We all get tired from time to time. Late nights, long work hours or the kids keeping you up at night – can all leave you feeling temporarily worn out. But this is not the only form of tiredness impacting the inhabitants of the modern world.
This blog is provided by guest writer, Bev Alderson from Practically Balanced, where she works with individuals, groups and workplaces wanting to take a more positive and proactive approach to enhancing wellbeing, and in turn achieving greater results.
Fatigue, sometimes called TATT (tired all the time), is the type that lingers, no matter how much rest or sleep is undertaken, leaving its victims struggling to get through, let alone enjoy, each day. The good news is that there is a lot that can be done to overcome that feeling of jetlag, without the holiday. To tackle fatigue and to claim your energy back.
Tiredness and Fatigue
The Oxford dictionary defines tiredness as “the state of wishing for sleep or rest; weariness” and fatigue as “extreme tiredness resulting from mental or physical exertion or illness”. Whilst there is seemingly an endless array of ways to be tired and fatigued, let’s explore three principal types – ‘General Tiredness and Fatigue’, ‘Prolonged Fatigue’ and ‘Chronic Fatigue Syndrome’.
General Tiredness and Fatigue
As human beings we are designed to be awake and functioning for around two thirds of each 24-hour period. Each night we are likely to feel tired, from how we have used that time, and will want to sleep for around the other third.
There will be periods where life has challenged us, we’ve overdone things or we’re recovering from illness. Here we may need extra rest and sleep to recover. This may see us needing to put our feet up, crash for the weekend, increase self-care or take a much-needed holiday.
For some, days that are too much can roll into weeks, and weeks can roll into months, of overdoing and under recovering. The term ‘adrenal fatigue’ was coined by Dr James L Wilson and describes below optimal functioning of the adrenal glands, which he both details and addresses in his book ‘Adrenal Fatigue: The 21st Century Stress Syndrome’.
Located above the kidneys, the adrenal glands are intrinsically linked to the stress response – the body’s natural defence mechanism against real or perceived danger. Their primary role is to produce stress hormones, including cortisol, in response to stress. Cortisol isn’t just needed to help fight or flight you out of danger though. It helps to get you out of bed in the morning, maintain steady energy throughout the day and then falls away to let you sleep at night. This is known as the diurnal rhythm.
Run your adrenals with your foot flat on the accelerator for too long and your cortisol production can become sporadic, leaving you with no energy when you need it, and too much when you are trying to rest and sleep. Your diurnal rhythm is out of whack.
|Ø An inability to get out bed in the morning
Ø Brain fog
Ø Extreme sugar or salt cravings
Ø Unexplained aches and pains
Ø Lower back pain
|Ø Unexplained weight gain, particularly around the mid-section
Ø A diminished ability to deal with stress
Ø Sleep challenges/Insomnia
Ø Decreased libido
Ø Anxiety and depression
… just some of the potential symptoms of prolonged or adrenal fatigue.
Here the road back to diurnal rhythm equilibrium is not a short one, and you are likely to have ‘destination prolonged fatigue’ saved in your internal satnav – should you choose to run your system too fast and for too long in the future. Functioning of the adrenal glands can be tested via blood, urine, or saliva, with the latter more readily used.
However, adrenal fatigue is not widely accepted by the medical profession, with some preferring to centre investigations around more scientifically accepted diseases such as adrenal insufficiency, thyroid or pituitary diseases. Equally, it can be overly diagnosed in the health and wellbeing world, without a formal diagnosis.
Chronic Fatigue Syndrome or Myalgic Encephalomyelitis (CFS/ME)
Growing up in the eighties, I can remember the emergence of what was deemed as yuppie flu. A fashionable form of fatigue that preyed on young middle-class professionals striving their way up the career and cultural ladder. A perceived copout for those that couldn’t keep pace with the high life. CFS/ME, as it is now known, is absolutely no joke. It can be a life altering and debilitating condition that can see some sufferers housebound and unable to function or cope with life.
