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Fatigue After Brain Injury: BrainLine Talks With Dr. Nathan Zasler

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Victoria Tilney McDonough, BrainLine

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Fatigue After Brain Injury: BrainLine Talks with Dr. Nathan Zasler
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BrainLine sat down with Dr. Nathan Zasler to talk about the issues of fatigue after a traumatic brain injury. Dr. Zasler is an internationally respected neurorehabilitation physician who specializes in brain injury.

BrainLine: Describe fatigue. What exactly is traumatic brain injury-related fatigue?

Dr. Zasler: Think about a car. It needs gas to run. If your tank is low, your car will start sputtering and then stop once you have reached the end of your reserve. It’s the same way with fatigue after TBI. Fatigue is caused by a decrease in physiological reserve, which includes a person’s physical and mental reserves. When your brain is “tapped out,” you feel tired. Basically, when a person’s brain is overtaxed, fatigue will set in.

Although one formal definition of fatigue that has been proposed states that it is the failure to initiate or sustain attention or physical activity that requires self-motivation, there continues to be debate about how best to define "fatigue." In part, it’s difficult to define the term because fatigue is subjective — that is, it is solely based on patient report — and it is really more a symptom than a diagnosis. Just like it is difficult to tell if someone is in pain, it is also challenging to know if someone suffers from fatigue unless they tell you so. But generally, people with TBI have described fatigue as a sense of mental or physical tiredness, exhaustion, lack of energy, and/or low vitality. Unfortunately, we don’t have any definitive screening tools for fatigue, so there is no universal way to measure it.

Cognitive and physical fatigue can occur separately or together, but most people seem to have more problems with the mental side of fatigue after a brain injury. They say they are not as quick as they used to be, mental tasks that were once easy are much more difficult, and they tire far more easily even doing something that used to be simple like reading, studying, or working.

Although there are limited long-term studies, some research indicates that fatigue is usually short-lived after most mild TBIs. And in my experience as a physiatrist, fatigue in patients with mild TBI usually lasts no longer than three to six months. However, for some people with mild TBI, their fatigue is more persistent.

BrainLine: How common is fatigue after a brain injury?

Dr. Zasler: In the general population, fatigue is a common complaint with some studies citing an incidence of 10 percent. But for people with traumatic brain injury, it is one of the most common problems post-injury. Fatigue affects not only people with moderate to severe TBI, but also those with mild TBI. And we still need more research to better understand this issue.

BrainLine: What does fatigue look like after TBI?

Dr. Zasler: The spectrum of fatigue is as broad as the spectrum of traumatic brain injury, itself. Everyone’s brain injury is different and everyone’s symptoms will be different. There are also many variables when it comes to post-TBI fatigue — from levels of severity to pervasiveness. Some people may be very fatigued all the time and others may only be fatigued after mental or physical exertion.

Most people who have fatigue resulting from brain injury only experience the problem at certain times and not all the time. They have more energy in the morning and tend to be more tired later in the day. People’s levels of fatigue also depend on how much they are pushing themselves physically or cognitively, and whether they are making time to rest periodically during the day and pace themselves.

Depression, anxiety, or stress can also contribute to the degree of a person’s fatigue or, alternatively, may even be the cause of the fatigue. Not everyone with a TBI will experience fatigue due to their brain injury. So, each person’s levels of fatigue, if present, may change over time during their recovery, in terms of both cause and level of severity.

BrainLine: Why do these problems occur?

Dr. Zasler: Unfortunately, we don’t really know. There have not been a lot of conclusive studies conducted on fatigue after brain injury. Much of what we are discussing is experiential. Some have theorized that damage to the basal ganglia — which are structures deep in the brain — are the critical areas involved in the generation of fatigue. Others have noted that other areas of the brain may be involved as well.

BrainLine: What kind of information should people with brain injury give their doctor to help the doctor better understand their issues with fatigue?

Dr. Zasler: This is a two-way street, of course. People should give their doctor as much information as they can and, in turn, the doctor needs to ask the right questions and get as full a picture of the symptoms and situation as possible.

First of all, it’s important to establish the cause of fatigue; it may not be a result of the traumatic brain injury. It could be something else, and those other potential causes should first be ruled out. Other common contributing factors for fatigue can include:

  • lack of regular and restorative sleep
  • psychiatric issues like depression or anxiety
  • chronic pain
  • chronic stress

There are also less common causes for fatigue that should also be ruled out. They can include:

  • seizure-related fatigue
  • hydrocephalus
  • hormonal abnormalities, like hypothyroidism
  • nutritional deficiencies such as low B12, anemia, or blood cancers (i.e., leukemia)
  • renal failure
  • hepatitis

All of these causes, common and less common, should be considered and then ruled out as the sole or contributing cause of a person’s fatigue before considering TBI as the cause.

Once other causes of fatigue are ruled out and the fatigue is found to be neurogenic —related to the damage to the brain’s nerve cells — some of the topics and questions that need to be covered in the doctor’s evaluation include:

  • When did the symptoms of post-TBI fatigue start?
  • Did the onset of fatigue symptoms correlate with any other event such as starting a new medicine or getting depressed?
  • What helps make the fatigue go away, or decrease?
  • What aggravates it?
  • What triggers it?
  • In what ways are you fatigued physically, and when?
  • In what ways are you fatigued mentally, and when?
  • How is your sleep?
  • How is your mood?

