Managing Cognitive Fatigue
Pain is generally considered the primary symptom of fibromyalgia, but I feel there is another one equal to, if not worse than, pain. That symptom is fatigue.
Now I know everyone has different levels of pain, fatigue, and all the other symptoms, so this may vary from person to person. But the thing about pain is that to a certain extent you can push through it and still get things done. There are pain medicines that can help get rid of, or at least curb, the amount of pain that we feel. There are topical ointments and lotions that help with pain. Heat and/or cold can help with pain.
But what helps fatigue?
A normal person (someone without fibromyalgia) would probably recommend taking a nap or getting some extra sleep at night, but I'm sure we all know that does not always help. Why is that? Put very simply, our brains do not work the way they should.
There are four stages of sleep. The first is when your eyes are closed, but you're easy to wake up. The second is a light sleep. The third is the deep sleep stage. It is during this stage that our body repairs itself and repairs the immune system, among other things. The fourth is the most important for a restful night's sleep, the REM stage. That is when our brain dreams.
People with fibromyalgia constantly have bursts of awake brain activity, preventing them from getting to these last two stages of sleep that are vital for a good and restful night's sleep. This is why, even if we sleep for a long period of time, we still wake up feeling tired and fatigued.
This problem not only causes the feeling of fatigue, it also affects our cognitive abilities, the ability to think and even learn. It is one of the factors in another common fibromyalgia symptom that of cognitive fatigue, often called brain fog or fibro fog.
Another factor of cognitive fatigue is that we frequently do not get enough oxygen in different parts of our brain. It feels like walking around in a fog. It is like you know there is something in the distance, but you just cannot quite make out what it is. That's what it feels like inside our head.
The Impacts of Cognitive Fatigue
This kind of fatigue or fog impedes our memory. It makes concentration very challenging. And it affects our capacity to process information.
Imagine you are a fairly well educated adult, with a large vocabulary. But suddenly, in the middle of a conversation, you can't remember the simplest of words. It seems as though a word that you use on a regular basis has been wiped from your memory.
You struggle to find another word that would work, but you can't think of any. You stand there with no clue how to proceed with your conversation because you no longer remember any words. Meanwhile the person you are talking to is staring at you, trying to figure out what in the world could be wrong with you.
Imagine you are in a grocery store. Suddenly you have no clue what you are there to buy. You wander from aisle to aisle, not able to recall anything you or your family eats. You end up buying a few things, knowing that you likely missed a lot and will have to come back in a day or two. You then realize, you have to drive yourself home. Everything looks far away and a little blurry, but you have to focus the best you can to get yourself home safely.
Imagine you are at work. You are in the middle of a task that you have done numerous times, but you just can't quite think what you need to do or how you need to do it. You start making mistakes. You try and force yourself to focus and complete your work but your brain feels completely blank. You feel like everything around you is going in slow motion.
Someone comes in and is talking to you, but they sound so far away. It takes a while before you can pull yourself out of the trance-like stupor that you are in so that you can listen to what they are saying. But even then the words they are using don't make sense to you. Not because they are saying anything odd, you just are unable to process what they are telling you.
For most of us with fibromyalgia, I'm sure these are not difficult scenarios to imagine. I'm sure that most, if not all, of us have been in a similar situation at some point. In fact, I feel it is probably safe to say that most of us find ourselves in these types of situations on a fairly regular basis.
The thing that makes cognitive fatigue so difficult is that, unlike pain, there is no pill you can take to remove the symptom. A heating pad doesn't help. Topical ointments and lotions don't work. So what can we do?
For me caffeine is a double-edged sword. When I try to avoid caffeine altogether I have a very difficult time functioning in the morning. But if I have too much it will affect my ability to sleep at night. Considering I already have difficulty getting a solid night of rest, I of course do not want to do anything to make that worse.
I have found that if I have one, maybe two, cups of half regular/half decaf coffee in the morning it helps me be more alert, but does not impede my ability to sleep at night. And I never have caffeine after noon. Drinking coffee after 12:00 p.m. is just asking for trouble.
Caffeine affects everyone differently, so even a little in the morning may be too much for you. It is important to listen to your body and find what is right for you.
Some prefer drinking tea. Some swear by a stretching routine first thing in the morning. The important thing is find what is going to help you to wake up and start your day.
I remember making fun of my mom for making lists and notes about EVERYTHING. There were always sticky notes everywhere you looked. But here I am now making lists and notes about EVERYTHING!
I do, however, have a different way of going about this – I find it is easier to keep digital lists and notes. I have found using an app that allows you to make lists, notes, and reminders is extremely helpful. I can access it right on my phone, which I always have with me. But I can also access the website from my computer, tablet, anywhere I can get online.
I also make good use of the calendar in my phone to keep track of anything and everything that I have planned or need to do. I set reminders for important events, usually several reminders, starting the day before.
This calendar is also connected to my email account so that my husband and I both can get email reminders about these events. These have been lifesavers for me!
Work When You Are Most Alert
This may not be possible for everyone, especially if you have a set 9-5 work schedule. But if possible, find when you are most alert and able to think clearly and do your work then.
Maybe you're a morning person. If so, get up and do as much as you can in the morning. If you're like me, mornings are not the best time for you. So take things slowly and then once you feel yourself wake up a bit mentally then get to it.
Possibly you don't have a set time of day that is best. In that case do what you can, when you can.
Exercise – Physical and Mental
Exercise is said to help with fatigue. Of course when you're in pain and exhausted exercise is a lot easier said than done! But slow gentle exercises, maybe just some stretching, can help to wake you up and help to get a better night of sleep. More than that, exercise can help clear the fog in your mind and allow you to think a little more clearly.
In addition to physical exercise though, we need mental exercise. Sometimes you do need to unwind and do something that requires little to no thought. But it is very important to also spend time on strengthening your thinking ability.
Read something that will help you learn something new. Try a new, low-impact hobby. Talk to someone else about their interests and experiences and see if they can teach you something.
Try writing about your day, but instead of using just the same old words you normally use, pull up the thesaurus online and see if you don't learn a few new words. When you read or hear a word you are not familiar with, look it up, try to use it in conversation.
These little things help keep our minds active and to an extent can help fight the effects of cognitive fatigue.
I know that some may disagree with my assessment that pain is not the worst symptom of fibromyalgia. It is certainly the most common and well known. But it is my opinion that physical and mental fatigue are much harder to cope with and get relief from.
That does not mean we have to throw in the towel and give up. We are fighters and have proved that we can make it through anything. With a few tweaks to our schedules and habits we may be able to find at least some relief from fibro's cognitive impacts.