Whilst it has been linked to stress and to viral infections, the causes of CFS/ME are not entirely known. It is generally characterised by extreme fatigue lasting over 6 months, along with an inability to function in daily life, that can’t be attributed to a medical condition.
Symptoms may include:
- Extreme or persistent fatigue that worsens with physical or mental activity but doesn’t improve with rest.
- Feeling unrefreshed following adequate sleep.
- Musculoskeletal weakness, dizziness, and issues with balance.
- Challenges with memory, focus and concentration.
- Enlarged lymph nodes in the neck or armpits.
There is no mechanism to diagnose CFS/ME – generally other conditions are ruled out to determine a diagnosis.
The road to recovery is not easy and requires time and a lot of support. Most people see symptoms improve, some continue to have flare-ups and others make a full recovery. An individualised treatment plan is usually devised, under the guidance of a doctor or specialist, supported by close family and/or friends.
Okay so I said three, but I can’t write a blog on fatigue, at this time, without mentioning covid-19.
It has now been a year since this relatively unheard-of virus began to plague our planet. Bringing with it a roller coaster ride of, amongst other things, hardships and restrictions – setting the stage for life to become increasingly challenging and decreasingly enjoyable.
The term ‘pandemic fatigue’ was devised by the World Health Organisation (WHO) and refers to a natural response to a prolonged global health crisis. In their pandemic fatigue report, WHO detail some of the known impacts and their recommendations. Unsurprisingly this prolonged period is taking its toll on physical and mental health, with many saying they are feeling worn down by the year behind us, and the uncertainty of what lies ahead. Whilst there is light at the end of this tunnel, there is much to be learnt about what will be left in covid-19’s wake.
Know Your Starting Point
Before we journey into solution mode, it’s worth considering your current position. What the underlying cause, or causes, of fatigue may be – to the problem you are trying to fix.
I recommend you pull over for a moment and get clear on exactly where you are:
- Consider your current situation or any challenges, that may be contributing to fatigue?
- What is the impact to your health and wellbeing, and the level of fatigue you may be experiencing?
- What are you doing about it, if anything – positive or negative?!
It is worth pointing out that fatigue is not a condition in its own right, rather a symptom of something else – namely a medical condition, a lifestyle factor or both.
If something isn’t running as it should, like any good mechanic, the first step is to take a look under the covers. There are many conditions that can cause, or significantly contribute to, fatigue, including:
· Thyroid disfunction
· Coeliac Disease
· Insulin Resistance
· Adrenal Insufficiency
· Anxiety and Depression
· Glandular Fever
· Deficiencies such as Iron, Vitamin D, B12
· Food Sensitivities
· Sleep conditions such as Sleep Apnoea and Insomnia
· Chronic Inflammation or Infection
· Certain Medications
· And more…
I advise working with your Doctor to first rule out or tackle any health concerns directly. If your Doctor falls into the camp of not recognising fatigue, then I would recommend finding one with a more integrative approach to medicine.
Fatigue is not always the result of a medical condition, rather life-style factors, or a combination of both. Again, those that contribute to fatigue can be wide ranging:
|· Relationship issues
· Financial worries
· Too much or too little sleep
· Work related stress
· A young family
|· Over or under exercising
· Shift or on-call work
· Alcohol or drug use
· Unhealthy eating habits
· Life events – weddings, house moves etc
The good news is that, if no medical conditions are identified, you are likely to be healthy. The not so good news is that, if lifestyle factors are causing or a contributing to fatigue, these will need to change – if you genuinely want to get your mojo back.
Each of us is moving through life in a different vehicle, that we use in a different way and on a unique journey. So, whilst there are some generic steps we can take in tackling fatigue, our approach to getting and keeping our vehicle running optimally is likely to be unique to us.
In my work as a Wellbeing Coach, I sometimes ask clients to create a wellbeing wheel which provides a flexible and individualised framework.
In the centre of the wheel, you put the challenge(s) you are facing, or a quality you would like to cultivate. Then in each segment, what you will do to either overcome the challenge, better manage it, or enhance this aspect of yourself or your life. Not a laundry list of the things you would like to do but 1-5 things you are either doing or will commit to do.