BrainLine


Nathan D. Zasler, MD Nathan D. Zasler, MD, Nathan Zasler, MD is CEO and medical director for Concussion Care Centre of Virginia, Ltd. as well as CEO and medical director for Tree of Life Services, Inc.  He is board certified in physical medicine and rehabilitation and fellowship trained in brain injury.


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Comments [47]

I've had TBI since 2012 and I could never figure out why I was so tired all the time, until now, including my insomnia problem. I'll stay up for 3 to 4 days at a time, no matter how many sleeping pills I take or prescribed medication. My insomnia usually kicks in at least twice a month and it's the worst thing in the world. I just started taking adderall, because I was diagnosed with ADHD after my accident, but I never took it because I was scared and now I'm wondering why waited so long. It really is a miracle drug if you actually have ADHD, but when it wears off, you crash and you crash hard. But at least it helps get me through the day, it also puts me in a better mood and I actually sleep better taking it. Now, as far as my temper, I snap so much more easier than before and it's really bad, like I have no patience and I cannot handle anything. I hate the fact I'll never be the same, but Alecia study more and find me more options I've never heard anything about. This yoga hoping, maybe I'll try that. I mean, I'm so so tired that I haven't cleaned my house in 3 years. Yes, I get the trash out and nasty stuff out, but it's still really messy and I'm so ashamed. I hope the future brings more reason to this because I can't stand being so tired and yet at times I'm up for days, people even ask me if I'm on something and it hurts. I was once pulled over and the cop made me do every sobriety test known to man and that was so embarrassing :( I wished people understood how bad it really is, and my memory is going, but before that, I started having seizures. Not to mention I am very very sensitive to noise and light. I finally went to a neurologist after five minutes he told me he didn't have time for this and I was billed $500 bucks for 5 minutes only for him to say, he didn't have time.

Jul 16th, 2016 2:54am

Mindful based stress reduction helps tremendously. Any type of meditation is beneficial. I currently practice TM. 

Dom - I would like to hear more about your results. 

J

Jul 12th, 2016 7:05pm

There is some research behind mindfulness based stress reduction being very helpful. Somebody below mentioned yoga- that is similar enough I think to work too. My OT recommended yoga actually.

good luck everyone

Jul 2nd, 2016 4:10pm

update 2016, after Tbi check growth hormone level-blood only 3x during 90 minutes, Gh is responsible for quality of life try than combination of peptides ghrp6-2 plus sermorelin than cycle with mk-677 you don't need gh for 1000s£ do it with private consultation cheers Dom

Feb 10th, 2016 2:24pm

I had history of seizures and found that scar tissue was the cause and qualified for brain surgery on the focus.after being over 2yrs now,there are days I feel tired but once I get around I'm ok til I get bored and sitting down for quite sometime.to me it just seems like certain weather makes me tired more quiet moody on cloudy days.if nice sunny I feel good like a new person that could do anything like my memory focus and concentration is all there.plus I can drink all the caffeine I want and still get tired.ugh...

Jan 7th, 2016 9:13pm

Hi I suffered a traumatic brain injury in October of 2003.... I was in a coma for 28 days at our medical center. I was an active 17 year old I played sports and that's basically what my life revolved around. I made a quick recovery and went back to playing softball ASAP. I assume this is why I never had much problems with fatigue until now? I agree that smoking marijuana did help with a lot of the symptoms now that I don't smoke. :) I was young and why not right? Well it is illegal here in Oklahoma so of course I quit once I got older? At the moment there is a fight for medicinal and I know several people who have suffered a brain injury and would benefit but the last.... 3 years or longer I have been struggling with the fatigue and when you get fatigued your emotions go rapid I have learned... also your temper? I never had much of one before I was easy going and just let things roll off but some days actually most I wake up just feeling most irritable. Its frustrating and that's why I've started looking online. I have had such a hard time getting in to a neurologist or finding someone who would even send me? I've been fighting for disability since 2008 and... I am lost at what to do about the fatigue. My psych. Currently has me on 40mg vyvanse and it does help but I still just... it feels and I know it appears like I have no motivation and I am lazy but lol I literally am sitting here thinking about all the things I need to do and want to do but I just have no energym I've done a sleep study tech. Two.. .. the first I did not sleep but ten minutes an that was the ten minutes before they wake you. The second I slept with the help of a lot of sleeping meds. They found I did not go into a true sleep the full 8 hours I slept. Also.... I seem to wake up feeling more energized and just better all around if I only sleep 3-4 hours compared to say the full 8 hours. If I sleep a full night I'm even more tired. I wake up tired and when I go to go to sleep it's like a switch switches and I am wide awake. I have seen a neurologist once and he informed me I have extensive damage that appears to have been caused from not having proper treatment all these years but that he cannot treat me without a psych eval and my insurance does not cover it. I'm currently waiting to get in with one at Ou medical but that will take months and months so I began looking for answers. I can't get help from anyone else so I've learned to do it myself. But I think I will have to try some of the things people have suggested in comments here. With the approval from my psych of course: ) but I have found that when I don't rest well my post traumatic headaches are worse and not much helps except naproxen sodium. The tylenol or excedrin seem to cause rebound migraines so I'm wondering is this common? The headaches and fatigue together?

