Fatigue after ABI: boom and bust

Fatigue after ABI: boom and bust

Almost every brain injury survivor will need to deal with fatigue following their Acquired Brain Injury (ABI). Headway UK states that ‘it is the most commonly cited effect of brain injury reported by the 11,000 callers to our helpline each year’1.

Fatigue caused by an illness or injury is known as pathological fatigue. This isn’t the same as simply being tired. The pathological fatigue which sets in after ABI is nothing like that which happens after a long work shift or a poor night’s sleep. Nor is pathological fatigue resolved with a night or two of good sleep.

Pathological fatigue is always there.

My apologies to anyone dealing with fatigue who just read that, but I’m afraid that it is true. Fatigue will change, and may lessen as you become stronger after your injury, but life after an ABI means managing your fatigue.

There are things which you can do to help improve your stamina and hence lessen your fatigue.

When I could finally get into an Adult ABI clinic 15 months after my injury, one of the first things the clinician signed me up for was Vocational Rehabilitation. Basically, a clinic which aimed to get me back to work. While they did liaise with my employer and make recommendations over the work environment, their main focus was training me in managing fatigue and building stamina.

Boom & bust cycle

This term is as relevant to fatigue management as it is to economics, where I first heard it. In pathological fatigue it describes how ‘the temptation to push ourselves when (we) have more energy means that we can burn ourselves out. 2 This leads to a period of low energy where we need to recover and rest before being able to resume our activities.

This cycle can stretch across a single day, where we wear ourselves out in the morning and are unable to do anything in the afternoon. Or it can last across a month. I have build my stamina to the point where I now have a week or two of feeling well enough to get in more exercise or tick off more tasks. But if I am not careful, I crash into a few days of rest and recovery.

Fatigue still needs to be managed seven years after the initial brain injury.

Fatigue and mood

This cycle can have a detrimental effect on a someone's overall mood. It is really hard to be chipper and upbeat when simply showering is exhausting. But beyond that, the mood lifts with the increase in activity as being able to exercise, achieve things, or see people all tend to be enjoyable.

When the bust happens, not only does the lift from enjoyable activities go, but there is an added depression from the feeling of being ill again. Add in the guilt over having mis-managed the fatigue, and the ‘low’ can be very low indeed.

Everyone needs a duvet day

My counsellor said this to me one session when I had been angry with myself over the failure to balance out my activities. A day of fun and seeing people had plunged me into a time of low energy and mood. This was a simple thing, but helped me to realise that I am not alone.

Yes, it is true that I do need more duvet days that those around me. But to get the best effect from those days, I needed to stop being myself up and rest. Wherever you are on the Boom & Bust cycle, it is important to still be kind to yourself.

Want to know more about my journey with Fatigue after brain injury? Please take a look at my debut memoir out now!

  1. https://www.headway.org.uk/news-and-campaigns/campaigns/brain-drain-wake-up-to-fatigue/ ↩︎
  2. From ‘The Boom-Bust Cycle’ PDF by Northern Lincolnshire and Goole NHS Foundation Trust. ↩︎
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