The aim is to include them in your schedule, to do them most days but not to be rigid or too hard on yourself. We want wellbeing to become a natural part of our lives, not something else on the to-do list.
In deciding on each segment, I recommend including the six key pillars of wellbeing that, when practiced regularly, help to maintain us humans in a place where we are able to function and feel at our best:
- Time Management: how you effectively manage your activities and responsibilities
- Nutrition: how you fuel your body and mind
- Stress Resilience: how you keep yourself and your life in balance
- Mindset: how you foster a supportive mindset
- Movement: how you incorporate movement that promotes health
- Sleep and Rest: How you restore and rejuvenate through adequate rest and sleep
There is likely to be one or more pillar that you are naturally talented at and others, well, no so much. You may also have other pillars that are fundamental to your wellbeing such as community, charity, spirituality etc.
Let’s assume you have put ‘tackling fatigue’ in the centre of the wheel and added six or more pillars. That you have populated your wheel with any advice from your Doctor and the things you are already doing. As I’m sure you will appreciate, each of the pillars is a topic in its own right. However, let’s take a look at each one and consider what else you might include in your wheel – in tackling fatigue.
If we are ineffective time managers, then it is not difficult to comprehend that an out of control to do list is going to take its toll on our energy expenditure.
Proactively planning and prioritising activities can help to take some control back, as well as balance activities with energy. Activities should be achievable and manageable, in line with how you are feeling. You may need to question if it really needs to be done and now. You may need to say no or ask for help if you need it. The way you do things is also important.
The Circadian Rhythm is a natural process that regulates your sleep wake cycle over roughly a 24-hour period. It is also responsible for whether you are a morning or an evening person, and what time you prefer to eat.
Nathaniel Kleitman, one of the early sleep researchers, discovered that we operate in 90-to-120-minute cycles. Kleitman called these “basic rest-activity cycles’ but we have come to know them as Ultradian Rhythms which work alongside Circadian Rhythms. During the day the Ultradian Rhythm moves you between high and low energy, in 90-to-120-minute cycles.
Whilst the two processes are not directly linked, if you do not get enough sleep you are likely to get more energy dips during the day. If you ignore your energy dips in the day, you are likely to end up feeling wired and tired, and your sleep may be affected.
To make the most of your natural rhythms consider dividing up planned and prioritised activities into 90–120-minute chunks and then take a break, to rest and recharge. Pausing between activities brings with it an opportunity to proactively influence your nervous system, bringing it from stressed to relaxed. From busy to calm. Doing this throughout the day may help you to come down at the end of the day, when you want to truly relax and prepare for sleep. Make sure you are adequately fed and watered, have a stretch, play some music, breathe, walk, or have a chat with someone – you get the idea.
Whatever takes you away from the task at hand and gives you an opportunity to recharge your batteries. Taking breaks when you are busy may seem counterproductive, but working in this way has been proven to also enhance productivity.
Overworked adrenals can become gluttonous little monsters that will see you craving substances such as sugar, salt, and caffeine.
If you recall, your adrenals produce cortisol, required to balance energy or to fight or flight you out of danger. If you find yourself under pressure, overwhelmed or depleted, your adrenals will entice you to go for quick energy fixes to get you through the day or out of harm’s way.
What you need to give them is sustainable fuel and rest, but what you actually feed them is what they, you, will ultimately crave. Like an addict, they will want their fix, whenever the need arises. Some practitioners recommend detoxing to overcome cravings and you can do that, if you are up for taking the bull by the horns. Or you may like to take the approach of enhancing your nutrition and eliminating your fixes one by one.
Right now, you need to regularly fill up with the highest-grade fuel you can get your hands on. Fatigue utilises more nutrients, and underlying factors can make it harder for nutrients to be readily absorbed. It may sound immensely dull, and it is rather, but I recommend putting together weekly food plans that ensure you get sustainable fuel, including good snacks.