Dec 8th, 2015 6:50pm

In 2013 I fell about 15 feet and head first into the concrete, just my actually head hit the floor my body was up against the house, so all my weight and force went to my head. As soon as I hit the floor I jumped up, I noticed my face and almost my entire head was completely numb. That actually freaked me out way more because I knew I should of been in excruciating pain yet I didn't feel a thing . My cousin convinced me to go to the hospital and about 30 min after impact I was beginning to feel the pain kick in. The Dr was completely shocked when he learned I didn't lose consciousness, got up off the ground on my own and he told me I could have died, and said "as a matter of fact you still can" It turns out I broke two eye sockets,nose,upper and lower jaw. He said I broke every soft bone in my face and I needed surgery ASAP. I ended up getting 35 screws and several metal plates put into my face but they cut me open above my upper gums inside my mouth and installed the metal (thus making it so I didn't have scars on my face) Let me tell you something, forget the fall! I never been in more pain in my whole life after that surgery, it hurt way more than the actual fall itself. I recovered fairly quickly, but honestly I swear the swelling didn't go fully down for at least 6 months. It took me about 9 months to get most of the sensation back in my face. To this day if I run my finger down my nose I feel electrical shock like sensations, as well as certain spots with no feeling (only on the inside of my mouth, the skin surface has sensation. It feels like I'm walking around with a fat lip all the time and it's horrible, but nothing compared to the journey that followed. Fast forward almost 3 years and I'm battling anxiety (mind you they did a great job fixing me up and the anxiety is not due to personal image etc, I look great, I look the same surprisingly) but about less than a year after surgery for no reason I just got smacked with constant fatigue. Waking up for me in the morning is horrible I feel groggy, bad temper, miserable, drained and almost like a mental ache. I know "mental ache" doesn't sound like a legitimate thing but that's the only way I can describe it. Psychiatrists don't seem to listen I'm on my third one already and they all just try pawning off SSRI or other variants of antidepressants, which don't do anything at all and make it worse. I decided to take matters into my own hands and life has been so much better. (Before you judge me I want you to know I tried my best to go about this the legal way, you just don't know what it's like to just have to deal with this with no break, I would have panic attacks and my BP would be 175/100. My Drs didn't want to give me Xanax (which I talked them into when I explained i know it's not a permanent solution or something that can be long term) so she also wrote me a script for vyvanse an amphetamine based medicine. (50mg) I tried asking for provigil but she told me I needed to do a sleep study, and she didn't have a problem with the vyvanse because she was also justifying it saying I might have ADD. The anxiety continued to a point and that's when I saw a post online about suboxone and how it's used off label by some knowledgable Drs for things like treatment resistant depression and anxiety, they make them in 8mg strips that go under your tongue, but one strip I would cut up and make it last 2 weeks. I wake up I have the peice ready, I put it under my tongue and lay back down and go back to bed. After about 1 hour my second alarm will wake me up for work and by this time I feel 1000% normal, no grogginess,anxiety,temper brain fog or anxiety. Most of the time I don't even need to be woken up by my second alarm and wake up alert on my own when the suboxone kicks in. I then wait to take my 50mg vyvanse because my goal isn't to get "high" I just want to function and be able to enjoy my life again, by around 11am-12pm I'll take the 50mg vyvanse and it gets me through the day and I notice it wear off by 5pm but will still do its job the rest of the afternoon. After adding low dose of suboxone 1/14th of an 8mg suboxone strip (extremely low dose in my opinion) I'm now able to do things like go to the gym, meet new people, work, keep my house clean AND enjoy doing it at the same time. I can now read something the first time and remember it, I don't have to go back because I didn't remember what I just read. I'm not forgetting things in the house and making 2 different trips back into the house for things like keys or wallet. If there are any Drs here reading this, PLEASE, look into the possible use of LOW dose suboxone (1/14th of a 8mg strip for me personally) it's given me my life back, it bothers me to know that there's this medicine and it changed my life, maybe even saved it, yet I have to resort to such means as buying 2 strips a month off the street. It helped with TBI related anxiety,depression and more. Also I just want to note that I never once abused opiates in my life, and I never was prescribed opiates for more than a month at one time (for surgery) And as far as "tolerance" I been using the same dose of suboxone for over two years and it works just as good as the first day! Me personally, I'd rather quit low dose suboxone than have to take tons of high doses of Xanax (which for me tolerance grows way too rapidly for it to be a plausible treatment) this is my situation and why I have to obtain it illegitimately, however my script for vyvanse 50mg is legit and authorized by my psychiatrist. I apologize for the atrocities of my grammar, I just wanted to make my post and was in a rush. Any questions or feedback feel free to reach out to me

Nov 27th, 2015 6:39pm

I currently have a tbi from a cart accident 6 weeks ago, my 13 yo son had a horrific tbi 1 year ago, my husband had one about 7 yeasts ago, and my other son, adopted, came to us at 3.5, now also 13, with what we now know was a concussion, fell back off his chair in the orphanage just before coming to us, 7-8 stitches in the back of his head at 3 yo. We have seen debilitating fatigue, my kids can't do much of anything on the weekends, or they can't get up for school during the week. My son last year only had enough energy in his brain to keep him awake for 3 hours a day, enough time to eat, use the bathroom, ands play with the dogs - that was for 6 weeks until we got him on a vitamin regime. Calcium floods into the cells during tbi, too much of it, and throws off physiologic and metabolic processes. My son had his first full day awake after starting his vitamin regime, and this same vitamin is helping the rest of us. Magnesium, needed for over 300 chemical process in the body. Most people are deficient regardless. Blood tests don't show it because only 1% of it is found in the blood, the rest is within the cells. Coq10, diminishes with age and provides the cells with energy B complex helps the nervous system Fish oil, particularly dha which is for the brain, epa is for the heat Not too much calcium, until things settle, calcium needs magnesium, if not enough magnesium calcium will calcite in brain and arteries and joints. My husband's lost his sense of smell but it comes back every once in awhile, he slept ALL the time to the point we almost went bankrupt. one MUST be mindful of triggers, and lifestyle NEEDS to change.

