MINDBODY TOOLKIT
Fatigue, Sleep and Therapeutic Rest
Understanding Fatigue
Chronic fatigue is a very debilitating symptom in itself and doubly so when associated with chronic pain or other health conditions.
It is incredibly hard to make someone who hasn’t experienced it understand and because there are no outward signs of fatigue people often don’t believe you.
We get it. We understand that every day it feels like you are wading neck deep in treacle just trying to achieve the simplest of tasks. Actress Miranda Hart described it feeling like climbing Mount Everest every time you climb the stairs to the loo. There is a wonderful article for explaining fatigue to those around you – The Spoon Theory.
Fatigue is a very frustrating symptom but there are a combination of things that you can do to help ease it. It won’t be an overnight fix as it takes 90 days for stress hormone adjustments to be maintained by the hypothalamic pituitary adrenal axis. These are the parts of the brain and the glands responsible for controlling and producing our stress hormones. When we have been under stress for a long time and stuck in survival mode this system gets exhausted and either stops producing the correct amount of cortisol or stops responding to the amount produced. It is important that bodies have cortisol levels higher in the morning as this is what helps wake us up and gets us going. Often with chronic or adrenal fatigue this is not happening meaning mornings are hard. There is nothing like feeling tired before you have got out of bed. The other factor regarding cortisol is that it can sometimes be too high at night instead. This can contribute to insomnia; the cruel cousin of fatigue.
With what we know about the relationship between chronic pain and illness and its relationship to stress, none of this is surprising and we can use many of the same techniques to help reduce the fatigue that we do to help reduce the pain.
So what tools help? We would look at what you as an individual require and your needs will depend on where you are in your recovery journey but whatever you find that starts to balance out your stress response is a good place to start.
Identifying Your Stressors
Addressing what is causing your current, ongoing and previous or chronic stress is important. You may have tried many things to help your fatigue but have you ever asked yourself – what am I missing? What do I need? What am I frightened of? What will I have to do if I get more energy? What made me tired? What can I do to feel nourished (emotionally)? Why don’t I feel safe? What was happening when it started? It is worth journaling the answers to any of these questions if they feel relevant and any others that come into your head. Often this helps to identify the key stressors that are implicated in your fatigue or pain. If anything comes up from these answers we recommend speaking to one of our SIRPA trained osteopaths who can help guide you with reframing these thoughts.
Pacing
This is important when you have fatigue. Many people who suffer with fatigue are achievers who just keep pushing on. But once fatigue kicks in we advise pacing yourself to initially about 25% to 50% of what you think, or want, to achieve. This is hard but in order to recover you will need to initially cut right back as much as possible to be able to build your reserves. We recommend therapeutic rest whenever you feel tired or overwhelmed. Therapeutic rest is also excellent for the digestive tract and if done after meals can help give your body time to absorb all the nutrients in your food.
Diet
Keeping your body sustained with the food it needs is essential and challenging because the sheer energy of trying to prepare healthy and nutritious meals can be tiring. On our Diet & Chronic Pain page we lay out some simple tips for making this easier and recommend some food choices that will help to sustain and stabilise your energy.
Meditation
As well as helping you rest and relax meditation can help you reboot your nervous system and teach your body to come out of the stress response associated with fatigue.
There are some really effective short, 15 minute, meditations on our Meditation page that you can do while resting.
Osteopathy for Chronic Fatigue
Our osteopaths can use gentle osteopathic techniques to help your body relax and settle which helps to balance the stress response. In conjunction with the other tools this can help to reduce fatigue. From a classical osteopathic philosophy point of view, reducing tension and balancing your body can also mean it requires less energy to maintain upright.
UK Osteopath, Dr Raymond Perrin, has published a system of osteopathic treatment and lymphatic drainage to decrease the symptoms of chronic fatigue. None of our osteopaths are trained specifically as Perrin practitioners but we are aware of the research and can apply cranial osteopathic techniques and lymphatic drainage to help stimulate your body’s drainage system.
Sleep
Good sleep is the foundation of good health and often in fibromyalgia and other persistent or chronic pain conditions it can be really poor.
Poor sleep adds insult to the already fatigued body and can increase levels of inflammation.
Pain, discomfort, anxiety or night panic, restless legs, brain ‘whizz’, light or noise sensitivity and your body’s inability to relax due to the overwhelm will affect sleep.
You have probably tried many things to help your sleep but these are some strategies we recommend.
- A bedtime routine may help. So even if you are not sleepy going through the same bedtime routine each night will help prepare your body and brain for sleep.
