Fatigue and Sleep

What is Fatigue?

We experience fatigue as extreme tiredness, weariness or exhaustion.

Fatigue is the normal way our minds or bodies tell us to take a break after doing something tiring. It is very common to experience fatigue after a brain injury.

Most people feel tired or can’t sleep sometimes. But the fatigue that some people experience after a brain injury can be different. It may not improve with rest and can last over some time.

However, there are things you can do to help manage your fatigue. In this booklet, we include some general tips and some ideas to help you sleep well.

I never wanted to admit to myself I was always exhausted. I eventually gave in and started taking a nap after lunch. I still get tired but the naps help. I only wish I had started earlier.

Michael from Kildare

What causes fatigue after a brain injury?

We don’t fully understand all the causes of fatigue. One reason is that your brain now has to work harder to do things like thinking, taking in information, talking and coordinating your body.

Other causes of fatigue after a brain injury include:

•  The parts of the brain that were injured.
• Sleeping difficulties, such as lack of regular sleep.
• Pain.
• Illness or the effects of medication.
• Anxiety, depression or mental health difficulties.
• An over-stimulating environment.

We’ll look at some of these reasons and give you suggestions for tackling them. As you recover, you may feel less fatigued. But, as time goes on, fatigue could be something you may need help with managing.

Don’t push yourself beyond your limits. Try to recognise when your body is telling you that you’ve had enough. Other people may expect you to be ok because you look fine, but there’s no shame in saying ‘No’ to something or having a nap if you’re tired.

How fatigue may affect you

Fatigue can affect how you think, how you feel and what you do.

Think	I cannot take in information. I get overwhelmed in busy situations. My brain feels like it is ‘in a fog’.
Feel	Guilty — ‘I shouldn’t be like this.’ Judged by others — ‘They think I’m lazy.’ Fearful that my fatigue will not improve.
Do	I am not able to return to work right now. I slur my words when I am over-tired. I do not have enough energy to go out.

In the first few weeks after your injury, you may feel very tired. This is normal. Your brain needs lots of rest to help it recover. At this stage, sleep as much as you need to, when you need to.

In the first few months if you feel less tired, just take naps when you need them. Short naps are best, because if you sleep too much during the day, you might not be able to sleep properly at night.

If your tiredness continues, and the suggestions in this book are not helping, talk to your GP.

General advice to reduce fatigue

 Eat a Healthy Diet

• A healthy diet is one rich in colourful vegetables, fruits and wholegrains. These foods will give you a steady supply of energy during the day.
• Drink plenty of water and smaller amounts of tea, coffee, milk or juice. Cut out alcohol if you can.
• Try to use healthy oils like olive and rapeseed. Reduce your intake of butter.
• Have fruit or nuts as snacks instead of sugary foods.
• Cut down on coffee, tea, cola, energy drinks and smoking. Caffeine and nicotine are stimulants and can affect your sleep. Try drinks such as water, juice, decaffeinated coffee or herbal teas instead.
• Alcohol can prevent you from having a good, restful sleep. It can also make you fall asleep earlier than you want to and so disrupt your sleep pattern. Try some non-alcoholic drinks instead.

Pace yourself – plan ahead
Try to spread out the activities you need to do over the week. This way you don’t use up all your energy at once.

Prioritise
Just do the things that have to be done. Leave everything else, or ask someone to give a hand.

Do things in stages
Do a bit each day. Remember, things that used to be easy might take a lot more out of you now. Doing a little and often is more effective than trying to do too much at one time.

Notice the signs of getting over-tired
These might be: forgetting words, blurred vision, getting very irritated or becoming tearful. After a brain injury, feeling over-tired can come on very quickly. If this happens, stop what you are doing and have a rest.

Regular rest
Build in regular rest periods or quiet times in the day, even if you don’t lie down. This will help you keep going for longer. Try to rest before you get exhausted.

Try to notice what tires you out the most
It could be going on the computer, having visitors, driving or going shopping. Do these when you are fresh. Then have a rest.

Resting means doing as little as possible. Switch off the TV, turn your phone to silent, close the curtains, set an alarm, and close your eyes if you can.

Good sleep habits

Getting enough sleep at night, and having a good routine to fall asleep, are really important in tackling fatigue. These habits can help you increase your chances of a good night’s sleep:

• Try to get some exercise during the day. It can make you feel better and tire you out naturally. Try to exercise earlier in the day and avoid strenuous exercise in the period before bedtime.
• Keep it regular. Try to go to bed, and wake up, at roughly the same time every day.
• Half an hour before going to bed, start to wind down. Turn off the TV or listen to quiet music. Develop your own calming routine.
• Only try to sleep when you are sleepy. Otherwise you can end up lying awake in bed. If you haven’t fallen asleep after 20 minutes, get up and do something calming until you feel tired. Then return to bed and have another try.
• Don’t watch the clock during the night. Checking the time too often will wake you up and can cause worry and frustration. This can make falling back to sleep even more difficult.
• Make your sleeping space comfortable. Check that your bedroom isn’t too hot and that it is dark enough. If your curtains are not thick enough, use an eye mask to block out early morning light. Use earplugs to block out noise.

Try not to put on the main lights during the night. This is because bright light tells your brain that it is time to wake up. Try plug-in night lights instead.

If sleep problems persist

If none of the tips listed here are working for you, talk to your GP to see what else might help.

It is important not to ignore difficulties if they continue. Your GP can give you advice and go through the possible reasons for your sleep difficulties. They may also want to make sure you don’t have an underlying medical condition or a sleep disorder that are affecting you.

Your GP may also suggest you keep a sleep diary to help them understand your sleeping patterns more clearly. A sleep diary is a worksheet on which you record the hours and times that you sleep and wake up.

“Sometimes I wake up and I know I’ve slept for eight hours but I feel like I haven’t slept at all.” – Anne from Limerick

“Sometimes I wake up and I know I’ve slept for eight hours but I feel like I haven’t slept at all.”

Anne from Limerick

Summary of key points

• Most people feel very tired and sleep a lot after a brain injury. This is normal and may improve over time.
• Do less. Rest more. Take short, guilt-free naps.
• If your sleep is affected, try following our tips and advice.
• Try improving your diet and cutting down on sugary foods, caffeinated drinks, alcohol and nicotine.
• Help yourself to de-stress, and sleep better, by getting some gentle exercise.
• If you don’t experience any improvement in your sleep over a few weeks, talk to your GP.