Nov 23rd, 2015 8:17am

I fell 20 feet off of a telephone pole in 87. I don't believe I passed out, I remember my helmet spinning away from me on the ground. I had a crushed L-1 with two rods placed in my back. Two weeks later I recall laying in my hospital bed and a flood of memories from the incident was rushing through my mind including preoperative care that I had received. When I got out of the military I would always have these neck pains and headaches, fatigue, slurred speech after too much mental engagements. I couldn't get through the Veterans Administration (VA) Rehab Education program and have even more problems with analyzing and focusing today with increased agitation as I'm getting older. I went to the VA for analysis and was told that I would have had to been knocked out to have a TBI and number two I would have improved over time. The fatigue has always been a constant with me since the incident.

Nov 13th, 2015 11:52am

In 2001 I sustained a TBI from a car accident. The doctors say my brain sheared at the brain stem.  I was in a coma for two weeks not expected to live. After I came out I was paralyzed on my right side, unable to talk, walk, swallow or care for myself. I was unable to open my right eyelid for several months as well. To the best of my remembrance of my ordeal, when my eyelid opened, my eye was paralyzed, so I had to wear a eye patch for several years until the Lord healed my eye enough for me to be able to not wear my patch. If I hold my head right I don't have double vision all the time. I can do most things now in a very limited fashion; ie; slurred speech, poor balance, poor eye hand coordination, memory loss, confusion, etc.  I am fatigued all the time, so I can relate to the stories on this site. It was a relief to hear some of the reasons. My limbs have felt heavy since I began to remember after my accident. I am able to do what I have to do, but it is only by pushing myself most of the time. I am no longer paralyzed, but numb as if I had a stroke on my right side. my muscles don't go into spasms nearly as often. It is by the Grace of God that I am here. Life is improving slowly. I asked my brother-in-law who is a registered nurse,if people recovered from brain injuries. He said, after the first 6 months recover slows & then they adapt to their disability.Here's to adapting!

Cathy

Nov 1st, 2015 4:22pm

Adrenal fatigue and/or an auto-immune condition can also come from the stress of TBI/PTSD.

Jul 26th, 2015 7:24pm

Professionals need to recognise the problem of fatigue post stroke it's debilitating and I feel disabled by it !

Jun 13th, 2015 12:39pm

Traumatic Brain Injury Fitness Cannabis, 5 words you would think should never go together, please think again.  I will say it again. Traumatic Brain Injury Fitness and Cannabis: What You Need to Know.  paying attention yet?

It might seem that cannabis and fitness wouldn’t make a great match, considering most people don’t associate physical activity with marijuana. But weightlifting and cannabis might be an exception. Cannabis users and fitness enthusiasts often have similar goals: to be in control of your body, a search for bliss and deeper awareness.

"Living life with a TBI while being the best father I can. Compare it to taking a journey of 101,009 steps but counting only every 10th step while wearing ski boots, in the sand, in the summer, without having any step count leftover.    All that while living it sped up to 3/4 time"...

Peace,

http://dadvocating.com/

May 13th, 2015 1:57pm

Dom,

Thanks for the response. You nailed a major symptom… Not being able to tolerate an LCD screen for very long. I hope to learn more about CRH receptors, but have found little information on the internet (most of it I can’t read anyway). Do you recommend any books on the topic? Feel free to email me directly at mister.e33two@gmail.com (***the two is numerical, as in 332).

Thanks!

J

May 4th, 2015 12:04pm

Hi J.

I'm 22 years old astrocytoma survivor, so I have plenty of experience,

most important endocrinologist is your best friend in Cerebellum there is biggest concentration of CRH receptors- you might have problem with crh-acth-cortisol or thyroid axis problem, if you can't tolerate your LCD screen brightness or feel very weak after hot shower or feel strange in air conditioned supermarket it will be cortisol as well check growth hormone level, problems might occur even in sexual area due to wrong signaling to hypothalamus

don't take any stimulants like ritalin it is short term solution, avoid herbs like gingseng or marihuana you might get psychosis long term

CRH stimulants are nicotine (best icywhite niccorete;-)

yoga split works great as well (CRH stimulants)

cold shower in the morning without head or if you think that you have chronic fatigue syndrome take cold shower even 3 times a day it restore adrenal function.

best medication  is modafinil but works only 3 month, but short cycling like 3 miles gives you boost as well

all the best Dom  

Apr 4th, 2015 7:39am

Hi all... wow TBI fatigue is such an unknown. I feel compelled to share a brief of my story as reading others post has helped me feel not so alone. I am 16 months post TBI due to debulking of a cerebellar astrocytoma (brain tumor). 31 years of age. Pre TBI held a high level finance job. So I was lucky, Doc said low-grade, good position for removal (even though the tumor was on my brain stem!) short recovery period. At 16 months, I now know that there will be nothing short about my recovery. While the major difficulties are behind me (i.e. normal motor movements, speech, vision), although the period of normalcy is short lived each day - 4/5 hours of good function in the morning, hour nap, 2/3 hours of okay function in the afternoon. I am able to workout for an hour at a time, I have regained some athleticism. Currently I am trying to push it, build up physical endurance. I maintain an elevated heart rate for 1/2 hour involving movements that challenge my vestibular system (squat movements, box jumps, kettle bell swings) and it just wrecks me for the whole day... even post nap I do not recover. I'm in bed before 9pm and sleep 9/10 hours at night, but wake up multiple times ruminating. My hope is that by pushing my capacity of physical endurance the threshold will expand. I have been on this schedule for about 6 weeks now, exhausted all the time, but hopeful I will see good results. It is too early to tell. My experience with a similar approach helped my cognitive endurance. For one month I endured intense cognitive training, while I noticed diminishing returns during the month, after a few weeks off I noticed a boost in cognition.

