Fatigue

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Fatigue is a common symptom following an acquired brain injury. Your brain will seem to have less energy. Even after a little effort, you may feel worn out and unable to go on. Your brain is telling you that you need a rest – listen to it. If you struggle on, you will make yourself even more tired and less able to cope.

What causes tiredness/fatigue?

Physiological causes

  • After an injury, your brain is not able to process information as effectively or efficiently as before (i.e. limited ability to multi-task, decreased processing speed). Mental activity now takes more effort which can result in rapid mental fatigue and feeling overloaded. Your brain has to work harder to do just basic day-to-day activities and your “energy bank” is rapidly depleted. You may find that other symptoms arise or symptoms worsen when you are tired and recovery from your injury may take longer.
  • Some chronic health conditions, poor nutrition and dealing with pain can cause fatigue
  • Medication taken for a chronic condition can have side effects that contribute to fatigue

Emotional causes

  • Anxiety, depression and stress can cause fatigue.
  • Fatigue also causes emotional dyscontrol (i.e. irritability, crying spells, outbursts of anger).

Environmental causes

  • Disrupted sleep can be caused by noise, light, a restless partner or being unable to “shut off your brain” from worries and thoughts.  If you don’t get a good sleep, you will be tired the next day.
  • Being in a noisy, busy environment and working in a stuffy, cramped office with artificial lights often results in fatigue. You may need to concentrate harder at times, as your brain may not filter distracting noises or lights as easily.
  • Not all activities are equal in the amount of brain energy required. Certain tasks are more demanding of your cognitive abilities.  For example, sitting on the beach eating an ice cream requires less brain energy than balancing a cheque book.

Our energy bank

View your personal energy as a bank, into which you make deposits and withdrawals. You need to budget your energy so you have enough energy for all your daily activities.

  • Do not run your energy bank on empty; make sure you always have energy in reserve.
  • To balance your energy bank, use the priority setting, planning and pacing strategies that are listed.
  • Do activities that replenish your energy bank.

What can I do to cope with tiredness/fatigue?

Sleep

  • Make sure you get sleep, with fixed hours for going to sleep and waking up. If necessary, talk to your doctor about sleep medication. Reduce or eliminate caffeine and alcohol in your diet.

Health

  • Eat regular, well-balanced nutritious meals and snacks
  • Avoid alcohol
  • Commence regular light aerobic exercise, gradually building up to 20-30 minutes, at least three times a week (e.g. walking outdoors or on a treadmill, cycling on a stationary bicycle). Talk to your health professional if more guidance is required.
  • Talk to your doctor or health professional about management of pain and headaches
  • Find ways of reducing stress in your life. Prolonged stress can lead to serious health problems and will slow down your recovery.

Try these strategies

Priority setting

Make sure you balance your life and make time for all the activities you need to do during the day. Your activities will fall into the following groups: leisure, family, looking after yourself, work, school or household chores.

  • Make a list of the activities you do during the day, group the activities (work/school, leisure, family, personal care, and household). Do you have a healthy balance of activities?
  • Spending all your energy on work or school does not promote a healthy life. Make lists and decide for yourself, what is:
    • Urgent (must be done today)
    • Important (must be done in the next few days)
    • For later (must be done this week or month)
    • Perhaps never (keep big picture in mind)

Planning

Just as you budget money to make sure you don’t overspend, you must plan your energy for the activities you need to do.  

Keep you energy bank as full as possible. Make time to re-fill your energy reserves.

  • Keep a daily diary of how much energy (scale 1-10) it takes to do each activity. Add up your totals for the day, note frequent activities that drain your energy and make adjustments to the number and type of activities you do during the day.
  • Plan your week the Friday before and prepare a weekly calendar/schedule that lists the urgent and important things to do. If you find you have too many urgent tasks, then re-think your priorities, delegate tasks to others, and learn to say “no” without feeling guilty.
  • Identify your energy boosters and plan time for them each day. 

Pacing

A common error is to deny your tiredness and carry on as usual. Set a new pace that allows for more rest periods or different ways of doing things. Be realistic.

  • Learn to recognize your brain fatigue signals:
    • Light-headed, headache, decreased balance
    • Slower thinking, pain, clumsiness
    • Irritability, stress etc.

Stop what you are doing, have a break for as long as it takes for the symptoms to diminish. It may take you several days to fine-tune the balance between the activities you do with the energy that you have.

  • Identify your own pace and stay within it
  • Be prepared to cut your “to do” list in half until you know your speed
  • Build in time for unanticipated mistakes or distractions
  • Use energy conservation techniques
    • Plan individual tasks by gathering all your tools and materials to your working place to avoid unnecessary stair climbing and trips from room to room
    • Analyze the activities you do and simplify into manageable chunks that you can work on at different times
  • Delegate tasks to others
  • Schedule rest breaks in your day. Spread out your activities over the day.
  • Vary your activities during the day (physical, thinking and relaxation)
  • Factor travelling time to and from work or school, into your work day
  • If you are anticipating a heavy day, build in time before and after for some rest and relaxation

Positioning

Your environment and how you position yourself can make a difference.

  • A good sleep position is one that keeps your spine straight and your limbs relaxed. Ensure you have a supportive pillow for your neck and you may wish to sleep with a pillow between your knees when lying on your side.
  • Minimize noise, and clutter. Use lights that are neither too bright nor too dim.
  • Make sure your work area is ergonomically correct (i.e. work surfaces at correct height, good posture, supported lifting techniques etc.)
  • Change positions every 15 minutes

Prevention

  • Listen to your body’s natural call for rest and do not feel guilty if you need to rest
  • Try to work in quiet surroundings and minimize the amount of “white noise”
  • Go shopping when it is least busy
  • Avoid driving in rush hour
  • Find ways to replenish your “energy bank”
    • Do at least one enjoyable activity each day
    • Consider breathing and relaxation techniques, meditation and listening to calming music

When can I start to do more?

Increase gradually

  • As your symptoms diminish, you can slowly step up the number and intensity of the activities that you do. Use your “energy diary” to guide you.

Get back to normal activity and work by easy stages

  • As you find you can do more and more, you can think of starting work again. It is important that you take the return to work in easy stages with activities that are within your capability. You may need a health professional to recommend and negotiate with your employer and/or long term disability plan and/or insurance company to:
    • Modify your duties, your hours and days of work. The ideal is to start working just two to four hours, Monday, Wednesday and Friday. Slowly increase the number of hours you work, when certain that you can cope and your fatigue is not increasing from day to day.
    • If your symptoms increase at any time, your body is telling you that you are overdoing it. Make sure you take a break immediately, and you will need to review what you have done in your day or what might be contributing to increased fatigue, and will likely need to make some changes.

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