I recently asked in my Facebook community how have people been feeling since their heart attack, cardiac event or open-heart surgery. At the top of the poll was fatigue closely followed up by sleep issues, anxiety and lack of motivation. I thought these would be great topics for me to talk about. So today I am focussing on fatigue.

Click play to hear the podcast episode or read on for the full article

Helping you understand the what, the why and the how. I am going to discuss what fatigue feels like, what the difference is between tiredness and fatigue along with why we get fatigued, what it is and what causes it. You will understand what fatigue is and is not. It will help you understand what causes it and accept that you are justified in how you feel. You will have some ideas and tools to help you minimise the impact of the physical and emotional effects of fatigue.

I have experienced fatigue three times in recent years, once after my heart attack, the second time when I was going through radiotherapy and again more recently during and after covid.

It’s hard to describe this kind of exhaustion to those who have never experienced it or to explain that fatigue is not relieved by resting or sleeping more. This fatigue is not the same as feeling tired. It’s more like having the flu, or having all the stuffing taken out of you, maybe similar to being run over by a very large red bus. It felt like I was existing in fog and couldn’t think straight. It’s not just tiredness, the mind and body feel completely fatigued and everything feels like hard work.

Woman exhausted and fatigued

Is it tiredness (being sleepy) or fatigue?

Feeling sleepy and being tired occurs when you don’t get enough good quality sleep. Also when you have a lack of stimulation and are bored. It can be a symptom of a health condition that interferes with sleep, such as sleep apnoea, fibromyalgia, and restless legs syndrome etc.

Tiredness happens to everyone — it’s an expected feeling after certain activities or at the end of the day. Usually, you know why you’re tired, and a good night’s sleep solves the problem. It’s likely to be short-term and is easily treatable with regular and consistent sleep.

But fatigue, especially when it is chronic is often associated with a health condition or problems like heart disease and cancer treatments. It is also its own chronic condition, called myalgic encephalomyelitis (ME) or chronic fatigue syndrome (CFS). It is officially recognised as a disability in the UK.

What is fatigue?

Nearly everyone is overtired or overworked from time to time. Such instances of temporary fatigue usually have an identifiable cause and a likely remedy. Unrelenting exhaustion, on the other hand, lasts longer, is more profound and isn’t relieved by rest. It’s a nearly constant state of weariness that develops over time and reduces your energy, motivation and concentration. Fatigue at this level impacts your emotional and psychological well-being, too.”

Definition By Mayo Clinic Staff

There is no specific test for fatigue but there are clear guidelines to help doctors diagnose the condition. Fatigue is subjective and it can manifest in people in different ways.

It is a feeling of exhaustion that is unrelated and more intense than would be suggested by your activity and lifestyle. It prohibits you from achieving the normal things that everyone takes for granted. This can range from something quite simple as replying to emails, to not being able to complete household tasks. Maybe even being able to walk and talk at the same time or being shattered after taking a shower. It is not something that cannot be remedied by a good night’s sleep. Whilst it can be triggered by an activity (eg taking a shower) it doesn’t always appear at the time. It may strike later on in the day which can sometimes make it difficult to identify what the cause was.

Fatigue can be

Physical – occurring after physical effort
Psychological – seen in states of depression, shock, trauma and anxiety
Mental – occurring after mental activity

Symptoms of fatigue

Chronic tiredness or sleepiness
Headache
Whole-body exhaustion
Dizziness
Brain fog
Difficulty concentrating
Aching muscles and muscle weakness
Slowed reflexes and responses
Impaired decision-making and judgement
Moodiness, such as irritability

The list above is not an exhaustive (excuse the pun) list of symptoms, you may experience many others …..

What it is not!

It is not easy for people to understand how it affects you. It’s a hidden disease that is hard for people to appreciate how debilitating it can be if they haven’t experienced it themselves. I liken the feeling to be like a really bad case of jet lag but even then, I don’t think that would work as an example for everybody.

It is not

Laziness.
Your imagination.
Just being overtired.
Fixed by a good night’s sleep.
Sorted by flopping on the sofa and having a nap.
Nor is it fixed by chilling out and having a Netflix binge session

It is much much more, it is mind, body and soul and it needs a holistic approach, kindness to oneself and patience.

Why might fatigue occur?

There are many varied and different reasons why you may experience fatigue and for today I am relating this specifically to heart health and the impact on our wellbeing.

Understanding why you are experiencing fatigue will not solve anything but it will help you relax and accept that it is “a thing”. That you can move through it with the support of others and by taking good self-care measures both physically, practically and psychologically.

A 2008 Swedish study out of the University of Gothenburg, for example, found that about half of all patients who survive a myocardial infarction (heart attack) are still experiencing “onerous fatigue” four months after the infarction.

Dr. Pia Alsén, author of this study, observed: “Many people experienced the fatigue as new and different, not related to physical effort or a lack of rest; it occurred unpredictably and could not be attributed to any definite cause.”

She believes the reason for post-heart attack fatigue might also lie in the damage to the heart muscle caused by the heart attack itself. When heart muscle is damaged from being deprived of oxygenated blood flow during a heart attack, scar tissue is formed on the damaged heart muscle, decreasing the pumping efficiency in the affected area. The resulting reduction of blood flow can produce fatigue, depending on the size and location of the scar tissue.

