Fatigue

Fatigue can impact people for lots of reasons and can be common in people who have lifelong conditions, or when recovering from a period of illness or after surgery.  
 
It is important to rule out any additional factors that might be contributing to fatigue, such as vitamin deficiency or sleep apnoea. Your GP can support you to rule these out with blood tests, and a simple screening questionnaire.

 

Managing your energy levels

Managing your energy levels can be difficult when you already feel low in energy to start with, but a technique called pacing can help. When starting anything new, it can take a little while to see the difference, but over time, you can see a positive change.  
 
Pacing works on the basis of taking periods of rest before you need to. This can seem counterintuitive at first, but it can help you to get more done over a longer period and to feel in more control of your energy levels. For people who experience fatigue, it can be tempting to ‘do as much as possible’ on ‘good days’ leaving them exhausted and wiped out. This is known as the ‘Boom and Bust cycle’.

For those with long term health conditions there can often be difficult choices about what needs to be done vs what they would like to do, and every action ‘costs’ some of their energy. A helpful way to understand this is the 'spoon theory', you may hear some people with chronic health conditions refer to themselves as ‘spoonies’ or ‘spoonholders’ and this term comes from Christine Miserandino’s 2003 essay entitled ‘The Spoon Theory’. It was written when she was trying to find a way of explaining to her friend about how her condition feels and impacts her day to day.

 

How 'spoon theory' works

Imagine starting the day with 15 spoons. Each spoon represents the energy you need to perform a task, things like showering, making breakfast, reading, talking on the phone. Every task uses a different number of spoons. You can use your spoons how you like, but once you run out of spoons, you are out of energy. Tomorrow you will wake up with 15 more spoons. You can borrow spoons from tomorrow to give yourself more energy today, but you will start the next day with less.

Here is an example of what different activities can ‘cost’ someone with a chronic illness in terms of spoons. Different tasks may cost each individual more or less spoons depending on how physically or cognitively challenging it is.

[spoon theory image]

Other things that can impact on how much an activity will impact energy levels includes things like hospital stays or hospital appointments, dehydration, increased levels of pain and emotional stress. On paper, two days could look the same, but if someone has a higher level of pain on one of these days it will take more energy.

Hospital stays or hospital appointments also take a toll on someone’s energy levels, not only are you likely to be feeling unwell at the time, but there is a greater need to be able to communicate effectively in order to access the right treatment and advocate for yourself in these situations. Hospital stays or appointments can be cognitively and emotionally draining and often leave you with new information to process and implement. From a ‘spoons perspective’ a hospital appointment could use all of your spoons for the day, between preparing for the appointment, travelling to and from and attending the appointment itself.

 

Using the pacing technique

When starting to use pacing for the first time it can be helpful to think about how long tasks take - we often over or underestimate this. Tasks can feel like they take ‘2 minutes’ or ’10 minutes’ but in reality this might take us half an hour, or we might start one thing and then move on to another.

 

Task one – How long do things take 

Write down what you do over the next few days, and notice how long these things take you – don’t change anything, just notice the length of time.  
Example: Monday – Washed and dressed – 30 minutes, Made breakfast – 15 minutes etc.

 

Task two – What type of activities, and what is your priority? 

It can be useful to think about what types of activities we have across our weeks.  
These might be things like:

• Essential tasks such as washing, dressing, cooking, managing appointments etc. 
• Leisure and hobbies such as reading, walking, crafts, puzzles, baking etc 
• Social activities such as meeting family or friends in person or online, this might be one to one or in a group  
• Movement – walking, stretching, swimming, dancing, seated exercises or team sports  
• Work – paid or voluntary, full or part time

Once you have your list of activities, you can now think about which are your priorities and put them in order. The order of these activities will be different for everyone.
Example:
Priority 1 – Essential tasks  
Priority 2 – Social time  
Priority 3 – Movement

 

Task three – Planning ahead 

When thinking about our energy and planning how we will use this, it can be helpful to think about the week ahead, rather than planning day by day. Weekly planning works because it allows for greater flexibility – it can be tempting to over fill a day when you look at it on its own, but when you look at it within a week, it is easier to compensate for busier times.  
 
Planning weekly allows us to think about any bigger activities coming up and how we will cope before we get to them. This might be a hospital appointment, or it might be spending time with friends. 

When using a weekly planner add any priorities for the week first, then add periods of rest around this. This gives you a foundation for your week, you can then see what space you have left for other activities.   
 
Example: If you have a hospital appointment on Wednesday, you might plan to have a rest day on Thursday. Or if you have an activity you attend on a Tuesday afternoon, you might plan to have a quiet morning so you can enjoy this without feeling too fatigued.

 

Other things that can help

 

Movement and activity 

We know that moving our body can help us feel better by releasing endorphins, improving our strength and flexibility and can reduce inflammation. Activity and movement can help promote quality sleep and can also improve our cardiovascular health, as well improving our mood.  

Movement does not have to be attending a formal exercise class, this can be gentle stretches, seated yoga or following a 10 minute exercise video at home.  

When thinking about starting a new activity, start small and look where you have sufficient energy to do this, do you feel brighter in the morning? Try adding this to your weekly planner, remembering to add space for a rest afterwards. 

 

Diet and hydration

It is important to eat a balanced diet, ensuring you have protein, carbohydrates, fruit and vegetables will ensure that your body is well fueled.  

Reducing foods high in processed sugar will avoid spikes and crashes in energy levels, caused by changes in your blood sugar levels.  

Keeping hydrated is also important for your body to work at its best. If you are dehydrated, this means that the body is working harder to do these things that it needs to, reducing your energy levels. Dehydration can also contribute to headaches and constipation.

 

Aids and technology 

Aids and gadgets that can be used for cooking, dressing or managing our home, can reduce the physical exertion needed to complete everyday tasks, and in turn can help to positively manage fatigue.

Technology can reduce the cognitive exertion for tasks, such as planning and organisation – using prompts and reminders within the home and to support appointments and medication management.

 

Support systems  

The people around us often want to help, even if they don’t know the best way to do this. Giving them a way to support you and your fatigue can be beneficial for both people. You get the support that you need, and they get to support you in a meaningful way. This might be collecting your shopping on the way to visit you or arranging to meet at a place and time convenient to you, to avoid you overly exerting yourself. Talking to friends and family about your fatigue can help them to understand what you are going through. The spoon theory can be a helpful way to explain this and can help people to understand that you do not have an endless source of energy. 

Remember that you can say no to things if you are invited somewhere, but that you can also ask to modify this. If someone asks to meet for a coffee across town at 4pm, you could reply with ‘I would love to, but it would help me if we could meet somewhere closer or at a different time’.

 

Emotional wellbeing 

Living with fatigue can have an impact on our mood and overall wellbeing. 

It can be helpful to have strategies in place to support your mood. 

• Mindfulness activities such as listening to guided meditations or breathwork can be helpful  
• Spending time doing things we enjoy, such as crafts, reading, listening to music  
• Movement can help lift your mood - yoga and tai chi can be helpful as slower activities, but so can moving your body to your favourite song 
• Connecting with others in person or online  
• Spending time outdoors in natural sunlight can help our mood and our sleep 

There are lots of resources for mood and mental health, including via your GP, 111 or by self-referring to talking therapy. The NHS has a good information page on talking therapies: NHS talking therapies for anxiety and depression - NHS