Fatigue is the feeling of being extremely tired or having no energy or motivation. While everyone feels fatigue after periods of extended physical or mental labour, it is extremely common in people with a brain injury. There are 3 main types of fatigue [1]:

  1. Physical – you don’t have energy to complete tasks
  2. Psychological – you struggle to get or stay motivated
  3. Mental – you aren’t able to concentrate or complete tasks

People with a brain injury often feel more fatigued because of causes such as trouble resting (insomnia); persistent symptoms of brain injury such as headaches; stress; and struggles with pain. Fatigue can also increase when a person is performing physically or mentally challenging activities. Fatigue affects many aspects of daily living, including memory, concentration, communication, and your general understanding. Research shows that when a person experiences fatigue, it can also have negative effects on their mental, physical and emotional health [2]

Topics in this section include:

Symptoms of fatigue

Fatigue most commonly is associated with feelings of exhaustion and lack of energy. Other symptoms can include [3]:

  • Being withdrawn
  • Blurry vision
  • Decreased balance
  • Increase in memory challenges
  • Irritability, anxiety
  • Loss of appetite
  • Lack of interest; lack of motivation
  • Slow speech
  • Shortness of breath

Causes of fatigue

The injury
There are parts of the brain that have a direct effect on your energy levels and your abilities to rest and recharge. Depending on the area of your brain that is damaged, you may find you now experience fatigue more often [4].
Muscle weakness
Some individuals experience muscle weakness or reduced mobility after their brain injury. Through the rehabilitation process or when completing activities of daily living, individuals become fatigued when using those muscles. For example, if you are relearning to walk, you will find the process tiring. Through consistent effort, people often build up their muscles again and don’t get fatigued by activities as much or as often.
Mental effort
For some, fatigue comes from cognitive activities. Tasks and actions may require more mental effort, which can leave you feeling fatigued. This includes reading, using a computer, watching television, or concentrating on a single task like writing, prepping a meal, or even listening to a conversation. Mental fatigue is something many people experience and like with physical fatigue it will improve over time.
Lack of sleep
Many people report experiencing disturbed sleep after a brain injury [5]. Lack of sleep could be connected to other symptoms of your brain injury, pain from a traumatic accident or your mental/emotional state.

If you’re experiencing trouble with sleep, try the following steps for sleep success [6]:

  • Use your bedroom only for sleep – no other activities
  • Keep the environment cool and dry
  • Set a consistent wake-up/bedtime schedule
  • Get lots of natural sunlight during the day
  • Exercise (if permitted). Avoid exercising right before bed, as this can make it more difficult to fall asleep
  • Minimize the number of naps you take and their length
  • Avoid caffeine, sugars and alcohol before bed
  • Keep your bedroom dark while you sleep. Remove your electronics, and use blackout blinds if too much natural light is entering your room from the window
If you’re experiencing either anxiety or depression, you may also be experiencing increased levels of fatigue. Fatigue is one of the most common symptoms of depression [7].

Some medications have a side effect of making you feel more fatigued. Your doctors will work with you to determine an appropriate medication regime and give you strategies to deal with side effects.
Stress is a physical, mental, or emotional response to a situation, and is meant to get you ready to take some sort of action. An example of this is an approaching deadline, making you work faster.

Stress is something everyone experiences, and in some cases (like meeting a deadline) stress can be good and easily managed. But many people, particularly after life-changing experiences like brain injury, can experience stress that is overwhelming and makes it more difficult to make decisions. Not being able to focus, make decisions, or cope with stress can lead to more stress. It’s a tough cycle that can cause both physical and mental strain. These levels of stress can be caused by environmental factors, social situations, or by internal factors such as the injury or the extra physical and mental effort needed to do tasks.

When a person feels that kind of overwhelming stress, it can cause fatigue because the brain doesn’t get a chance to rest, and stress can interfere with sleep.

There are a few ways you can manage stress [8]:

  • Identify what is causing the stress. It could be work, school, life changes, travelling, or other activities of daily living (ADLs)
  • Don’t avoid decisions. One of the main causes of stress is avoiding problems or decisions, which makes them bigger and more challenging the longer they go unsolved
  • Ask for help. Caregivers and mental health supports are available to help you cope with stress
  • Do one thing at a time


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