- Off loading your thoughts before you go to bed is a really useful exercise. You may want to do this an hour or so before you go to bed so that the thoughts are not rushing through your head at bed time. This ‘brain dumping’ type of journaling can just be a list of what you need to do tomorrow, what things you were really grateful for today, or just all the random thoughts that are going around your head at the time. Just clear your head to prepare it for sleep.
- With the brain/fibro fog that often affects the thinking capacity of people with persistent pain, worrying about the tasks you need to do the next day can take up more brain power so keeping a notebook and pen a nearby is always handy.
- If you wake up and have thoughts rushing just jot them down rather than spend hours with them keeping you awake.
- Preparing your room for sleep can help. Our bodies find it much easier to fall asleep if the room is slightly cooler between 16-18°C (60-65 °F).
- Light may be a problem for you and even the tiniest LED light may cause disturbance so turning them off completely or putting tape over any small electrical lights is recommended as well as effective black out at the window.
- Sometimes curtains with black out still let in a lot of light so a piece of blackout fabric pinned to the window frame or suction blackout blinds that attach to the glass are more effective.
Just remember that your body and brain are feeling overwhelmed so anything that will reduce the stimulation will help.
- Noise can also be very disturbing so you may benefit from ear plugs but if you have tried these and find them uncomfortable then the distraction of ‘white noise’ may help. There are numerous free apps with different types of white noise. An easy one to use is White Noise generator by Relaxio. You can choose from a variety of sounds from rain to a fan and alter the volume to set it to play for as long as you require (up to 8 hours).
At this point it might be a good time to mention electronic devices such as tablets and phones. Whilst it is best to not use them at bedtime or during the night they can have some really helpful technology on them to assist your ability to get to sleep so just a couple of factors to consider.
- Installing an app that reduces the blue light emitted from your device will help it be less stimulating.
- Reducing the screen brightness right down also creates less visual stimulation.
- You can enable the ‘Do Not Disturb’ mode. This means you can set your phone to not make any notification noises between the hours you select, except from people you chose for instance your parents or children. You can then rest easy.
- It may be best to not use your device as your clock. It certainly is convenient, but there is a temptation to just check your messages if you wake up and want to know the time.
- It is recommended to avoid all social media before bed and during the night, even if you have been awake for ages as it can be very triggering.
Where devices are useful is for bed time stories…yes bed time stories!
- On YouTube (free) and via apps such as CALM (some free, some paid) there are bed time stories for adults. You can fall asleep whilst someone reads to you. You may never hear the end of the story but that is perfect. You do need to search through for a voice that feels calming to you. One of our favourites is Blue Gold read by Stephen Fry.
When going off to sleep is troublesome or going back to sleep is difficult there are some really good sleep meditations specially designed to calm your body and nervous system and help you go into a deep sleep. There are some links included here which are effective but find something that suits you.
The EnTrance sleep meditations are good and allow you just to drift off when they finish.
Flat headphones, in a headband, are also useful so that you can lie on your side and not irritate your ears.
Other things you can do to prepare yourself for sleep include breathing techniques, a very gentle and simple Tai Chi or Qigong routine or an EFT tapping routine.
Therapeutic Rest
Therapeutic rest is a simple tool to help your body all round. It is a simple and effective way to help pain, fatigue and even digestion. It also gives us time for self care and to reset our systems.
Therapeutic rest is just as it sounds – resting therapeutically. All you need is a quiet place where you can rest undisturbed for 15 minutes upwards.
Equipment required:
- A yoga mat for on the floor*
- A pillow for under your head
- Several pillows or cushions for under your knees
- A blanket
*If you find it too hard to get up and down to the floor then you can rest on your bed. Ideally you want a supportive and not too soft surface to lie on.
The aim is to get yourself as comfortable as possible by supporting your head and neck with a pillow and put pillows under your knees so you can rest your legs in a semi bent position. You can cover yourself with a blanket if you wish.
This position allows your spine muscles to relax and be supported by the floor. It may be uncomfortable when you first lie down but after a few minutes the spine muscle should start to soften. To help them you might want to try one of the breathing techniques from the toolkit. one of the most effective is the relaxation breathing technique.
It also allows a quieting of the nervous system especially if you combine your therapeutic rest with a short meditation.
It is also helpful to do it just after you have eaten so your whole body can focus on digestion rather than trying to do that as well as keep you upright and this can increase the nutrients that your body takes up.
This simple technique can be done for 15 minutes or up to 45 minutes. It is hugely beneficial if you start to feel an increase in your pain levels or an increase in the sense of overwhelm or fatigue. Think of it as your reset button.
Start your journey towards better health.
Call us on 01825 840582 or email hello@osteopathyforall.co.uk.