Drained by fatigue?

Fatigue is one of the most commonly reported effects of a brain injury. Unlike 'normal' fatigue, which is time-limited and alleviated by rest, the intense feeling of fatigue after brain injury may be present most of the time and can have a significant impact on quality of life.

We've put together eight effective strategies to help.

Watch your mood

Fatigue is one of the main criteria used when diagnosing depression. However, not everyone who experiences fatigue is depressed. Brain injury can have a significant impact on mood and behaviour. This may be a consequence of direct damage to the brain itself or because of the impact the injury has had on an individual’s life.

Feeling depressed, stressed and anxious can leave you feeling tired. Equally, when people experience high levels of fatigue, which stop them from doing what they want to do, they may report feeling low and irritable.

What can you do?

• Be realistic in your planning – pacing activities to avoid the boom-bust cycle.
• If you don’t achieve an activity try to reschedule it for when you are not fatigued.
• Try not to brood on things you haven’t achieved. Notice when you have done things well and celebrate these achievements.
• Be aware of and acknowledge your feelings and emotions, but try not to dwell on them.
• Plan time in your schedule to do pleasurable activities that will make you feel good about yourself.
• Acknowledge that you may not be able to do as much as you did previously.
• If you are really struggling with your mood see your GP. Options may include medication, counselling or psychotherapy such as cognitive behavioural therapy (CBT).

Pace yourself

Pacing is a way of balancing activities that you do throughout the week. By spreading tasks out you may be able to reduce fatigue.

Pacing includes:

• Having regular rest breaks
• Planning your time and being organised
• Prioritising where to use your energy
• Knowing what your triggers are and working within your available resources.

Sleep hygienically!

Sleep hygiene is nothing to do with personal hygiene, but is simply about having a regular sleep routine. This helps the body to prepare for going to sleep by winding down and helps you to feel more alert on waking.

Some dos and don’ts for sleep hygiene

DO...

• Establish a regular routine by going to bed at the same time each day, and getting up at the same time.
• Use your bed for sleeping only – don’t watch TV in bed.
• Develop sleep rituals before going to bed to wind down and relax; for example, have a bath or listen to gentle music.
• Get regular exposure to outdoors and bright lights.
• Avoid eating heavy meals late in the evening.
• Reduce your intake of caffeine and nicotine in the hours before going to bed.
• Avoid drinking alcohol for a few hours before going to bed.
• Create a calm bedroom that is cool, dark and quiet - earplugs and blackout blinds can help.
• Use relaxation techniques.
• Avoid stress and worry at bedtime.
• Avoid taking a nap after 4pm.

DON’T...

• Exercise within three hours of going to bed.
• Look at the time if you wake up, as this may make it difficult to get back to sleep.
• Take another person’s medication.
• Have too much tea, chocolate, coffee or fizzy drinks in the evening.

Fatigue always starts with losing half of my vocabulary, I can’t recall the word for anything or I use the wrong word and then start stammering and getting confused.

- Steph Healy

Exercise

Exercising improves our capacity to undertake physical activities. Current government guidelines recommend 30 minutes of moderately intense exercise five times a week to improve our physical fitness. Try to choose something which you enjoy as you are more likely to stick to it. 

Some people report that exercise has an energising effect and research shows that it can have a positive effect on mood. Exercise can also help you to sleep more deeply. 

Ways to introduce exercise into your everyday activities:

• Park the car further away from work, or at the other side of the supermarket car park.
• Get off the bus a stop before your destination. 
• Take the stairs instead of the lift or escalator.

Monitor your nutrition and hydration

Some types of food can make us feel more ‘sluggish’ and lacking in energy, while others can help to maintain energy levels for longer periods. Thinking about eating the right things at the right times, according to what you are doing, is important in managing fatigue.

Fast-releasing carbohydrates, in foods such as sweets, sugary cereals, white bread and sugary drinks, break down quickly and flood the blood with too much sugar. Surges in blood sugar levels may result in a short term increase in energy, followed by decreased energy and concentration. 

Slow-releasing carbohydrates, in foods like brown rice, wholegrain pasta, fruit and vegetables, are more ‘complex’ and contain fibre that helps to slow down the release of sugar and so maintain energy levels. It is important for the diet to have a balance of ‘complex’ carbohydrates and protein from foods such as meat, fish, dairy products and nuts.

Drinking enough fluid, particularly water, keeps the brain and body hydrated. This is important to help the brain and body to work effectively. Drinking lots of caffeine, such as in tea, coffee and some fizzy drinks, may increase your alertness initially, but this is often short-lived.

Discuss medication

There is currently very little research into the effectiveness of medication for managing fatigue following brain injury, although some types of medication have been found to be helpful with other conditions where fatigue is a symptom.

Medication may be helpful in managing other factors associated with your injury, such as anti-depressants for low mood, but it may also influence the fatigue you experience.  Some side effects may include drowsiness and could make you feel more tired during the day.

It is important to discuss these issues with your GP, who should be able to advise you on the benefits of medication and suggest any alternatives.

Modify your environment

To make best use of your available mental and physical abilities you may want to think about the environment in which you live and work. Being organised and avoiding distraction can help to minimise the physical and mental effort that is required to complete an activity.

Suggestions:

• ‘Energy conservation’ techniques will be helpful if you experience ‘physical fatigue’; for example, sliding instead of lifting items, using a laundry basket on wheels or having items used regularly within easy reach.
• Organise your workspace, such as your kitchen or office area, keeping it as uncluttered as possible. Keep things in the same place so that you don’t waste energy searching. Try to have ‘a place for everything and everything in its place’.
• Use good lighting in order to prevent eye strain.
• Use labels/signs to help you to find things more easily.
• Think about turning off the TV or music when you are trying to concentrate on a task.
• Prevent interruptions from other people – put a ‘Do Not Disturb’ sign on the door.

My friends and family can see the change in my face, sometimes before I’ve even noticed it myself. Probably because I want to plough through as I’m fed up of giving into it.”

- Catherine Hammond

Explore cognitive (thinking) strategies

Following brain injury you may need more mental effort to perform a task and you may experience difficulty sustaining this effort over time. Some people have described reaching a point at which their brain ‘shuts off’. When experiencing ‘mental fatigue’ people describe being unable to think clearly and have difficulty concentrating.

It may be that cognitive difficulties resulting from your brain injury may be more noticeable when you get fatigued. Everyone tends to become forgetful and make more mistakes when they feel tired. Therefore, making best use of your thinking resources through applying strategies may be a way to make fewer mistakes and make things take less effort.

Some cognitive strategies that might be useful are:

• Using checklists to help you stay on track, such as a shopping list
• Scheduling your time using a diary, electronic organiser, phone organiser or filofax
• Using alarms to prompt you to stay on task or take breaks
• Doing one thing at a time to help your concentration
• Using flow charts for planning and decision making
• Using written notes or ‘Post-its’ as reminders, rather than trying to ‘hold something in mind’
• Using cue cards to act as reminders.

“In those first few months especially, I didn’t realise the difference between physical and mental fatigue. However with time, I eventually learnt to treat my brain as a battery – with some things draining it quicker than others.”

- Belinda Medlock

Find out more

This information is taken from our booklet Managing fatigue after brain injury (PDF). You can download a copy from our information library, or contact our helpline, who can send free printed copies to people with a brain injury and their families. 

If you are affected by fatigue, you should speak to your GP and seek referral to specialist services such as a neuropsychologist or occupational therapist. Many Headway groups and branches can also offer support. 

To discuss fatigue or any other effects of brain injury, please contact our helpline on 0808 800 2244 or helpline@headway.org.uk.