy retirement. She said the campaign underscores the internist's role in adult health care, so people can make an informed choice when selecting a physician. More than half of Americans do not know what an internist is or does, according to a national survey conducted by the Philadelphia-based medical association in 1997. One-fourth of those polled said internists were "interns" or "just out of school."
After medical school, internists spend at least three additional years studying acute and chronic diseases. After that, many seek additional training to subspecialize in certain diseases. For example, many internists practice cardiology (heart and blood vessels), endocrinology (diabetes and other glandular disorders), rheumatology (arthritis), or oncology (cancer).
Founded in 1915, ACP-ASIM comprises more than 120,000 doctors of internal medicine and medical students. Its mission is to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice of medicine.