Fatigue Management

Coping with tiredness

Pay attention to how you rest to improve your quality of life.

Overview

• Tiredness is one of the commonest symptoms reported by cancer patients and can be caused by several different things.
• If you are affected by fatigue, first try to pin down if something specific is causing it.
• If you can find a reversible cause of your tiredness then this may be straightforward to correct.
• The second thing to check is whether you are getting good quality restorative sleep.
• If not, then applying the principles of sleep hygiene described here may help.

How does this work

Fatigue management is simply about applying some basic principles and common sense.
Once reversible causes of fatigue have been excluded or treated a well as possible you need to focus on the quality of rest that you are giving your body.
Good quality rest, ideally deep restorative sleep, is absolutely essential for all of us.  During sleep, the body calms the effects of stress and it is a time for healing and repair.  We often are guilty, in our busy lives, to deny ourselves the benefits of good sleep and some simple routines can help us regain this very important element of well-being

What are the benefits of fatigue management?

If you practice fatigue management you will find you have:

•             Improved levels of energy

•             Deeper more refreshing sleep

•             The body will be stronger and better able to look after you

What is the evidence:

The most recent systematic review of the published literature of clinical trials of complementary and alternative medicine to treat or prevent cancer related fatigue found only limited evidence of benefit for some interventions.  However, this is a difficult area of research and most of the trials done were classed as methodologically weak.
Despite this there is consensus that simple measures described in this article can help with cancer related fatigue and are neither intrusive, expensive, unpleasant or time-consuming.  As a result we have given this element the approval score of 2.

Who would this be good for?

•             All people benefit from good quality sleep

•             It’s likely to be of interest to anyone who reports fatigue to be a regular symptom

Who should be careful?

• No restrictions

Myth Busting

• It is frequently assumed that all you can do if you feel tired is rest.  While rest is obviously important, and good quality restorative sleep is the most important rest of all, rest is not always best
• First you need to make an effort to exclude reversible caused of tiredness.  This may require discussion with your doctor or nurse and review of your medications
• Secondly, exercise can actually help, particularly in helping you get good quality sleep

Preparation and Self-assessment

First look for reversible causes of fatigue.

Here is a simple checklist of things that can commonly cause tiredness or fatigue:

1. Being anaemic (having a low haemoglobin)
2. Taking medicines that cause tiredness as a side effect: for example: pain relief, anti-sickness, anti-histamines
3. Having a low level of thyroid hormone
4. Recent chemotherapy, radiotherapy and or surgery
5. Not sleeping well
6. Not eating enough

Think about this list and see if any apply to you.  You may need to discuss this with your doctor (GP or hospital doctor) and see if you need a blood test.  If you can identify any of the above as a cause of your tiredness this may suggest appropriate treatment.

Once you have done your best to look for and correct any of the reversible causes of fatigue, if you are still troubled by tiredness, you should look carefully at how you currently get your rest and see if this can be improved.

Here is a second checklist for you to think about

1. What is my usual routine for going to bed?
2. Is my bedroom as calm, comforting and free from interruptions as I can make it?
3. What time do I go to bed?
4. What time to I get up in the morning
5. What is the quality of my sleep?
6. Are you taking rest during the day?  If so, where? and how long?
7. How much physical activity am I taking each day?

Keep a diary for a week of your normal daily habits and record how much and how well you slept. 

Local Resources

• First and foremost, if you find you are affected by fatigue you should have a discussion with your GP to help check for reversible causes
• If you identify anxiety and stress as major factors in your life then seek out local resources for mind / spirit practice - see the Spirit / Mind domain in this programme for ideas of things that you might like to include in your PlanBe
• Regular physical activity is an underlying theme throughout PlanBe, look for local resources: for example, your local gym, swimming pool, park, or even at your local hospice that offer you enjoyable opportunities for regular activity.

 Gadgets and Apps

You don't need to buy any gadgets or spend money to help you sleep well but, for those that like them there are a number of  "wearables" such as Fitbit, the Apple iWatch etc. which monitor you during your sleep and give you some feedback about the quality of the sleep you are getting.
There are so many smart phone apps that help you with establishing a practice of regular physical exercise that it is hard to know where to start!  MyFitnessPal is a favourite for many people and also includes help on recording your diet.
Method/Planning what to do

Sleep hygiene

It’s important to get good quality restful sleep. 
Review your bedtime routine.  Set yourself a sensible time to go to bed so you can get the amount of sleep you need.  We are all different in the amount of sleep and this is something you can to decide yourself.  However, as a starting point, most people should get about 7 hours if possible.  You need to start getting ready for sleep well in advance: calming yourself from the stresses of the day.  Many people find it helpful to follow a regular routine, this could be a good time to do a calming meditation or breathing practice for example, or take a relaxing bath.  Try to let disturbing thoughts go from your mind before you go to sleep
Avoid eating too late; try not to have stimulating drinks like coffee and tea if you find you are sensitive to caffeine. If you find you are woken up at night with the need go to the toilet, cut down on drinks after 6pm.
When you go to bed, have you removed those things from the bedroom that will disturb your sleep?  Is the room the right temperature (slightly cool is best), quiet, dark?  If you are disturbed by noise or light you may find using earplugs and an eye-mask helps. 

Getting support from the family

If you live with family members, they can help you by supporting your routine.

Exercise as a cure for tiredness?

It may be surprising but taking a little extra exercise when you are feeling very fatigued may be the best medicine.  Inactivity can actually make fatigue worse partly through leading to poor quality sleep.  Some physical activity each day can turn fatigue into sleepiness and help you get proper good quality rest.

Eating: giving your body the fuel it needs

If you have a poor appetite and are just not eating very much, you will naturally lack energy.  If you haven't yet done so, we would recommend you keep a food diary for a week or so to assess how much and what you are eating.  If your calorie intake is less than the daily recommended amount for you then this may be part of the problem.  If this is the case it is likely you may be losing weight.
Check out our article on Diet for those with unintended weight loss to see what you can do to improve your diet and give your body the fuel it needs.

Setting personal goals

•             Set regular times for going to bed and getting up in the morning

•             If you need extra rest, add extra sessions into your weekly plan

•             Record how well you slept

•             Record your energy levels daily

Monitoring your progress

In your diary, keep a record:

• How much you slept.
• How well you slept.
• How you felt after you had woken.
• Whether you took additional rest during the day.
• How much exercise you took.

Summary

•       Bedroom review: make your bedroom a place where you will get really good sleep

·           Evening routine: create a calming evening routine as part of going to bed

·           Set small goals and record your progress in your weekly plan

Resources

·           You can also read through the following guides on fatigue management:

o    Macmillan’s guide to managing symptoms of fatigue

o    Cancer Research UK’s guide to tiredness and cancer

o    National Cancer Institute page on managing fatigue