My wisdom at 16 months post TBI is that doesn't get any easier, it just sucks less.

I want to mention something else that is helping me and hope for feedback from others. When I am in the second half of my day (during the period of okay function), cannabis helps tremendously with motivation and PTSD. I live in Colorado (cannabis is legal) and use a medicinal strain that is low in THC (cannabinoid that gives high feeling) and high in CBD (cannabinoid that is associated with pain relief). I hate feeling like a stoner, but it helps better than any of the pharmacological stuff! Most of the time I'm not smoking it. I ingest it J Does anyone else find this helps with motivation issues caused by TBI? 

Clean, organic food lifestyle and yoga help tremendously too

Be well. j

Mar 10th, 2015 3:11pm

I'm going to try HBOT treatments either in OK or LA soon. Check out HBOT.com for more information. I've had five brain injuries in just over nine years time. I've had the more extreme fatigue since a fall on the ice in Nov 2013. The second of three TBIs in a two year period. The other two were car accidents where my car was rear ended each time causing whiplash injuries.

Mar 4th, 2015 6:50pm

I am a vet post tbi 15 yrs ago. I am still having cognitive issues as well as chronic fatigue . Hearing loss/ tinnitus.

Feb 16th, 2015 10:41pm

I am six most post tbi. I would like to offer some information that I believe will be helpful to myself and others. Yoga Nidra is a type of healing meditation yoga that puts you in a deep healing sleep. Its like getting 4 hours of sleep in 30 minutes. Please do the research and look this up Yoga Nidra. I plan to go for a weekend and learn the techniques. Ill do anything at this point to get my life back. Good Luck 

Jan 4th, 2015 9:43pm

This is helpful. I conked my head six weeks ago and am keen to resume exercise but walks wipe me out. I really can't figure out if I should rest up or resume regular light training. Sounds like resting too much can cause fatigue which is what I hoped but maybe I'm reading this as I want to. My doctor is ok with gentle exercise.

Dec 7th, 2014 2:24am

I'd be interested to know how exercise effects people? I'm post tbi 4 years and the after effects of exercise still causes stunted or slurred speech and difficulty retrieving words. Sometimes I feel agitated or annoyed about an hour post workout. I used to be a runner before my accident. Thanks.

Nov 3rd, 2014 10:59pm

I suffered a TBI in early 2013 and also developed post-traumatic epilepsy. I also am terribly fatigued and wonder if anyone else with a seizure disorder has tried any of the stimulants mentioned in this article? I'm not sure if it is an option in my situation. I will discuss with my MD but am curious about anyone else's experience.

Jul 30th, 2014 11:29pm

I just thought of someone else's comment I would like to respond to in regards to insomnia and being awake all night (even though tired) but not being able to "turn the thoughts off" and go to sleep.  My psychiatrist said she thinks it may be because during the day there is so much going on (stimulation) that sometimes makes it hard for us with TBI to concentrate and focus. So ... we seem to "try" to get more done during the night time when things are more calm and quiet and we can focus more without the additional stimulation of day to day life. Hope this helps ... it makes sense to me.

Jul 29th, 2014 2:57am

My TBI was in 1997 and I still to this very moment fight fatigue. I am on Social Security disability. There are two drugs I have taken (as needed) for energy if I have a day with alot going on and need "help" staying awake and focused. I was told that these drugs were originally for people with narcolepsy. They are called Provigil and Nuvigil ... they are pretty much the same.  They really do help but sometimes I'll take one and STILL get extremely tired and CANNOT sleep but most of the time they help alot. I do not take them daily because I do not want to become dependent on them. Good luck and hope this helps!

Jul 29th, 2014 2:49am

I work with individuals who have sustained TBI and I am also putting together my latest research idea. I have read tonnes of literature and have noticed diet changes can help. Eat lots of eggs and red meat is one of the things I have seen

Jul 23rd, 2014 9:17am

My 'injury' was the surgery performed to remove a glioblastoma. Lucky as hell and in generally very good condition, including virtually no loss in cognition, or so it seems most of the time. Depending on how well I've been feeling, I can push my brain 4,5, 6 hours or a little more before I'm outta gas and sleep is going to happen. I'd better at least sit down. Golf is a bit of mental exercise, but the physical side of that is enough to keep me awake. I can take up to three naps a day, but am usually awake, up and going between 5 and 7 every morning. My ability to sleep at night is interrupted by an aging male's prostate, too, eliminating my chances at a good night's sleep. More of my great luck is an ability to turn the euphoria enjoyed through the use of cannabis into an energy that motivates activity. It's why I walk 5-8 miles a day, depending on how well I hit the ball, 4-5 days a week. Fatigue is unbeatable, but we can still lead active and reasonably normal lives.

