Fighting Fatigue

Better Health Magazine

By Jordan D. Jones

West Haven High School teacher Kimberly Boyke is generally out the door by 6:30 a.m. for a busy day in Spanish class. By the time she finishes her school day, she’s usually exhausted, but has no time to think about slowing down.

“I usually run off to the gym, then I’m back home correcting assignments and preparing my lessons — that’s if I’m not in class myself,” says Boyke, 24, who also works on her master’s degree in the evenings.

Boyke averages six hours of sleep a night, which often leaves her feeling tired and fatigued in the late afternoon.

“When I start to feel tired, I try to keep busy,” she says.

A better choice would be to slow down and sleep more, says Herbert Knight, M.D., the Hospital of Saint Raphael’s section chief of Pulmonary Medicine. To feel and function at our best, we need to make time to rest our bodies and get enough sleep.

“There’s a common misconception that we can overcome tiredness and feelings of fatigue by moving around and pushing ourselves to keep going,” says Knight, who’s board certified in pulmonary and sleep disorders medicine. “The reality, however, is that we need to develop a finer sense of what our bodies need for sleep and rest. Sleep needs to be a priority and given the same sense of urgency as other activities in our lives.”

Fatigue vs. sleepiness

Fatigue and sleepiness are often confused or used interchangeably. But they are distinctly different, Knight says. “Fatigue is difficult to describe. I hesitate to call it a symptom; rather it’s a sensation we all feel sometimes which may not necessarily connote illness. Fatigue is often associated with a sense of listlessness, exhaustion and tiredness, as well as lack of energy and motivation.”

Sleepiness, on the other hand, is a measurable feeling of the need to sleep. “Sleepiness can be objectively measured, whereas fatigue remains much more subjective,” Knight says.

Both are generally normal and necessary responses from our body when we’ve experienced too much physical exertion, emotional stress or sleep deprivation.

Though you should call your doctor if either becomes a chronic problem. In addition to being caused by lifestyle, fatigue can sometimes be caused by common yet treatable illnesses like anemia, depression, diabetes or thyroid problems.

The good news, however, is just as fatigue can be brought on by a variety of factors, it can also be treated a number of ways. These treatments generally include getting additional sleep, eating nutritious foods, exercising regularly and reducing the stress and worries that can keep us lying awake at night.

Eat right
Saint Raphael registered dietician Jackie McCollough, R.D., believes eating nutritious foods are key to fighting fatigue.

“The most common food problem is not having a balanced diet,” says McCollough. “People need balanced meals, which include five to six servings of high-fiber fruits and vegetables.”

Breakfast is vital. Starting your day with a low-fat, high fiber meal will give your body the energy it needs to keep pace with your day. Consuming high-fat and high-sugar foods can make you sluggish in the afternoon.

Also, limit junk food, says McCollough. Junk foods are simple carbohydrates that affect blood sugar levels, leading to a decrease in activity.

“It’s important to remember that not all carbs are bad,” says McCollough. “We still need to have complex carbohydrates in our diet, as they provide energy. We can do this by increasing our intake of fiber and grains in addition to fruits and vegetables.”

Another mistake is not getting enough water. Southern Connecticut State University public health professor Diane Frankel-Gramelis says getting enough fluids is essential. “We should drink water throughout our day,” says Frankel-Gramelis. “It helps our body fight fatigue, and helps us to be optimally energized.”

Get moving

Exercise is also important. As little as 30 minutes of daily exercise can make you feel energized and alert for hours after, says Knight. Exercise also helps reduce your risks of heart disease, stroke, diabetes and high blood pressure — illnesses that often have fatigue as a symptom.

Yet timing is critical. Exercise too close to bedtime, and you’ll lie awake. Exercise earlier in the day, however, and your body will be relaxed at night and ready for sleep. The latter is what Knight calls “good sleep hygiene.” See page 16 for more information.

“In general, exercise should be avoided directly before bed time,” Knight says, “because it can have a stimulant effect and make sleeping more difficult. Too much exercise should also be avoided because it can make us fatigued. The rule here with exercise is don’t over-do. Find the level and time that’s right for you, and stick with it.”

Let go of stress

Emotional stress is another fatigue factor. Stress is the body’s response to environmental demands and pressures called “stressors.”

“Stressors are all around us,” says Frankel-Gramelis. “Major life events, such as marriage, death, divorce or childbirth can all be stressors.”

Everyday tasks can also be stressors, whether it’s caring for a sick child, commuting to work or finding time to accomplish the day’s tasks.

Stress is also the body’s way of warning us we need to slow down.

“Often we bring more stress upon ourselves by worrying about things that haven’t happened yet,” says Frankel-Gramelis. “We need to let go of the worry and take time to breathe. Deep breathing can be very relaxing, plus help us relieve stress and sleep better at night.”

Boyke says she wasn’t giving herself any time to breathe. Not only was she rushing through her day, she was worrying about pretty much everything — especially when she slowed down at night.

“It’s in bed that I usually think about what I have to do the next day. I have a million thoughts running through my head,” says Boyke.

In an attempt to reduce her nighttime worries and improve her sleep, Boyke now listens to music and writes in a journal — leaving her problems on the page.

Knight recommends a similar strategy.

“The pace of life is so rapid that we give ourselves little time for reflection,” he says. “For many people, it’s only when we go to bed that we finally reflect on our problems and the day’s tasks.”

He recommends committing yourself to thinking about your problems for a short while before bedtime. Then push away your problems as you pull up the covers. “It’s extremely rare to have a middle-of-the-night revelation about our problems, so put them away and get some rest.”

Make a commitment to sleep
Chat rooms, books, DVDs, all-night supermarkets and a host of other distractions keep us from getting enough shut-eye, Knight admits.