Once you have done the hard work up front and built up a few weeks of these it makes deciding what to eat, shopping, budgeting, and food preparation so much easier. Start by documenting what you eat in a week, tweak as needed and voila you have your first week’s plan.
I also recommend cooking and freezing extra portions of meals, that you can turn to when you are not up to cooking. You may also like to consider the use of supplements to enrich your diet and support your body further. A good quality multivitamin is always a good option and below are five of my favourites, for supporting busy lifestyles, stress and fatigue, and the principal reason why:
- Adaptogens, such as Ashwagandha, for adrenal support and in helping to keep cortisol balanced.
- B Vitamins to help balance and maintain a healthy nervous system.
- Vitamin D to support fatigue as well as nutrient absorption.
- Magnesium for nervous system and sleep support.
- Vitamin C for immune functioning and iron absorption.
Each of the above has further benefits and are not the only supplements that support this cause. Speak with a nutritionist or do your research, if you’re unsure which ones may be right for you.
Ensure you get adequate hydration as feeling tired is just one of the many symptoms of even minor dehydration. Drinking a glass of water on waking is an easy hack to include in your regime and kick start your day.
The opposite aspect to the stress response is known as the relaxation response. This is the spectrum of the nervous system we are functioning in when life is ticking along nicely. It promotes optimal body functioning, maintenance, restoration, and repair.
When fatigue is present, we need to be doing all we can to maintain ourselves in this place. To have enough in the tank to get us up and maintain us physically and mentally throughout the day. But not so much that we start to feel the negative impacts of too much stress, cortisol, in the body.
To be stress resilient doesn’t mean eliminating stress. Whilst changing your career, your relationship, your home, or anything else, that is causing stress and fatigue, may seem like a valid goal and may be necessary, it isn’t always the external that needs to change. What it does mean is that you must aim to manage your demands and responsibilities in a way that keeps you, your adrenals, and your diurnal rhythm in a state of equilibrium.
To promote operating in the relaxation response and optimal functioning throughout the day, by taking breaks and not overdoing it. If you feel stress taking over stop, as soon as is possible, and elicit the relaxation response. Breathing practices are one of the best ways to do this and you will find 10 to choose from in my blog ‘Let the Breath be Your Guide’.
Sleeping through life is no longer an option, you need to learn to select a cruise control speed that is within your own limit. Pulling over regularly so your engine doesn’t over heat and to cool it down.
Think for a moment about the following scenarios:
- Going on an extended overseas holiday
- Having good friends come and stay for a month
- Turning off all technology and having a day at home doing nothing
Do you perceive these scenarios as positive or do you feel stress and fatigue setting in, just thinking about them? The answer will of course be different for everyone.
What about the following scenarios?
- The anticipation of an event such as an exam.
- Knowing you have too much coming up on the to do list at work or at home.
- Running over a scenario that didn’t go your way such as a difficult conversation.
None of these scenarios are in real time but the stress and fatigue you experience, just thinking about them, can be. Interestingly our perception of a situation doesn’t just influence how we feel but how much cortisol is released into our system.
If we perceive a situation to be stressful, we get more cortisol and are more likely to experience the negative aspects of stress – overwhelm, anxiety, tension, sleep challenges etc. If we perceive it as a positive, we are more likely to experience the more positive aspects of stress – excitement, motivation, improved performance etc.
Suffice to say that mindset is crucial to how we experience a situation, and ultimately the impact it has on our energy reserves. If you are unable to change a situation, can you change your perception and response towards it?
You may like to try running it through the 3’R’s:
Rationalise: If how stress and fatigue is experienced can be driven by perception then you have an opportunity to question that perception. To apply some reason and logic and to try not to blow a situation out of proportion. Try comparing the situation to something more important, to question how much it will matter in time.
Reframe: Once you have applied some rationale to a situation, it is possible to put things into a more realistic context; “I have been given too much to do” becomes “I have been asked to do more than I can manage”.
Responsibility: When you are able to take some ownership for your perception, you are empowered to choose how you respond. If you have been asked to do too much and this may impact your fatigue, you may choose to reprioritise activities, ask for help or speak with your boss.