Apr 13th, 2014 12:40am

Anna here, I get 2-3 hours of sporadic sleep a night.  Was told I have Chronic Fatigue Syndrome.  I cannot takes meds because of my TBI, we've tried.  I'm so tired of being tired.  My TBI came about from an auto accident in 1993, so, for almost 20years I have been exhausted.  Sad because my son was 8months old and I couldn't do much with him that little boys are supposed to do.  I constantly worry about TBI's and Alzheimers.

Mar 20th, 2014 12:11pm

I am tired often. I need to sleep for 4-5 hours after a seizure. I sleep at least 8 hours a night. But force myself to stay awake often.

Mar 16th, 2014 7:02pm

Quite interesting, thanks for sharing. A large, and oft overlooked contributing factor to neurofatigue is diet. I sustained a TBI 10+ years ago and found that fatty, carbohydrate saturated foods dramatically increased the mid-day "brain drain" that so many survivors report. I found that modifying my diet and including regular cardio exercise into my daily routine drastically improved my fatigue.

I'd be interested to see what research exists on exercise and also nutrition on fatigue after a brain injury.

Mar 16th, 2014 9:35am

While I was fighting to get social security disability, the judge looked at the variability of my fatigue levels as reason to assume the problem was not disabling. He was not impressed that on the only day that I did not get regular naps, my daughter's wedding, that I was rushed to the hospital against my wishes because my lips were blue, in addition to other obvious signs that I was mostly not awake. When I heard my lips had been blue, I purchased an oximeter and checked my blood-oxygen saturation over three days. I took the evidence to my doctor. In spite of the doctor observing blue lips at the wedding himself, he did not believe I had low oxygen levels because staff in his own office misread their oximeter, swapping pulse and oxygen levels in her report. So I had to go through a CT scan to rule out that I might be hallucinating before the doctor actually used a third party to check my oxygen levels. Since my TBI fatigue was at least partly due to inadequate oxygen, I wonder how many other TBI survivors are also struggling with low oxygen levels?

Mar 16th, 2014 7:18am

i have lost my smell sensation to some extent, i in 90% cases dont feel smell what others can,but while and after exercising , smell sensation works well but for 30 minutes after exercise.

Mar 15th, 2014 10:31pm

and after passing stool , feel completely energy less.i need to eat a lot which helps me feel energetic and have no fatigur in the morning but again makes me fatigues in the afternoon,so even if i take a nap or eat food, i get fatigued.I need to take a nap and exercise to get back to work.

Mar 15th, 2014 10:29pm

i had forgotten to mention-  the real cause for my fatigue is constipation , i dont pass stool for 3-4 weeks or more if i dont exercise and if i exercise , i pass stoll but in a very less quantity, after passing stool , fatigue goes off.

my previous comment-

When did the symptoms of post-TBI fatigue start?before weight loss

Did the onset of fatigue symptoms correlate with any other event such as starting a new medicine or getting depressed?depression after accident

What helps make the fatigue go away, or decrease? exercise in the morning and evening and fitnessblender metabolism 5 minute exercise every 2 hours , speak a lot the whole day and keep thinking and repeating things in brain

What aggravates it?no exercise, little or excessive food, walking fast for around 10 minutes and not for an hour to get enough exercise(i lost wt by walkingfrom 7pm to 2 am in the 3rd month of wt loss)

What triggers it? lack of exercise, depression, negative thoughts, inability to focus,

In what ways are you fatigued physically, and when? afternoon or after heavy exercise for 10 minutes.After 9.30pm and 12.00pm , sleep is must and my body automatically sleeps and i cant think at all and i must sleep.TO work at night, i must take a nap at 9.30 pm for 30 minutes

In what ways are you fatigued mentally, and when?morning

one day no exercise, its all over

How is your sleep? 6-7 hours

How is your mood?depends

Do you suffer from significant chronic pain?back injury , otherwise, i do feel left front brain and sometimes right front brain paining a bit and at the rear of the left brain.Apart from this, i sometimes feel something wrong with my right side of the heart, some sort of choking.and sometimes, this heart pain becomes severe and i can feel the vein of that right part of the heart tapping some 4-5 times very heavily.

Apart from this, on monday i have signs of panic anxiety, as doctor says.Chest becomes real hot, brain stops working and pains a bit and i become nervous.

All my heart and brain reports are normal.ECG report was abnormal but doctor said its a machine error, there are p waves in the report which the machine isnt able to recognise and hence is generating wrong report

and  comment of the 52 kg loss

Mar 15th, 2014 10:23pm

When did the symptoms of post-TBI fatigue start?before weight loss

Did the onset of fatigue symptoms correlate with any other event such as starting a new medicine or getting depressed?depression after accident

What helps make the fatigue go away, or decrease? exercise in the morning and evening and fitnessblender metabolism 5 minute exercise every 2 hours , speak a lot the whole day and keep thinking and repeating things in brain

What aggravates it?no exercise, little or excessive food, walking fast for around 10 minutes and not for an hour to get enough exercise(i lost wt by walkingfrom 7pm to 2 am in the 3rd month of wt loss)

What triggers it? lack of exercise, depression, negative thoughts, inability to focus,

In what ways are you fatigued physically, and when? afternoon or after heavy exercise for 10 minutes.After 9.30pm and 12.00pm , sleep is must and my body automatically sleeps and i cant think at all and i must sleep.TO work at night, i must take a nap at 9.30 pm for 30 minutes

In what ways are you fatigued mentally, and when?morning

one day no exercise, its all over

How is your sleep? 6-7 hours

How is your mood?depends

Do you suffer from significant chronic pain?back injury , otherwise, i do feel left front brain and sometimes right front brain paining a bit and at the rear of the left brain.Apart from this, i sometimes feel something wrong with my right side of the heart, some sort of choking.and sometimes, this heart pain becomes severe and i can feel the vein of that right part of the heart tapping some 4-5 times very heavily.

