President Donald Trump is tired. He will probably never admit it directly, but the effects of his fatigue are all over the news. In a controversial speech about Islam that he delivered in Saudi Arabia on Sunday, for example, Trump audibly stumbled on his words, confusing the terms “Islamist” and “Islamic,” a small change that makes a big difference. The implications of this gaffe, being quite severe, underscore an increasingly serious public concern: Is the president too worn out to do his job?

While only Trump’s doctors can officially diagnose him with chronic fatigue syndrome or some other exhaustion-related condition, it’s clear to anyone with eyes and a news feed that he is, in fact, tired. You can’t blame the guy: Between firing James Comey, keeping secrets from Mike Pence and Jeff Sessions, and spilling national intelligence to the Russians, he’s had a hell of a week.

Even White House officials admit it’s wearing on him: On Monday, the second day of his trip to Saudi Arabia, Trump skipped an event on social media and terrorism, sending his daughter Ivanka in his stead, because of “exhaustion.”

When asked by reporters why Trump went off-script to talk about Islamist terrorism in a speech to Middle East leaders, a White House official said: “Just an exhausted guy.”

And in the Monday edition of The Daily, the New York Times White House chief correspondent Peter Baker, commenting on Trump’s Islamic/Islamist gaffe, said, “He uses both of them at different points in the sentence because I think he’s a little tired. He tripped up.”

The Guardian reports that Trump is a “reluctant traveler” and was not looking forward to the trip.

Trump is reported to be dreading the trip and to have inquired unsuccessfully if it could be shortened. He is a reluctant globe-trotter. Given the experience so far of the National Security Council and the state department, he is unlikely to read briefing notes longer than a page.

Representing the United States in the midst of the Israel-Palestine conflict is not a situation where one should be tired. Getty Images / Lior Mizrahi

If Trump is suffering from fatigue, he can count it as another thing he has in common with the rest of America. Fatigue takes both acute and chronic forms and is a common complaint among the general population. The former type is the sort of tiredness that usually results after an experience that’s especially physically or emotionally taxing; in a 2015 article in Biological Psychology, researchers, defining fatigue as a “subjective state of exhaustion, tiredness, weakness, and lack of energy that impairs daily activities,” showed evidence for a link between stress and next-day fatigue that was linked by the quality of a person’s sleep. Preventing stress and intervening in sleep-stress cycles, the researchers write, can usually remedy acute fatigue. If this is what he is suffering from, it would probably not hurt for Trump to try getting more than his usual four hours of sleep.

And then there is chronic fatigue syndrome, a more serious, long-term condition affecting over 1 million Americans. It is, according to the Centers for Disease Control and Prevention, also not particularly well understood and has a lot of overlap with other conditions, so it’s hard to diagnose. All we know is that it’s the kind of tiredness that won’t go away after taking a nap and lasts for six months or more. It manifests in different ways, both physical and mental. In addition to feeling joint and muscle pain, people with chronic fatigue syndrome tend to have sleep problems, headaches, and issues with memory and concentration.

It remains to be seen whether Trump’s medical team will acknowledge his exhaustion — or what they will do to mitigate the effects it’s having on his performance. Common treatments for fatigue include balancing the patient’s diet, introducing moderate exercise, and improving their sleeping habits. Given Trump’s appetite for fast food, belief that a round of golf is sufficient exercise, and the aforementioned lack of sleep, his doctors will likely have their work cut out for them.

As for reducing the stress that might be making him so tired? Given the epic string of controversies he’ll return to when he’s finished touring the Middle East, running the country — which he thought “would be easier” — is unlikely to get any less difficult from here.

Trump famously said in the days before the election that his supporters “would get so tired of winning,” but it seems that Trump is now just plain tired.