Are You Merely Exhausted or Unrelentingly Exhausted?

My neighbor was sitting on the park bench watching her twin five year-old granddaughters feed bread to the ducks. After the obligatory remarks about the cuteness of the pair, I asked her how her weekend was. “Exhausting!” was her immediate response, “The twins stayed with us and I am bone tired. I may never get up from the bench!”

She did look exhausted, but we both knew that once the parents took the girls home, she would relax and by the next day feel, if not entirely rested, much better than today. She is one of the lucky ones. Her exhaustion is situational and an inevitable (but reversible) consequence of incessant care of two very active little girls.

Many of us can relate to her fatigue. We take upon ourselves too much to do both physically and mentally, and feel exhausted when our bodies and minds no longer can deal with yet another task. Sometimes we continue to do too much despite fatigue, because there is no other choice. Too long hours at work because of staffing problems, twenty-four hour care for a sick or elderly relative, a home renovation deadline that has passed: all kinds of situations cause tiredness. But eventually there comes a time when we can rest our bodies and minds and have our energy restored to us.

But what if the fatigue never goes away? What if the body feels weighted down with sleepiness, getting out of bed is a major accomplishment, or cutting through the mental fog seems an impossibility? What if instead of reversible weariness, the exhaustion is unrelenting?

According to a National Health Interview Survey about six years ago, more than 15% of women and 10% of men suffered from fatigue or exhaustion. Some reasons may be situational, such as excessive physical activity, lack of sleep because of insomnia, jet lag or shift work, medications that induce drowsiness like antihistamines and antidepressants, and excessive fat and alcohol intake. Some of these, such as shift work or constantly changing time zones because of work (like pilots and flight attendants experience), may be difficult to avoid and certainly diminish the quality of life.

Worse yet are medical conditions associated with unrelenting exhaustion: acute liver failure, anemia, chemotherapy and radiation, chronic fatigue syndrome, concussion, major depression, chronic infection, diabetes, underactive thyroid (hypothyroidism), multiple sclerosis, chronic kidney disease, fibromyalgia, stroke, drugs for hypertension, epilepsy, chronic stress, and major depression.

Some of these conditions, such as underactive thyroid, anemia and well-controlled diabetes, are correctable. And often the exhaustion will diminish as the body heals, for example, from a concussion or stroke (although it may take months for the post-stroke fatigue to disappear.)
The reason for the severe exhaustion is sometimes obvious and treatable, or disappears with recovery from the illness or treatment. Iron deficiency anemia responds to iron supplementation unless there is an underlying cause for loss of blood. Too low or high blood sugar in the diabetic that causes fatigue may require more intense monitoring of food intake and insulin dosing. Chemotherapy and radiation is usually of a limited duration, and people recover from concussions and infections.

But there don’t seem to be effective ways of overcoming the mental fog and intense tiredness of multiple sclerosis, major depression, chronic fatigue syndrome and other medical conditions, in large part because no one really knows what causes these symptoms. What causes cognitive sharpness to retreat into dullness? What causes well-nourished, developed muscles to feel too weighed down to move? How can a mental illness manifest itself in fatigue so great it is hard to get out of bed?

Because there is so much unknown about why fatigue seems to accompany illnesses from allergies to strokes, it is easy to point to available nutritional villains as the reason. Dairy products, gluten, fruits and vegetables belonging to the nightshade family like tomatoes, potatoes, peppers and gooseberries supposedly cause significant fatigue. Refined carbohydrates, saturated fats, and caffeine are also to be avoided. Conversely, foods that, not surprisingly, resemble those comprising a nutritionally sound diet, are recommended to fight fatigue: lean protein, fruit, vegetables, high-fiber foods, and low-fat dairy products. Of course, these food groups must be eaten not just for their supposed fatigue-fighting capacity, but also for the maintenance of general good health. Keeping hydrated is also very important.  However, there is little evidence that following a nutritionally sensible diet will alleviate the all-encompassing exhaustion associated with certain diseases.

Physical activity is recommended, although it should be low impact and of short duration. It seems counter-intuitive that using energy to exercise restores energy to the chronically tired, but it does seem to decrease fatigue. In fact, research showed athletes suffered from unrelenting exhaustion when they were not allowed to exercise for several weeks.

When exhaustion lingers, as it often does after a stroke or in chronic fatigue syndrome, the most usable advice is to accommodate to it. Frugality in using energy seems to be the most workable solution. Like budgeting one’s money, energy should be spent only on necessary activities. Simple things like sitting rather than standing to prepare a meal, consolidating errands, and avoiding unnecessary movements are helpful. Programming rest stops into the day’s routine and decreasing non-obligatory commitments are also important.  Meditation is thought to be helpful, as is simply sitting in a quiet room. When exhaustion includes a decrease in cognitive function, the so-called mental fog, it may be necessary to ask others to do the tasks, like paying bills, that seem impossible to carry out.

My friend’s exhaustion disappeared after a day without the grandchildren. Let us hope that research will make unrelenting exhaustion soon disappear as quickly.

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