Apart from this, on monday i have signs of panic anxiety, as doctor says.Chest becomes real hot, brain stops working and pains a bit and i become nervous.

All my heart and brain reports are normal.ECG report was abnormal but doctor said its a machine error, there are p waves in the report which the machine isnt able to recognise and hence is generating wrong report

Mar 15th, 2014 10:20pm

this is how i damaged my brain-

1. I gained too much fat (130kgs) that i needed to sleep after every meal and after that meal i again felt hungry.I had no exercise for 9 or more years before i lost weight.

then one day i decided to loose weight and then in 3 months i lost 52 kgs ,the last month without having food.(ketones found in blood)

Even after weight loss, the sleep issue didnt got resolved and i had one more issue ,i couldnt focus at all while sitting.

So i need to stand and speak aloud to read something and i gained too much interest in reading that i never took a single second pause and keep on reading.Then i took a pause.This is when i felt something isnt good.I am losing listening power, bvefore weight loss i used to write at the speed at which someone speaks but now i cant

another issue that i am facing after weight loss is in the morning.BEfore wt loss, i could wake up any time in the night or anytime i want and i never lack energy but now i just have hardly any energy to think.I need to do exercise to start my day.

Mar 15th, 2014 10:06pm

This answered a lot of questions I had and still have about TBI's. It explains a lot to me, about why I'm so tired all the time.

Mar 15th, 2014 6:22pm

It is a feeling like you brain is in quicksand.

Mar 15th, 2014 4:44pm

Hi Nicole (Nov 11 2013)

I know what you are going through. Please call/email.

bjry@hotmail.com

252-757-2627

Jean

Feb 14th, 2014 9:42am

Hi I acquired a traumatic brain injury when I was 11 years of age, am 28 now, and suffer quite badly from fatigue. It is only in more recent years that I can read a full chapter of a book without wanting to sleep. Anyway I'm back in college now doing a masters and college days are very long. Usually after Lunch I can't stop yawning until little break, 2 hours later and so am not taking in afternoon lectures. As far as memory goes I have trouble encoding information so being alert is very important. Can you please give me any suggestions as to how to combat this. Thanks Nicole :)

Nov 18th, 2013 12:52pm

Going into my 3rd week after brain tumor removal. Feel 100% better than when it was in there. But get very very tired. Trying to do the right thing and listen to my body. If it says I need rest or a nap then thats what I do. Never been one to be idle during day, but I have discovered that if I rest im much nicer.

Sep 26th, 2013 5:00am

For me, coffee - several FDA approved caffeine compounds - alertness aids temporarily improve my alertness level a little as well as temporarily reduce fatigue/provide some small, real energy - both mental and physical. Charles Thomas Wild - Inattentive ADHD/Organic Brain Syndrome as a result of a non-normal, three day delivery (identical twin) in 1946. ADHD at one time in the USA was officially called Minimal Brain Damage (MBD). Thank you.

Mar 27th, 2013 10:26am

These comments are good to hear in that I see that I am not alone in being exhausted. I sustained a sacral spinal injury and one yr out sustained first of two TBIs where I loss consciousness, developed epilepsy, memory loss, chronic fatigue, etc. Although I hold a MSN I cannot work for a variety of reasons. My speech came back after about 5 months and I also relearned how to perform simple tasks. I still had energy after the spinal cord injury but the TBIs really took it from me, especially the second one. My left arm movement returned. My anti-seizure meds had to be adjusted after the second TBI because of the fatigue. I just hate that I am so tired.... I used to be the most energic person with endless energy. If I don't rest and overexert, I wind up seizing and losing bladder and bowel function. I hope that more research is done as TBIs are so common now with our veterans. I started taking Savella for fibromygia and it has helped the fatigue tremendously. I recommend it! Does anyone take any herbs or vitiamins which help? Thank you and Good Luck!!

Nov 19th, 2012 8:43am

Startle reaction: yes, I experience it too. I thought I was the only one in the world because it happened once in a doctor's office and he yelled at me. I was sitting during a rough exam and he reached across my face, in front of my eyes, to touch the other part of my head. Inadvertently, I jumped and my arm swung out and I hit him. I told him I was sorry, that I jump when things surprise me visually, but he was angered and threatened me with cancelling the rest of the appointment. In retrospect, I should have cancelled it. But he was the only game in town and I was too dizzy and physically stressed to take the affirmative steps that I would have taken if I had not been injured and had not been there in the first place. Still hopping to the drugstore on a broken leg for pain pills. (By the way, this happens in response to aural stimulii as well. There is a special sense of unreality when the people paid to treat us have so little understanding of our condition.