Shifting your perception, enables you to take ownership of a situation and your response to it. Potentially removing, or at least minimising, resulting stress and fatigue.
Whilst movement is a key pillar to health, those with fatigue need to approach exercise with caution. If the body is already depleted, over exercising may contribute further to fatigue rather than help to resolve it.
When those adrenals are peaking and cortisol is pumping around your body, you are going to feel the urge to flight or fight. To run, to pump your muscles and to burn excessive cortisol from your body. If you feel stress building in you, and your body has gone into a state of physical preparation, then by all means give it a physical response. However, a short walk is a better option when fatigue is a challenge.
Another reason you are likely to want to exercise hard is that cortisol may have added weight to your midline and have you feeling bloated, due to its links to inflammation. Great protection mechanisms when faced with danger, but not great if how you look and feel is important to you. Building in a workable exercise regime, in line with your energy and threshold, is a more sensible approach. Include movement that helps to nourish you, to balance your nervous system and disperse cortisol, such as walking, yoga, tai chi etc.
Rest and Sleep
Sleep plays an absolutely vital role in physical and mental health and wellbeing. After a good night’s sleep, we wake each morning with a rested and reconstructed mind and with a number of the body’s systems effectively reset. From the moment you wake up each day you need to start creating the conditions to get the recommended eight hours of sleep opportunity each night.
Taking breaks to rest, to disperse cortisol and to bring your nervous system down throughout the day, will give it a better chance of staying down and you getting to and staying asleep at night. Consider implementing a sleep routine to help you prepare for sleep.
Aim to do your routine every night, regardless of whether you are in a period of experiencing sleep challenges. This helps your body and mind to become familiar with the routine and recognise it as a call to sleep.
Check out the National Sleep Foundations Sleep Hygiene Tips for ideas on what to include in your routine.
Commit to your cause
If fatigue is your unwanted companion then you are going to have to commit to severing the relationship and claiming back your most important asset. You. Keep your eyes on the road ahead but not too far down it, taking each day or each moment as it unfolds. Catch yourself and your habits deviating you off course and get yourself back on track as soon as you can, both for your own sake and for everyone, and everything, you hold dear.
You may need a team to support you. Medical professionals, wellbeing specialists, family, and friends – whatever and whoever you need and lean in. But no one can do it for you. There will be times when it feels like you are trying to get up a steep hill when there is ice on the road. Your wheels will spin and you will feel yourself slipping backwards, no matter how hard you try to move forward.
But know that the stronger you get your body and mind, and the more you can balance your inner and outer worlds, you can move forward.
Whilst there is so much more I could have included in this blog; I will leave you today with an example of a wellbeing wheel for fatigue. This technique helped roll me back down the road to wellbeing and ultimately into the life I love today, when I had my own up close and personal experience with fatigue, over 10 years ago now. I truly hope it is of help and support to you – no matter how big the bags under your eyes.
Bev Alderson is a Mindfulness, Yoga and Stress Management Consultant who works with individuals, groups and workplaces.
Having spent 18+ years in management in the IT industry, in both the UK and Australia, Bev learnt first-hand the impacts of a high-pressure environment and lifestyle and how, left unchecked, this can negatively impact performance and health.
Today, through her business Practically Balanced, Bev brings authenticity to the work she does, drawing upon her personal experiences, management capabilities and expertise in mindfulness, stress resilience, yoga and more.
Bev completed a Diploma in Yoga with the highly respected Qi Yoga School in Sydney in 2012 and with Sivananda in India in 2015. She also completed a Certificate in Stress Management with the London Centre for Coaching and Counselling in 2014, an ILM with the Stress Management Society in 2014 and a Diploma in Meditation with the British School of Meditation in 2016.
With many thanks to Bev for this blog. If you have any questions regarding the health topics that have been raised, please don’t hesitate to get in touch with Amanda via e-mail or phone:
Amanda Williams and the Cytoplan Editorial Team