Fatigue and TBI

Craig Hospital
Fatigued woman holding head

What is fatigue?

Fatigue is a feeling of exhaustion. It is tiredness, weariness, or listlessness. It is a feeling of not being able to finish a task. Fatigue overwhelms most other feelings and can make it hard to work physically and mentally. With some kinds of fatigue, even sleep doesn't help.

Why is fatigue important?

If you are overwhelmed by fatigue, you have less energy. It may be hard to care for yourself. You may not feel like socializing. You may not be able to do the things you enjoy. Fatigue can affect your mood. It keeps many people with TBI from going back to work.

How common is fatigue?

Fatigue is very common. Almost one-quarter of all people who don't have a TBI complain of fatigue. Research shows that each year, fatigue is responsible for seven million visits to the doctor's office! More than $1 billion is spent each year trying to evaluate or treat fatigue.

Studies of people with TBI found that between 37% and 98% of them said they had some kind of fatigue. As many as 70% complained of mental fatigue. It doesn't matter how severe the TBI is. Fatigue is a very common problem among all people with TBI.

What other kinds of people have fatigue?

Fatigue is more common in women and in people who:

  1. have other kinds of neurological problems
  2. live alone
  3. have chronic pain
  4. have psychological or psychiatric conditions
  5. abuse alcohol or drugs
  6. take certain kinds of medications
  7. have stressful, low paying, or boring jobs

If you fit into any of these groups and have a TBI, you may be even more likely to have fatigue.

Are there different kinds of fatigue?

A person with a TBI needs to know about three different kinds of fatigue:
Physical fatigue: "I'm tired and I need to rest. I'm dragging today."

Psychological fatigue: "I just can't get motivated to do anything. Being depressed wears me out; I just don't feel like doing anything."

Mental fatigue: "After a while, I just can't concentrate anymore. It's hard to stay focused."

Physical fatigue?

Physical fatigue can come from muscle weakness. It can come from having to work harder to do things that were easy before the TBI. That includes things like dressing, working around the house, even walking. Physical fatigue gets worse in the evening, after a busy day. But, the next morning, after a good night's sleep, it should be less. Often, this kind of fatigue will get better if you become stronger, more active, and get back to your old life.

Psychological fatigue?

Psychological fatigue comes with depression, anxiety, and other psychological conditions. This kind of fatigue gets worse with stress. Often, sleep does not help at all. Psychological fatigue is often at its worst when you wake up in the morning. To "cure" psychological fatigue you must find its cause. If it is depression, medications may help.

Mental fatigue?

Mental fatigue or cognitive fatigue can happen after a TBI. It makes it hard for you to think or concentrate. The more you have to concentrate, the more mentally fatigued you may get. It's possible that this happens because the TBI forces you to concentrate harder to do tasks that used to be easier. Think about it: Working harder to get dressed or walk can make you physically tired. And, working harder to stay focused can make you mentally tired. In some people, mental fatigue causes them to be irritable. Other people have headaches. Overall, mental or cognitive fatigue is the kind of fatigue that we know the least about.

What kind of fatigue do YOU have?

Here are a few ways to get an idea about the main cause of your fatigue:

  1. Psychological fatigue may cause you to be tired early in the morning, even before you do anything. Physical fatigue gets worse as the day goes on, after you have done more and more. Mental fatigue probably will get worse as the day goes on also.
  2. Rest usually does not help psychological fatigue. Taking a day off or a vacation won't help either. With physical fatigue these things should help. They may help mental fatigue too.
  3. Over time, exercising and being more active should help lessen physical fatigue, and probably even mental fatigue. Exercise builds your stamina. Some researchers feel that it builds your mental stamina as well. Why? They don't know, but they have noticed that people who exercise are more likely to get back to work. And, work requires both physical and mental strength and stamina. People with TBI who exercise also seem to have less depression and other symptoms.

What can you do?

  1. Do you think your fatigue may be coming from depression or anxiety? If so, see a doctor who knows about TBI. He or she may be able to help you with counseling, or maybe even medications.
  2. If you think your fatigue is physical, or even mental, try some of these things.
  • Get more sleep and rest. You may want to look at your sleep patterns. Do you have insomnia or sleep apnea? Sometimes, these are side-effects of TBI. If either of these problems is affecting how well you sleep, tell your doctor. There may be treatments.
  • Try to change your schedule. Do the things that require the most physical or mental effort earlier when you are fresher. Don't save the grocery shopping for evening. Don't try to balance the checkbook or figure out your income taxes in the evening either.
  • Allow time for rests during the day. After one of these rests, you may be fresh again and able to take on some of those more difficult tasks - like the checkbook!
  • Start exercising. You may need to check first with your therapist or doctor to find out which is the best and safest type of exercise program for you. Start gradually and then increase. Hopefully, your physical endurance and your mental alertness will improve. Eating a good, nutritious diet will also help. Research has shown that people with TBI who exercise have fewer symptoms and better cognitive function. They feel their health is better, and say that they are less depressed. They may be more mobile and more productive. Participating in a wellness program may be a good idea.
  • If you have mental fatigue, keep your eye on the research. Some new drugs are now being researched. Craig Hospital is currently studying one of these drugs. In the future we'll be writing another brochure to tell you about this study.

How to find more information

The Mayo Clinic's website has several resources relating to fatigue. For a general one, go to: www.mayoclinic.com. In the site's own Search box, type in the word "Fatigue." Try the articles titled, "Fatigue: when to rest, when to worry." Or, "How much exercise is enough?"

You might also try www.webmd.com. Once there, just search with the word "fatigue".

Posted on BrainLine July 25, 2008.

From Craig Hospital, Englewood, Colorado. Reprinted with permission. www.craighospital.org.

Comments (6)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

Thank you for sharing what you have gone through and have learned

Hi,  I can clear up a drought with all the tears I have shed since my husband's tbi in June 2013. Over week-ends I get so lonely because our kids have left the home already and hubby just rests all the time.   The fatigue also seemed to get worse after the first 6 months.  We had his hormones checked. He is now on thyroid treatment and growth hormones.  It is better, but we are not nearly out of the woods yet.  I promised myself to post a reply if we find a solution to this fatigue.  I am sure anyone can live with the other bad stuff like the hemi- paresis, the difficult speech even the double vision, but the fatigue is the worst. It is incapacitating.  He is going for his second eye op next week.  Stay strong.  

The body is very responsive to new environments, gradual increase in exercise allows for certain release of neurotransmitters in the brain. Serotonin (happy, feeling well) nt, dopamine (mental energy, reward, motivation) nt, just to name a few are influenced by simple exercise. Secondly, diet also supports the mind and body. Diets that include adequate protein, provide development for these neurotransmitters. Instead, of using conventional medication, speak to a naturopath or herbalist, as there is a wide array of foods that can help us get going. Hope this helps. Emotional support is also invaluable. God Bless.

I am 22 years post tbi. I had mine when I was 12 & I suffer BIG time from psychological fatigue. I've gotten help though and am getting better. If you are, or ever have been bullied by someone because of your disability/tbi; this is why. You are not dumb, there is nothing wrong with you.
I think you need to get some counseling asap . I am a man that is 12 years post tbi . I have a very hard time still with major fatigue . It is very important to support and understand what your husband is dealing with as he hates being like this also . Please do not give up on him .
being my husbands caretaker the worst part of tbi is him sleeping all the time. i am lonley and have lost my best friend. we used to do alot together, now i sit and watch him sleep all the time. he doesnt even want to bath like he used. i dont know how much longer i can be like this. im getting so depressed. i need a man like he was befor the tbi.