by Dr. Tatiana Habanova
“I am so tired even my tiredness is tired”
Fatigue is a universal feeling we all experience at one time or another: from trying to stay mentally alert on Zoom meetings, to that feeling we get after completing an exercise routine, to not feeling refreshed due to a sleepless night. In fact, the Merriam-Webster thesaurus has a long list of synonyms for the word fatigue, so clearly people have tried describing this feeling of tiredness, exhaustion, or lack of motivation for some time.
Fatigue is actually a symptom, not a condition, with just as many causes as synonyms. Many health care providers believe fatigue is just a combination of lifestyle, social, psychological, and general wellbeing issues rather than an underlying medical condition. Even though fatigue is a normal phenomenon usually resolved with a nap or a few nights of good sleep, for brain injury survivors, fatigue can be debilitating. It becomes a barrier to doing day to day activities, negatively impacting relationships and the ability to work.
Fatigue can be categorized into seven different types:
Physical fatigue: comes from muscle weakness and diminished cardiovascular stamina, usually occurring after strenuous or extended physical activity. Typically, physical fatigue gets worse in the evening or after a busy day, and improves after a good night’s sleep. Physical fatigue sounds like: “I’m tired and I need to rest. I’m dragging today.”
Psychological fatigue: comes with depression, anxiety, and other psychological conditions. This type of fatigue gets worse with stress. Many times, sleep does not help and for many it gets worse in the morning. Psychological fatigue sounds like: “I just can’t get motivated to do anything. I just don’t feel like doing anything.”
Cognitive fatigue: also called mental fatigue or neuro fatigue, this occurs while performing cognitive tasks such as concentration, information processing, and recall. This type of fatigue is common after a traumatic brain injury where the brain is devoting a large amount of its energy reserves to healing itself. With less energy available for thinking and concentrating during this healing time, the brain is less efficient in sending electrical signals, compounding the effects of cognitive fatigue. Researchers found that the severity of fatigue seems to have no relation to the severity of trauma, time since injury, or the area of the brain primarily affected.
The type of fatigue can arise quickly, and when it does, it makes it very difficult for the person to continue with ongoing activities. It also takes a disproportionately longer time to recover. Cognitive fatigue sounds like: “After a while, I just can’t concentrate anymore. It’s hard to stay focused. My mind goes blank.”
Sensory fatigue: comes with irritability, restlessness, or anxiety, usually occurring with sensory overload. This happens when input from your five senses outweighs what the brain can sort through and process. This type of fatigue is seen with various neurological conditions and is also a common sequela that occurs in mild traumatic brain injury survivors when concussion symptoms last beyond the expected recovery period after the initial injury. Multiple conversations going on in one room, flashing overhead lights, or a loud party can all produce the symptoms of sensory overload. Sensory fatigue sounds like: “I need to get out of here. I feel tense. I want to leave now.”
Social fatigue: also called social burnout or post-socializing fatigue, this fatigue happens when you don’t get enough alone time and have socialized to the point that you can’t do it anymore. This type of fatigue tends to affect introverts and brain injury survivors to a greater degree as they tend to invest a lot of energy trying to navigate socially demanding environments, leading to social exhaustion. Social fatigue sounds like: “I feel like I hit a wall. I’m running on empty. I don’t feel like going.”
Compassion fatigue: comes with withdrawal, feelings of helplessness, and lack of self-satisfaction leading to a diminished ability to empathize or feel compassion for others. Commonly seen with health care professionals working directly with victims of disasters, trauma, or illness, it’s also seen with family members and caregivers of a loved one with a chronic illness. Compassion fatigue sounds like: “I feel sad. Nothing I do helps. I don’t enjoy my favorite activities anymore.”
Chronic illness fatigue: also called post-exertional malaise (PEM), chronic illness fatigue is a complicated disorder characterized by extreme fatigue lasting for at least six months that can’t be fully explained by an underlying medical condition. The type of fatigue worsens with physical or mental activity, but doesn’t improve with rest. It is a serious long term illness causing dizziness upon standing and affecting many body systems, sleep, and memory. Chronic illness fatigue sounds like: “I feel unrefreshed when I wake up. I get really tired with any exercise. My muscles and joints are in constant pain.”
Each fatigue type has specific strategies and tools available to help cope with the symptoms and lessen the degree that it interrupts daily function and mental health.
The challenge many face with one or more fatigue types is being mistaken as lazy, unwilling to participate, or apathetic. It can be very difficult for family, friends, or coworkers to understand the limitations caused by different types of fatigue, and often place an expectation on the individual to quickly become “normal” again. Realistically, recovery time can be prolonged and extended.
Attempting to describe fatigue to someone who never experienced it before can be a thankless task. As an invisible symptom, people often don’t understand the sheer scale of what someone with fatigue goes through. Careful communications can help provide the understanding needed to help family, friends and coworkers comprehend the lack of energy needed to complete tasks, go to social events, or provide care for a loved one. This lack of energy does not equate to lacking desire to complete those tasks, attend an event, or continue to be the caregiver.
Dr. Habanova is the host of Brain Health Savvy, a weekly podcast that inspires listeners through real conversations on all things pertaining to women’s brain health. She transforms women in simple, yet real ways. Her sass, wit, and straight-from-the-hip style on women’s brain health and empowerment encourages women to seek their true potential, to be fierce and unapologetic while leading from authenticity, and to embrace change as they buck societal norms in favor of better brain health.