For many of us, exhaustion is a fact of life. But for the rich and famous, it seems acute weariness can be so debilitating that it requires hospitalization and, in the case of Chicago Symphony Orchestra music director Riccardo Muti, a monthlong rest along Italy's Adriatic coast.
Though eyes often roll when celebrities vanish to be treated for "exhaustion," experts say it can be a valid medical condition, even for those who don't have a publicist. Prolonged periods of physical stress and sleep deprivation can cause problems that shouldn't be ignored, they say, though Americans may not want to admit it.
"Exhaustion is real on many levels, but it's not part of our medical lexicon," said Dr. John Stracks, a mind-body specialist at Northwestern Memorial Hospital's Center for Integrative Medicine who treats chronic pain. "So when you hear about Muti (being prescribed rest), it seems like a spoof, which speaks to how jaded and hard-driving we are these days."
Americans have more sleep loss and longer work schedules than residents of most other industrialized countries, and both factors can lead to physical and emotional collapse, said Dr. Eve Van Cauter, a sleep researcher and professor of medicine at the University of Chicago.
Experts say chronic stress can trigger a cascade of negative health effects -- in particular, the gastrointestinal distress suffered by Muti. The condition is frequently seen in night or shift workers, a description that, in some ways, applies to the maestro.
"Your mood and your gut function are intimately tied together," said Dr. Gerard Mullin, a gastroenterologist and associate professor of medicine at Johns Hopkins School of Medicine.
When you're stressed, for example, the body's "flight or fight" response causes a surge in adrenaline, which can result in valves in the upper digestive tract staying open. When this happens, food and digestive enzymes can travel the wrong way, resulting in reflux, heartburn and other stomach problems, Mullin said.
Sleep loss and fatigue also lead to problems with people's circadian rhythm, which can promote inflammation throughout the body and cause gastrointestinal issues, Van Cauter added.
In some cases, fatigue is a sign of an underlying disease, including cancer, low thyroid, anemia or other metabolic abnormalities, such as adrenal insufficiency. Exhaustion is commonly seen with depression and is a possible side effect of many prescription drugs, including beta blockers, muscle relaxants and mood stabilizers.
But University of Chicago Medical Center internist Dr. Alex Lickerman said fatigue caused by dehydration, infection, drug or alcohol abuse, or lack of sleep -- either due to insomnia or just burning the candle at both ends -- is treatable in the outpatient realm. Lickerman has yet to admit anyone to the hospital for being tired.
"It's a symptom," he said.
Of course, dozens of celebrities -- from hip-hop star Wyclef Jean to actress Lindsay Lohan -- have been carted off to the hospital amid reports of exhaustion. Though the term is a common euphemism for "drug or alcohol addiction" or a mental illness such as depression, performers also can suffer physical effects from their frenetic lifestyle and the harsh glare of the spotlight.
"It is a legitimate diagnosis when exhaustion causes someone to collapse and be unable to function," said Los Angeles-based psychiatrist Judith Orloff, who frequently treats exhausted celebs. "Exhaustion can also lead to low serotonin, which causes depression, anxiety and insomnia. But it's not accurate if the real diagnosis is drug or alcohol intoxication or overdose."
Exhaustion, by any name, is hardly a new phenomenon. In the 1800s, women were said to suffer from hystero-neurasthenia, or "nervous exhaustion." Triggers included excessive amounts of exercise, cohabitation, brain work and worries over motherhood, according to an 1887 article in the Journal of the American Medical Association. Women were also at risk if they worried too much about "impending or actual misfortune."
In the 1950s, around the time women were having "nervous breakdowns," scientists published research showing that it was, indeed, possible for business executives to suffer from exhaustion. Today the term burnout, which is characterized by emotional exhaustion, is recognized in Europe and is a common concern among those who work in the medical or humanitarian aid fields.
Still, while the World Health Organization recognizes several forms of medical exhaustion due to heat, pregnancy, excessive exertion, combat, malaise and other conditions, the U.S. government has not given it a diagnostic code.
Some data suggest "vital exhaustion," or a state of excessive fatigue, irritability and hopelessness, can be a risk factor for heart attacks and death. Dutch researchers found that people with high vital exhaustion scores were three times as likely to suffer a subsequent heart attack, perhaps because it increases blood clotting.
In the U.S., a problem is that the main treatment for exhaustion -- sleep -- is often seen as laziness, a bother or a barrier to productivity. In 1960, the average American received a luxurious amount of shut-eye: 8 1/2 hours a night. Today, most people get by on an average of less than seven hours, and a substantial proportion sleep less than six hours, according to National Sleep Foundation data
Stracks says he believes investing in rest for the chronically tuckered-out could have a large payoff down the road. "Would a two-week break really cost that much more than another MRI or ER visit?" he asked.
He recently prescribed several doses of sleep and relaxation for Chicago's Kat Ryan, who made her way to his office two weeks ago feeling dizzy and complaining that she "couldn't get her head on straight."
Ryan, a new mother, said she has been exhausted by her pregnancy and by getting up every two hours for the first six weeks of daughter Zoe's life.
"It had been building for months," Ryan said. "I was a little dehydrated, I wasn't eating well, I was tired, I was going back to work (after six weeks) and the combination was causing the dizziness."
Ryan, the artistic administrator for the Chicago Jazz Ensemble, spent the weekend sleeping; her daughter's father cared for their infant.
"I now know what stress can do to your body," said Ryan, who still has residual dizziness if she doesn't get enough sleep or eats poorly. "But Dr. Stracks was dead-on. On days that I do get rest -- which are few and far between -- I feel fine."
FOUR WAYS TO FIGHT EXHAUSTION
Exercise. Once you have enough energy to stand, get moving. Exercise can especially help if the exhaustion is related to depression.
Take meditation mini breaks. If you're wired all day, you'll have trouble calming down at night and getting to sleep. The short breaks "will help you decompress, calm your mind and relax," said Judith Orloff, an assistant clinical professor of psychiatry at the University of California at Los Angeles and the author of "Positive Energy." "Take a few deep breaths to relax the body," she said. "Focus on a positive image such as a sunset, a flower, a child's face. Stay focused on the positive image, breathe and relax. This will keep you in a centered place so you are not frazzled."
Stay present. Worrying is exhausting. "Do not project into the future or catastrophize," Orloff said. "Take doable action steps to solve problems."
Nip it in the bud. Before things get too bad, prescribe yourself some rest. Manhattan's Lisa Zaslow, 46, recently decided to put her work on hold and spend a month in the remote town of Marfa, Texas, to recharge emotionally and reflect on her life. "My business is about helping people create time and space, and I needed to do that for myself," said Zaslow, owner of Gotham Organizers, who has been in Marfa a week so far.