My thoughts

I think that this also applies after open-heart surgery, cardiac arrest as well as a heart attack. With heart failure and with abnormal heart rhythms the heart and other organs are impacted and have to work harder. This is exhausting physically, emotionally and mentally. The trauma, the healing and the experience use much of your energy reserves.

If you’ve experienced a cardiac arrest this may have resulted in an interruption of oxygen supply to the brain. The brain also requires energy to heal and repair itself so may have difficulty sustaining energy over time.

Dr Marcus Raichle, a professor of medicine at Washington University School of Medicine has found that while the brain represents just 2% of your total body weight, it accounts for around 20% of your body’s energy use. That means during a typical day, you use about 320 calories just to think.

So, add to this the fact is that your body has a massive job to do to heal itself quickly and efficiently no wonder you don’t have the reserves you had previously.

Worth bearing in mind

Symptoms of crushing fatigue can be caused by other medical conditions, treatments, medications, viruses, anaemia, disturbance of sleep, or a disruption to the regulation of hormones like diabetes. If combined with cardiac recovery the chances, are that you’ll be experiencing a double whammy.

Perhaps it is caused by the medication that you take. Some medications that you are taking for heart disease can also cause fatigue. These include beta-blockers and statin drugs. If you also have a sleep disorder like sleep apnoea (a condition linked to heart disease), you can feel extreme fatigue during the day.

Weakness, fatigue, and shortness of breath are to be expected in virtually all those recovering from a heart attack. Especially in the early days after discharge from the hospital patients should be made aware that they may find just getting out of bed, taking a shower, and dressing can feel utterly exhausting, especially in the early days and weeks. I know, I found I couldn’t even get up my stairs, I had to make a stop halfway, rest and then continue. I was going up on my hands and knees though, due to having my leg in a plaster cast.

What can be done, how can you help yourself?

Fatigues and laying on the sofa

There is no cure for fatigue it’s about allowing the mind and body time to heal themselves and, in some instances, living with it. Find ways to manage the energy you have that allows you to live your life your way. Because many different factors contribute to the fatigue experienced it means that there is not only one suggestion that will work for everyone.

To help you I have these 4 recommendations:

Check in with your medical team

Make an appointment with your doctor if lifestyle changes and better sleep habits aren’t helping you. You should also talk to your doctor if your tiredness is accompanied by any of the symptoms I have mentioned today or if you have other concerns about your health.

Your doctor can perform tests depending on what they think might be causing your exhaustion. For instance, a blood test can help identify if hormone depletion is the cause. They can also check for deficiencies such as iron, vitamin D or vitamin B-12.

You can also have a discussion about any side effects of medicines you take and perhaps there is alternatives or the best time of day to take them to avoid fatigue.

Keep a record of your sleep

It may be helpful for you to keep a sleep diary to give your doctor a full picture of your nighttime habits. Include when you fall asleep and wake up, how often you wake at night etc., to help you with this you can download my FREE Sleep Easy Journal and there will be a few episodes in the future to help you get a good night’s sleep. You can also jump on the waitlist for my 6-week Sleep Easy After A Cardiac Event Workshop.

Non-Sleep Deep Rest (NSDR)

This is a new term coined by my new hero Andrew Huberman (Huberman Labs podcast). It encompasses techniques that have been around for the longest time.

NSDR is a state whereby your body enters a deeply relaxed state. It is not sleep but you get the benefits of effectively taking a nap, without taking a nap.

  • Yoga Nidra

This is simply Yoga Sleep. It involves following a guided meditation (called a script) to enter a self-directed state of calm. You can find these on YouTube.

  • Guided Relaxation.

A progressive physical relaxation that allows your mind to focus just on the speaker’s voice and on a journey of peace and calm. Listen out for next week’s podcast episode when I will be talking about relaxamations and releasing some guided relaxations to help you calm, regenerate and feel good.

  • Simple Laying Meditation

For details, you can read more in my article You Can Feel Fine After A Heart Attack. You can follow the instructions there but the difference is that you find somewhere where you can lay down on your back with your feet slightly elevated.

Be kind to yourself

Do not feel guilty. This is a condition you are experiencing, it’s just invisible as no doubt is the cause of it. If you had a broken leg that is visible, you wouldn’t feel guilty when asking someone to help you. Understand and accept that fatigue is a thing. Fighting it just uses more of your energy when really you want to conserve it. And most importantly listen to your body, your mind and your intuition (gut). When the body says “No more” – stop and rest up.

What thoughts could get in the way of you taking action?

I have seen my doctor before and it’s just tiredness.

Don’t be put off, see them again. Persistence does pay off and if not see a different doctor. Be your own advocate and show your sleep diary, ask for blood tests and to discuss your medication.

I think people don’t believe there is anything wrong with me.

That is their issue and not yours. You know how you feel, who cares what others think. If people are unsupportive or unhelpful, it might be worth considering if they should hold any importance in your life.

So as I sign off now, remember the beat goes on one moment at a time. Go be magnificent!

Resources I have mentioned
Download my zero cost Sleep Easy Journal which will help you have conversations with your medical team and identify or rule out any sleep issues.
Jump on the waitlist for my 6 weeks to Sleep Easy after a Cardiac Event workshop.
Learn a Simple Way to Meditate to gain the benefits of Non-Sleep Deep Rest.
Join me and others on Facebook in the My Heart & Mind Community.

021 Fatigue, the What, the Why and the How-To Work It Out
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