What is fatigue?

People describe fatigue as overwhelming tiredness or complete exhaustion. It is a symptom, not a condition. Fatigue can affect you physically and mentally (psychologically), and can seriously interfere with what you are able to do in your day-to-day life.

What causes fatigue?

We don’t fully understand the exact cause of fatigue yet.

Primary fatigue is directly related to your neurological condition i.e., stroke, multiple sclerosis, transverse myelitis, Parkinson’s disease.

Secondary fatigue is linked to other factors that are not necessarily related to your condition such as stress or worry (concerning work life, home life or relationships) and disrupted sleep patterns.

Fatigue may be made worse by long periods of inactivity caused by your illness, like bed rest. Malnutrition and dehydration can also increase feelings of fatigue. Other medical problems such as pain, depression, seizures, anaemia or infection can also make fatigue worse.

The effects of fatigue and explaining these to others

Fatigue can affect your mood, memory, concentration, decision making and emotional state. You may feel you lack strength and motivation at times which can limit the amount of activities you feel able to do or want to do, such as housework, hobbies or socialising. It is very common to feel like this as a result of neurological injury or illness. It can be useful to mention how you feel to others so that they can try and understand your situation.

How long will I feel like this?

Everybody is different. You are likely to have good days and bad days. Your neurological condition and your general health will both have an effect on how long you experience fatigue for. It is helpful to learn what techniques and approaches towards managing fatigue work best for you.

Doctors and therapists can score your fatigue levels, suggest suitable exercises and help you to set realistic goals. Having these goals can help you prioritise and pace your daily activities.

Ways of managing fatigue

Balance your activities with rest

Try to incorporate some exercise into your routine each week, even if you are wheelchair-bound. Evidence shows that exercise is helpful for fatigue, so long as you don’t overexert yourself.

It is just as important to find a relaxation method that suits you. Tai chi or yoga may be good options. There are now websites and mobile apps designed to help you to plan and focus your rest breaks. See Headspace and Calm for some examples.

Prioritise your activities and pace yourself

If you work during the week consider leaving other jobs to do until the weekend. Break down any large or complicated tasks into smaller, more manageable ones. Also think about whether you could ask family, friends or colleagues for help with tasks.

It may be useful to keep a record of how you feel throughout the day or at what part of the day you begin to feel weary. Energy conservation is important; recognising fatigue ‘warning signs’ may help you to pace your activity and avoid exhausting yourself. There are now mobile apps that can prompt you to pace your daily activities.

Plan ahead

Set yourself realistic goals and remember to congratulate yourself when you reach them.

Plan for your important events (celebrations, trips etc) so that you can enjoy them but you don’t overexert yourself. Accept you may not be able to attend the whole event and remember to factor any travel time into your plans. Be prepared that a special event or trip may cause fatigue for a day or so after the event.

Organise your space

In the office and at home, keep items that you use a lot in easy-to-reach places, especially if you use a stick, crutches or a wheelchair. Good lighting and a well-ventilated, clutter-free area will make activities safer, easier and less tiring.

Eat a healthy, balanced diet

Eating well will greatly benefit your general health and wellbeing. Try to include the following food groups in your diet everyday:

• Fruit and vegetables
• Starchy foods (wholegrain foods and high fibre cereals)
• Dairy or dairy alternatives (low fat cheeses, milk, yoghurt, soya)
• Proteins (meat, fish, eggs, tofu, beans, pulses, nuts)
• Small amounts of unsaturated fats

It is also important to drink plenty of fluids to keep yourself hydrated.

Public Health England’s Eatwell Guide gives more information on what foods you should be eating everyday to stay healthy.

Practise good sleep hygiene

It’s not just the quantity of sleep you have but also the quality. Have a rest or nap during the day if you need to, but try to keep it to 20-30mins. Try to stick to a regular night-time routine and don’t stay up too late. Avoid eating heavy meals late in the evening if you can. If you are feeling fatigued it can be tempting to use caffeine or alcohol as a pick me up. However, too much caffeine or alcohol can actually disrupt sleep.

Chronic fatigue syndrome (CFS)

Also known as post viral fatigue syndrome or ME, chronic fatigue syndrome is a condition in its own right. This article does not cover CFS, but if you would like to find out more about the condition you can visit the NHS website or the ME Association website.

Tips from people who have experienced fatigue

Below are some tips shared with us by people living with fatigue on what they find helps them to manage day to day.

• “Know when the fatigue is starting to affect you and immediately take action. It is critical to recognise the early signs.”
• “Dealing with fatigue, one of the key things that helps is to have anticipatory rest, shut your eyes for 20mins.”
• “Pacing myself is crucial and not attempting too many things in a day/week. Knowing when to rest is crucial too.”
• “The best advice I can give is to be kind to yourself, to learn your triggers and know your limits, particularly if you experience post-exertion fatigue that might not really kick in until the following day. That said, I have found one of my coping strategies is not to be afraid of pushing myself a little each day, even if that is motivating myself to cook a meal, going out for a short walk or going to a ‘do’ with friends for an hour (rather than being out with everyone else for hours!). The rewards can be immense and help to keep things to look forward to.
• “Finally, after months off work, I am soon hoping to return to work on a phased return to work. I fortunately have a very flexible and supportive employer. We are being realistic about what needs to be adapted and what can be achieved within my limitations. Returning to work is a terrifying but exciting prospect. We all need to start somewhere, even if that is a toe in the water, little baby steps, and having realistic expectations I am confident that I will get there slowly but steadily. The Equality Act is there to support you. ‘Access to Work’ have also been very helpful and can help not only with things like equipment to enable you to get back into and stay at work, but also things like support with travel options. There are also some tremendous employment support agencies out there, not least National Careers Service if you are looking at getting back into work or changing your career options.”