Types of Fatigue After Brain Injury
Yes, there are multiple types
Fatigue after Brain Injury and How to Help
Fatigue is one of the most common symptoms after brain injury. Fatigue after brain injury is often much more than just feeling tired. It can be an overwhelming and all-encompassing exhaustion. Fatigue can worsen other brain injury problems. It can make thinking more difficult. It can make you more irritable. It can worsen headaches.
Brain injury can lead to different types of fatigue:
· Mental fatigue: It is hard to concentrate and to think. Remembering conversations may be more difficult. Your mind may even feel blank.
· Physical fatigue: You feel tired and need to rest. You have less energy to do physical activities, including caring for yourself or doing things you enjoy.
· Psychological fatigue: You can’t get motivated and may feel depressed.
You can see how important it is to recognize, understand and address fatigue after brain injury.
Daniel Avesar has taught me much about fatigue after brain injury. Daniel sustained a severe traumatic brain injury at age 18 when a car landed on his head. Fourteen years later after an extreme amount of effort and support, he attained his PhD in neuroscience from Dartmouth College. Today he is working to build awareness about brain injury.
Daniel has dealt with fatigue for years. He has talked about fatigue with many other brain injury survivors. Daniel says fatigue “overwhelms and is always lurking in the shadows”. He describes two fatigue stages. One is a constant low-level fatigue where everything is hard and ‘the inner gears are slow and stuck like in mud’. The second is an overwhelming fatigue where you cannot function. It feels like a total crash, like a computer crash.
What causes fatigue after a brain injury?
We have some understanding of what causes brain injury fatigue, but we do not know the whole answer. We do know that the brain needs to work harder after it is injured. Functional MRI scans show that more brain activity is needed to complete a task after a brain injury. Brain function is often less efficient after an injury. It takes more effort to listen to a conversation, to follow a recipe, to remember where you put your keys.
The reticular activating system is a network of neurons in the brain. It helps focus the information coming into our brains. It filters out excess information that we don’t need. If this network is injured, then too much sensory information gets into the brain. This is overwhelming and fatiguing.
Brain injury can lead to sleep difficulties. Of course, this would increase fatigue. Muscle weakness can lead to physical fatigue. Depression and anxiety can lead to psychological fatigue.
Other medical conditions can worsen fatigue after brain injury. Headaches, hormonal problems like hypothyroidism, sleep apnea, anemia, and certain medications can cause fatigue. Even a lack of physical exercise or movement can worsen fatigue.
What can you do to improve fatigue?
Fatigue after brain injury can be improved. You can increase your brain endurance over time. You do this by being active and by thinking, by working your brain. But you also need to take breaks during activity and thinking. Generally, it is helpful to take a 5 to 10 minute rest every one to two hours. This helps you avoid fatigue while you are building your brain capacity. It is much better to avoid fatigue than to overcome it once it has started.
Here are some tips to avoid fatigue:
First, pay close attention to what makes your fatigue worse. What are your earliest signs of fatigue? Do you get irritable? What were you doing right before you became fatigued? Can you avoid these triggers in the future?
One of the most common triggers for fatigue after brain injury is pushing too hard, doing too much. A huge problem after brain injury is doing too much. Any of us want to do what we always could do. It is heartbreaking to not be able to do what we previously could. The problem is that it causes fatigue.
Daniel says, “The act of learning to not push to the limit is very counter intuitive and needs to be learned.” He has found that the ‘improvement’ becomes learning to not push yourself anywhere close to the overwhelming fatigue or to your limits.
Observe yourself to find what you can do without becoming fatigued. Gradually increase what you are doing by taking baby steps. Planning and keeping a daily schedule can help with this process. Avoid over-scheduling and always build rest periods into the schedule. When you have a big event to attend such as family party, plan extra brain rest before and after the event.
Another trigger for fatigue might be lack of sleep. One of the best things you can do for poor sleep is to go to bed and wake up at the same time each day. If you have a lot of difficulty sleeping, tell your doctor. If possible, see a doctor with experience in brain injury.
If you can, exercise daily. After brain injury, exercise improves function and recovery. Even light walking can help.
For more information from Daniel Avesar see the Building Brain Awareness talk series on YouTube: https://www.youtube.com/@buildingbrainawarness2139
Check out his podcast Experiencing My Brain:
https://podcasts.apple.com/us/podcast/experiencing-my-brain/id1596998070