“Life was much different before the invention of electricity,” he explains. “After dark, the day was over. People would go to sleep. Today, given our technology, we can keep going 24 hours a day. This has drastically altered the natural sleep-wake cycle.”

The reality, however, is that most adults require seven to eight hours of sleep a night. “Although some need a little more, and others can get by with less,” Knight adds. After age 60, for example, people tend to spend a little less time sleeping.

Boyke agrees that getting enough sleep is essential.

“I’m definitely more productive and dynamic when I get a good night’s sleep,” says Boyke. “I have a better attitude and teach better.”

Sleep disorders
So what happens when you follow all this advice but still can’t get to sleep?

See your doctor. Severe, prolonged fatigue or sleepiness may be a sign of an illness or sleep disorder. Yet according to Harvard health experts, only one in 20 Americans with a sleep disorder seeks professional help. A sure sign you need to see a doctor is if chronic sleeplessness makes you unable to function at normal levels during the day.

“If a person has persistent sleepiness and is practicing good sleep hygiene, it’s possible they suffer from one of three major sleep disorders: sleep apnea, restless legs syndrome or narcolepsy, which is less common,” explains Knight. See page 14 for definitions of these conditions.

Many people attribute prolonged fatigue and sleepiness to aging. But this is just a myth, Knight asserts.

“There are some minor age-related changes to the quality of sleep. But generally fatigue and sleepiness are not normal consequences of getting older,” he explains. “Getting a good night’s sleep can be more of a challenge when you’re older, but it shouldn’t be impossible.”

Chronic Fatigue Syndrome
Severe fatigue lasting more than six months may be Chronic Fatigue Syndrome, Knight says. The national Centers for Disease Control and Prevention recognizes CFS when prolonged fatigue is combined with at least four of the following symptoms:

  • Memory impairment
  • Sore throat
  • Muscle pain without swelling
  • Headaches
  • Fever
  • Joint pain

This list may make the disease appear cut and dry. But it’s often difficult to diagnose, says Bloomfield resident Michelle Lapuk, co-president of the Connecticut Chronic Fatigue and Immune Dysfunction Syndrome & Fibromyalgia Association.

“It’s like having the flu that never goes away,” Lapuck says. And that constant state of fatigue and fogginess can decrease a person’s ability to function by up to 50 percent.

The CDC reports 800,000 adults in the U.S. suffer from CFS, mostly women. But Lapuk notes CFS can affect children, men and women of all races.

“The number of people with chronic fatigue is fairly small. But that doesn’t mean the disorder, or fatigue in general, should be ignored,” adds Knight. “People tend to minimize fatigue. But they shouldn’t.

Learning about the causes and treatments is an important part of healthy, happy living.”

The most common sleep disorders include…

Narcolepsy: A condition that affects about 1 in 2,000 people, causing profound daytime sleepiness. Symptoms usually begin in childhood or young adulthood and last throughout life. Those with narcolepsy may suffer sleep attacks where they suddenly fall asleep for 5 to 10 minutes during the day, no matter what situation they’re in. Other symptoms may include cataplexy, where muscles suddenly become paralyzed, causing the effected person to fall; temporary sleep paralysis; hallucinations when falling asleep; disturbed nighttime sleep; or automatic behavior, where the patient performs tasks on “automatic pilot” while partially asleep, but then doesn’t remember.

While there’s no cure, medications can help improve a person’s wakefulness during the day.

Restless legs syndrome: A common problem that generally strikes as you begin to relax, causing an unpleasant tingling in your legs (and sometimes your arms). These sensations persist, interfering with you falling and staying asleep. Several prescription medications can help.

Sleep apnea: A potentially life-threatening condition in which breathing stops hundreds of times each night. It is most common in overweight men, with a stop-and-start pattern of breathing or very loud snoring the primary symptom.

This failure to breathe right at night increases your risk of heart attack, stroke and congestive heart failure. Treatments range from lifestyle changes like losing weight to using a corrective airway device to surgery.

Having trouble getting to sleep?
Make sure that there’s nothing to disturb your sleep. For example, no pets in the bedroom, keep the blinds drawn at night, and remove anything else that might cause noise or disruption.

Make sure you’re comfortable. The mattress and temperature should be appropriate. Too warm a temperature at bedtime may actually hinder sleep, and exercise, which warms you up, or hot showers right before bed, may be counterproductive.

If after 20 minutes in bed, you have not fallen asleep, leave the bedroom and do something relaxing until you feel sleepy. Then, return to bed. Repeat as many times as necessary.

Avoid naps during the day, or lying around in bed in the morning.

Try to get out into the sunlight — especially in the morning when you first wake up. This helps keep your biological sleep clock in good order and may make it easier to sleep at night.

Go to bed and wake up at the same time every day. This consistency is particularly important in the morning, where a fixed time of awakening, coupled with good, bright light, can help to keep your biological sleep clock regular.

Everyone suffers from occasional bouts of insomnia. If it becomes a recurring or chronic problem, however, be sure to talk with your doctor.

Hygiene: n. A system to help preserve health and prevent disease.

Good sleep hygiene

To wake up refreshed and ready to tackle the day, Saint Raphael pulmonologist Herbert Knight, M.D., recommends you:

  • Set a regular time for going to bed and waking up.
  • Keep your bedroom at a comfortable temperature. It’ll help you relax.
  • Avoid smoking and drinking within two hours of bedtime. (Though it’s best not to smoke at all, and drink only in moderation.) While alcohol can have an initial sedative effect, it can disrupt sleep later in the night.
  • Avoid caffeine late in the day.
  • Take a relaxed attitude to bed. Don’t bring problems or worries with you. Instead, jot them down in a pad or journal and let go of them for the night.
  • Use your bed only for sleep and intimacy.
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