At the end of most workdays, we’re exhausted. But I’m not talking about “long week when every patient needed x-rays, a new patient covered you in vomit, and you ran out of all barriers midday” type of fatigue. I’m referring to the kind of exhaustion that sleep doesn’t fix, weekends don’t fully resolve, and time off only temporarily masks
When every conversation starts and ends with “I’m just tired,” that is chronic fatigue—which is most often a symptom of a capacity problem
Defining chronic fatigue
Chronic fatigue exists on a spectrum; at one end are medical conditions such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), fibromyalgia, and autoimmune disorders, where fatigue is a primary symptom driven by complex neurological, metabolic, and immune dysfunction.1,2 These conditions are real, multifactorial, and not solved by simple lifestyle changes
At the other end of the spectrum is something far more commonly experienced by clinicians: capacity-driven fatigue. This occurs when physical demand exceeds physical capacity, cognitive and emotional load exceed recovery, and/or the nervous system is consistently activated without adequate downregulation. Most of us fall somewhere in the middle where underlying physiology, workload, and recovery habits all interact
Even without a diagnosis, many clinicians experience a subclinical version of this physiology—chronic underrecovery disguised as “always just tired.” And while not all fatigue is fully controllable, capacity is always trainable
Dentistry creates a perfect fatigue storm: prolonged isometric muscle loading (static posture in awkward positions), high-precision work under time pressure, continuous sympathetic nervous system activation (we are on at all times), and minimal recovery between patients: a combination that increases neuromuscular fatigue, metabolic demand, and nervous system strain with generally inadequate recovery. Over time, that mismatch becomes chronic fatigue
The three drivers of chronic fatigue
- Metabolic dysfunctionFatigue is fundamentally an energy production problem. Chronic fatigue has been linked to impaired mitochondrial function, altered energy metabolism, and reduced tolerance to exertion.¹ In simple terms: the body shuts its energy-creating mechanisms down.
- Chronic inflammationLow-grade inflammation contributes significantly to fatigue. Research shows increased inflammatory signaling, oxidative stress, and ongoing immune activation in individuals with chronic fatigue.1,3 This creates a system that is constantly “on,” even at rest.
- Nervous system dysregulationChronic fatigue is closely tied to autonomic imbalance. Common patterns include: sympathetic dominance, reduced parasympathetic recovery, and impaired autonomic regulation.1,4 Clinically, this presents as mental exhaustion, difficulty shutting down after work, and feeling “wired but tired.”
Postexertional malaise
One of the most overlooked concepts is postexertional malaise (PEM)—a worsening of symptoms after even minor effort.1,5 This means fatigue isn’t just about workload; it’s about how the body responds after the workload. Many clinicians try to push through fatigue, which often worsens the cycle
How to win the fatigue battle
Build physical capacity for resilience. Strength training becomes part of our endurance and reduces relative workload. At work, move. Alternate sitting and standing. Stretch between patients or simply shift weight between feet. Movement variability reduces static strain. When the body is more capable than the job requires, fatigue decreases
Stabilize energy with nutrition that reduces energy crashes. Prioritizing protein, minimizing rapid glucose spikes with low sugar snacks, and avoiding missing meals all lend to metabolic stamina. Stable blood sugar supports sustained energy
Train for consistent recovery through intentional behaviors that support downregulation of the nervous system by prioritizing sleep quality, getting out of the office on lunch breaks, stimulate the parasympathetic nervous system with breathing exercises like box breathing (inhale to the count of 4, pause for 4, exhale for 4, and pause for 4, repeat) during exceptionally stressful moments. Sixteen seconds for sanity is worth it!
Clinical implications
Fatigue doesn’t stay internal, it shows up in our work by way of compensatory posture, reduced precision, errors, and lower patient engagement/advocacy
Not all fatigue is preventable—but much of it is modifiable, even with medical conditions that make us feel otherwise. It reflects capacity relative to demand. When demand exceeds capacity, fatigue wins. When capacity improves, fatigue loses. In summary: dentistry is a sport. Train accordingly
Ali SA, Kheirabadi D. Chronic fatigue syndrome. Updated December 13, 2025. In: StatPearls. StatPearls Publishing; 2026. Accessed June 2, 2026. https://www.ncbi.nlm.nih.gov/books/NBK557676/
Centers for Disease Control and Prevention. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Updated 2023. Accessed June 2, 2026. https://www.cdc.gov/me-cfs/index.html
Morris G, Maes M. Oxidative and nitrosative stress and immune-inflammatory pathways in patients with chronic fatigue syndrome. Curr Neuropharmacol. 2014;12(2):168-185. Accessed June 2, 2026. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964747/
Freeman R, Komaroff AL. Does the chronic fatigue syndrome involve the autonomic nervous system? Am J Med. 1997;102(4):357-364. doi:10.1016/S0002-9343(97)00087-9
Chu L, Valencia IJ, Garvert DW, Montoya JG. Onset patterns and course of myalgic encephalomyelitis/chronic fatigue syndrome. Front Pediatr. 2019;7:12. Accessed June 2, 2026. https://pubmed.ncbi.nlm.nih.gov/30805319/