Apr 4th, 2011 9:57am

I am a 60 yr old survivor and midlevel provider of 3 Severe TBIs from one incident, now 2 yrs. My story or comment is intended for help to others and TBI Awareness. Prior to my TBIs I interviewed potential military mTBI, and seen or managed very few mod or severe TBIs. These were done bt generalist AND REFERED TO SPECIALTY. I interviewed and followed minor cases and refered to determine further rehab management. All cases complained of fatigue in ome form or another most had family, work or family involvement, esteem, depressed or anxiety/frstration components. If applicable would be refered to BH mainly for safety. I didnot and really have not understand the full story of a TBI and idiosincrasies until mine. I donot have headaches or bad memory lapses or confusion. However I HAVE EXTREME FATIGUE TO POINT OF EXHASTION, SPEECH GARBLE OR SLURINESS and word droping, but I BECOME Tangent, wordy and try to talk to get my point across. Sometimes I feel like the energizer rabbit, but my collegues and friends laugh always with me as they don't see this as abnormal, as I seemed to be like this before my injury. The difference now is that they try to be polite and wait till my point is made which I usually forgot a long time prior, before they would leave. I wake up tired, get tired if ride in auto more than 20-30 min, at diinner time, but at 12 midnight like now Wide awake, can not turn thoughts off at night, insomnia during bedtime. During night can't turn off, day unable to be fully awake. Ask my phsiatrist who told me fatigue is common, usually if made aware seem to accept and becomes waiting game. I HAVE ANTE AND POST AMNESIA OF MY EVENT THEREFORE NO PTSD, but experience vivid dreams. I experience polyuria due to my worse diabetes from oral to insuliN dependent which also causes fatigue, drowsiness with hyperglycemia. Rarely hypoglycemia and no coma episodes also normal thyroid. nOW i INTERTAIN MY DREAMS TIRER ME AS THEY ARE PANORAMIC, LARGE SCALE BUT NON TERROR. Than I read my med may interact on the fatigue and diabetes which is Cymbalta. Seen Psychiatrist who felt cognitive stable and most physical didn't need to see him unless want to change med so will start Prosac soon after 1 week taper and sleep hygiene. Was originally d/c with Oxygen but NOT MONITORED AND HAVE NOT USED SINCE D/C'D 2 yrs ago. May restart. Was using aricept caused me increas urinating got up too much at night, also anti spasmotics and pain meds increased drowsiness so d/c'd and didn't notice change with provigil but it raised B/p. I am in for long haul will wait and see. This articl is helpful and is reference for use now and fture. I sustained a Glasscoe Coma 3 on presentation, remained in coma 2 weeks, sustained a intra cranial subarachnoid bleed, frontal and temporal shearing, thus 3 severe TBIs that were confirmed by spect scan 3-4 months later. Subarachnoid bleed resolved in accute phase. Released after cervical fusion C5C6 24 days post trauma to rehab and sent home 34 days later. Initially return to work trial, however fatigue was very interfering thus awaiting MMI and retirement. Hope this helps someone. Just sharing this is helpful for me.

Apr 2nd, 2011 3:51am

My 17 year old daughter is 7 years post TBI. Stills becomes extremely fatigued, both physically and mentally. she needs to be in bed no later than 9 pm or she is exhausted the next day. We have her taking Yi yoga and she sees a personal trainer to try to build her muscle/body strength. But she has developed these extreme 'startle reactions" to simple noises!! We have tried meds like Stratera with no evail. Any suggestions? could this be related to the fatigue; since you mentioned anxiety. It's so bad that we have to warn her before we sneeze! Any suggestions would be greatly appreciated.

Apr 1st, 2011 9:26pm

I sustained mtbi in 1994 and 1998 and still feel like a failure because fatigue makes me less able to take care of myself. People can often see the debilitating fatigue come over me before I feel it. It comes with blurry vision, slurred speech, slow processing, clumsiness. Glad to see fatigue addressed here. But I am confused by the doctor's comments, "One thing that surprises me time and time again is that no one these days takes the initiative to interview potential doctors before making a selection. You can set up an appointment with a doctor you are considering to get a sense of his bedside manner, knowledge, and philosophy. When it comes to TBI, the patient/physician relationship may continue for many years, so choosing well is very important." In my case, the tbi prevented me from doing the things that I knew to be reasonable. I can't even set up one doctor appointment much less set up some (dealing with medical office structure, insurance requirements, telephone answering methods, scheduling, arranging transportation, dealing with MD's (even when appt is for discussion only) who place a person with tbi in a disabling physical environment, etc. All the things that are tbi to me are the things that prevent me from doing as the doctor is surprised more people don't do. It's like expecting me to hop to the drugstore on a broken leg to get a pain pill. I am stunned at the doctor's surprise. I wish I lived in the world where I could do those things-or had someone to do them for me. I'm just too damn tired.

Apr 1st, 2011 2:36pm

o HAD A RPUTURED MIDDLE CEREBRAL ARERY ANEURYSM IN LATE oCTOBER 2009, EQURING CRQINOTOMY TO DIP THE WNEURYWM, WITH CRQINOPLASTY IN LATE jANUARY, SUFFERED 3 MINOR STROKES ON mri AND MOTOR FUNCGION HAS COMPLETELY RETURNED THANKS TO 4 MONTHS O F HARD THRAPY. i STILL AM COMPETELTIED OT. IS THIS USUAL? FURTHER COMPLICAIONS INCLUDED BLOOD CLO OT THE LEG SHOEWEING TO THE BRAIN CAUSING HE "STROKES". I JUST WAN MY USUAL ENERGEY BACK. DIET IS HELATHY, ND TAKING A DAILY MUTI-VITAMIN ON TOP OF POEIN SHAKES.

May 17th, 2010 3:30pm


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