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I’m tired all the time, but rest doesn’t help. What is fatigue and what can I do about it?

By Anne Taylor

Fatigue comes in many forms, and can be an intrusive, frustrating symptom of many different conditions, such as Chronic Fatigue, Multiple Sclerosis and Depression. It can also be a byproduct of some drug therapies, such as in cancer treatment. Sometimes fatigue doesn’t have a known cause. 

Fatigue is not the same as tiredness

Tiredness

Feeling tired is a normal part of life. We feel tired when we are run down, when we haven’t slept enough or have been burning the candle at both ends. Tiredness is something that rest and support can remedy. Tiredness is hard, but tiredness makes sense. 

Lassitude fatigue

This is the fatigue in your whole self that looks like exhaustion, even though you may be well rested and shouldn’t have a reason to feel tired. But lassitude fatigue will stop you from feeling able to get out of the bed, or make you have a nap that you know won’t change things. 

Cognitive fatigue

Some people describe this as brain fog, where your thinking is muddy or befuddled. It is hard to process and understand conversation. It is difficult to find your words, make decisions and communicate. It is difficult to concentrate for any length of time. Your body may feel completely normal, but the ‘thinking cogs’ are not turning.

Physical or neuromuscular fatigue

When part or all of your body becomes tired it just stops working. This can be when someone has walked a certain distance they stop picking up their feet and catch their toes or you just can’t get your arms up to reach the mug in the overhead cupboard anymore. 

All these different experiences can happen on their own, at the same time or in any combination. Fatigue is a significant and an important part of someone's health and is deserving of support and attention. 

Fatigue is manageable. 

There are many things that can be done to reduce the effect of fatigue and get back to what’s important. 

So what are some management strategies that can help?

1 - Budgeting (who doesn’t love a budget!?) 

Learn how much particular activities cost you in your day, and plan accordingly. If you know you have $20 of energy throughout the day, and going to work will cost you $10, what will be the best use of your remaining $10? Perhaps doing the grocery shopping costs you $5, and cleaning costs you $4, which leaves $1 for some fun! But now you have to deal with a leaky sink, so there goes the fun fund. 

It is helpful to find ways to include fun in the budget, perhaps you could do your shopping online and have it delivered? Or maybe you could delegate that task to someone else, or perhaps work would cost less if you change the way you do things. 

Learning your budget and then using it to your advantage means you can still do things you love. The secret is to understand what things cost, and then bring some creativity into your planning and see what works best for you. 

2 - Learn your triggers. 

Some people find that when they have to deal with particular people or situations, their fatigue can get worse.  Knowing who the expensive people and situations are means you can plan for them, or learn which situations actually require your attention and energy.  Some people find their fatigue is affected by the temperature or the weather, so perhaps having a hot water bottle in the office is a useful thing for you. 

3 - Build a support team. Recruitment matters!

By speaking about your fatigue with the right people around you, there may be some ideas that present themselves from the brain's trust. Perhaps your friend would love to come to your place for a coffee instead of meeting at a cafe. By including friends and family in understanding you, they are more likely to be understanding and not feel stood up when you cancel at the last minute. 

There are also health professionals who can help you! This could be:

  • Occupational Therapist
  • Psychologist
  • Social Worker
  • Physiotherapist
  • G.P.
  • Specialist (e.g. your Neurologist if you have Multiple Sclerosis)
  • A local support group

Ask your local therapist if they have experience in managing fatigue, or if they can recommend someone who does have experience.

4 - Pacing

Pacing is an important part of managing fatigue, of all types. By being intentional about what we do, we can achieve more each day, instead of falling into a boom and bust pattern, where you expend all your energy and are then written off for the days following. It goes with the budgeting ideas, because unfortunately you don’t get to borrow from your next days budget without paying for it, usually with interest. 

5 - Exercise

Of course, as a Physio I’ll be banging the exercise drum.  But just hear me out! Thinking back to your budget, imagine if over time, your budget just kept getting smaller and smaller, as you slowly move into a cycle of inactivity. Like all people when we don’t exercise, our capacity for exercise and daily activity reduces (have a look at Courtney Turner's Deconditioning Blog). In a totally unfair twist, it takes 3 weeks of consistent exercise to start to have positive changes in our muscles and only 3 days of inactivity to start to lose muscle mass (that’s rude of our bodies really!). When we lose our fitness, our budget or energy capacity essentially becomes smaller. But by regularly engaging in exercise, we build wealth and tolerance. 

Exercise does amazing things to our body, not just helping us grow those muscles

Exercise helps to:

  • Improve our mood
  • Reduce inflammation
  • Provide an opportunities for fun (find a form of exercise you actually enjoy, not just something your friend likes)
  • Improve your capacity to cope with load
  • Improve balance and efficiency of movement

If you want to find someone who can be supportive and help you work through possible solutions to your fatigue, your Physiotherapist, Occupational Therapist, GP, Social Worker or Psychologist is well positioned to help you.

Fatigue may be invisible, but it’s important, and something that doesn’t have to be faced alone.

ttReferences

Pyszora, A., Budzyński, J., Wójcik, A. et al. Physiotherapy programme reduces fatigue in patients with advanced cancer receiving palliative care: randomized controlled trial. Support Care Cancer 25, 2899–2908 (2017). https://doi.org/10.1007/s00520-017-3742-4

G. Galeoto, J. Sansoni, D. Valenti, et.al. The effect of physiotherapy on fatigue and physical functioning in chronic fatigue syndrome patients: a systematic review. La Clinica Therapeutica (2018). doi: 10.7417/T.2018.2076

Leonard A. Jason, Meredyth Evans, Molly Brown, Nicole Porter, What is Fatigue? Pathological and Nonpathological Fatigue PM&R, Volume 2, Issue 5 327-331  (2010), ISSN 1934-1482, https://doi.org/10.1016/j.pmrj.2010.03.028. (https://www.sciencedirect.com/science/article/pii/S1934148210002960)

https://www.ms.org.au/support-services/education/facets.aspx

https://www.ms.org.au/attachments/documents/publications/understanding_ms.aspx

 

 

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