Fatigue

Fatigue is a symptom of many different conditions, including:

• Stroke
• Heart attack
• Heart failure
• Long Covid
• Breathing problems

Fatigue can also be caused by other issues, like stress, fear, or poor sleep.

What is fatigue?

Fatigue is sometimes explained as a tiredness that doesn’t go away, but there is a lot more to it than that. As well as feeling tired, fatigue can also cause:

• Difficulty sleeping, or sleep that doesn’t make you any less tired
• Low tolerance for exercise
• Low energy and difficulty completing tasks that used to be easy
• Difficulty with remembering things
• Difficulty thinking, or constructing a solid train of thought
• Dizziness or light-headedness
• Aches and pains
• A feeling that there is a weight on top of you, or that your arms and legs are very heavy
• Low mood or a sense of emotional numbness

Fatigue can be caused by all sorts of health issues, but the common factor is that people with fatigue have low energy and get exhausted more easily.

Fatigue is not a mental health condition, although it can sometimes be a result of mental health conditions. Fatigue does not mean that someone is “lazy” or “not trying hard enough”. Fatigue is a problem with how your body processes energy. There are measurable effects on how your body works when you are fatigued. Fatigue can affect all parts of your body – muscles, brain, nerves, and digestion – and can be difficult to manage. However, there are things that you can do to reduce your symptoms and manage your energy.

Many people with fatigue find that it improves over time, especially fatigue caused by a specific medical incident like a stroke or heart attack. Even if your fatigue does not go away on its own, you can manage your symptoms effectively, and people with even severe fatigue can live full and happy lives.

How does fatigue work?

Fatigue responds to your level of activity. If you are very active, exercise heavily, or experience a period of stress, you may find that your symptoms worsen as a result.

Everyone has a limited amount of energy which they can draw on. In fatigue, this level is lower. One way of understanding this is through “spoon theory” – you can imagine that you have a set number of “spoons”, representing energy, and every activity you do throughout a day will take some spoons from your collection. When you run out of spoons, you will be unable to do any more activities. People with fatigue have fewer “spoons” – and, especially if there are other health problems, you might find that some activities take more “spoons” than they would if you were healthy.

People with fatigue often experience a “boom and bust” pattern. This means that there are times when fatigue symptoms are relatively mild, and you may feel well. This “boom” period often tempts people to overwork themselves, trying to catch up on activities which you may have missed while fatigued. As a result, symptoms flare up and you enter the “bust” period, where you feel much worse. This can last for days or weeks.

This “boom and bust” pattern can become a vicious cycle, since people who are in a “bust” period may feel frustrated and fall behind on the things they would like to be doing, which makes it even more tempting to overwork when they feel good.

How is fatigue treated?

Fatigue is usually treated by making changes to your daily routine and habits. It may also be helped by treating the underlying problem – for example, if your fatigue is caused by heart failure, treating the heart failure directly may reduce your fatigue symptoms.

If your doctor or health professional suspects that your symptoms are affecting your sleep, or that they are a result of you not being able to sleep well, you may be offered medication such as melatonin to help you to sleep more easily. You can also buy these supplements in a pharmacy or chemists – however, you should always speak to your health professional before taking new supplements, and stop taking them if you experience unexpected side effects.

The main way to treat fatigue symptoms is through rest and energy management. By managing how you use your energy, and making sure that you get enough rest, you can make your fatigue symptoms less severe and reduce the chances of falling into the “boom and bust” cycle.

Rest

One of the most important things you can do to manage your fatigue symptoms is to make sure you get adequate rest.
This does not just mean sleeping. It is important that you build time into your day, every day, when you are not sleeping, but are doing things that replenish energy rather than using it. This can be difficult to begin with, but it can also have a huge positive impact on your mood and your energy levels as well as your general health.

A good way to make sure that what you are doing qualifies as “rest” is to ask yourself whether you could do it indefinitely without getting tired. For most people with fatigue, this means that some activities you may think of as rest – reading, watching TV, talking to people – actually aren’t rest.
Common things that count as rest include:

• Meditation
• Mindfulness and relaxation exercises
• Lying in a quiet room
• Listening to relaxing music

Pacing and energy management

One of the best things you can do for fatigue is managing your energy to avoid “boom and bust” patterns.

There are two main aspects of this:

• Finding how much activity you can do safely, and staying below that level
• Prioritising your work

Finding a baseline

You can find a baseline for how much activity is safe for you by tracking your activity (you can use an activity diary or technology like a smart watch) over one or more weeks and seeing whether your symptoms get worse.

You could start off with a rough baseline by considering what you think you could do for five days out of seven without worsening symptoms. Most people overestimate their capacity – it’s best to halve what you think you can do. If, after a week, you don’t see any worsening of symptoms, you could start to slowly increase the activity you do.

You should never increase your baseline unless you have tried it for at least a week without your symptoms getting worse.

Prioritising your work

A key part of managing your energy is making sure that you know what is most important to do.

It can help to write down all the things that you want to do, and try to order them by importance and urgency. Consider, also, how much energy each task might take. You will have to let some things go. Learning how to prioritise can be a long and difficult process, but it gets easier with time.

It can be tempting to only prioritise work and chores, but it is important to make sure that you do some things which you enjoy.

It is also important to remember that energy isn’t just used on physical activity. Anything that needs you to think hard, to maintain focus, or which causes strong emotions may use up energy.

Pacing

Another useful thing to do is to make sure you keep your activity levels reasonably steady. This may mean breaking up activities over hours or days to build in rest and recovery. Essentially, you should try and keep a similar activity level day by day, and avoid some days being much busier than others.

You should also try, where possible, to balance mental exertion with physical exertion – so if you have to do a day’s worth of desk work and a day’s worth of household chores, it is better to have two days where you do both, rather than one day of each.

Coping with fatigue symptoms

Even with practice and support, it is normal for people with fatigue to occasionally experience symptoms flare-ups. There are some things you can do to help with fatigue symptoms when they are present, as well as trying to avoid them through energy management techniques.

• Prepare for bad days – It can be helpful to have easy-to-prepare foods on hand, to make sure you will be able to reach any medications from your bed, and to talk to friends, family, and employers in advance so that they will understand more easily when your symptoms are bad.
• Have a comfortable space – Being physically comfortable can make fatigue symptoms easier to handle. Sitting or lying down may be easier than standing. Comfortable clothes, a warm and soft place to sit or lie, and the ability to block out noise can all help.
• Put the kettle on – Many people with fatigue find that a hot drink – preferably one which does not have caffeine in it – helps them to feel better.
• Write things down – Fatigue can make it hard to remember things. Communication can also be difficult. Writing down tasks and important things to remember will take away the stress of trying to remember them. Writing emails or notes rather than speaking on the phone can allow you more time to think when you are struggling to get your thoughts in order.
• Mindfulness and meditation – Many people find that mindfulness and relaxation exercises can help them to get in touch with their body’s needs, and to reduce their stress and exhaustion. You may want to use an app such as Headspace.
• Get support – If you live alone, you may want to ask friends or family to check in on you. People may be able to help you with chores. Talking to someone about your symptoms can also help you to manage them.
• This too will pass – Remember that fatigue symptoms are not usually dangerous, and that they will go away on their own if you manage to rest.