Fatigue

A state of mental or physical exhaustion which reduces a person’s ability to perform work safely and effectively. Fibromyalgia (FM) syndrome is characterised by chronic widespread pain1 with similarities to neuropathic pain in clinical findings, pathophysiology and neuropharmacology. Chronic widespread pain, the cardinal symptom of fibromyalgia (FM), is common in the general population, with comparable prevalence rates of 7.3% to 12.9% across different countries. It usually presents with symptoms like fatigue, sleep disorders, morning stiffness, headache, paraesthesia, hyperalgesia and allodynia. Fibromyalgia is often comorbid with psychiatric disorders,3 such as depression, anxiety and irritable bowel syndrome (IBS),4 that worsens the quality of life (QOL) of the affected.1

Prevalence

In world

A total of 39 articles from 13 other countries and 4 articles from Korea met the criteria of this study. The prevalence of chronic fatigue and chronic fatigue syndrome was about 10% and 1% respectively. The prevalence for Korean was 17.7% and 1.4% respectively1

FM prevalence of 7.3-12.9% has been reported from different Western countries, including the United Kingdom, the United States, Canada, Israel and Sweden2

In 2010, a survey in five European countries, France, Germany, Italy, Portugal and Spain estimated overall FM prevalence in the general population to be 4.7%2

In Pakistan

The cross-sectional study was conducted at the Department of Internal Medicine, Indus Hospital, Karachi, between December 2016 and March 2018, and comprised patients of either gender presenting with complaints of chronic fatigue and or generalised body pain for at least six weeks. They were assessed for fibromyalgia according to the 2010 Fibromyalgia Diagnostic criteria questionnaire. Of the 267 patients, 197(73.8%) were females and 70(26.2%) were males. Fibromyalgia was detected in 149(55.80%) patients.

  1. Son CG. Review of the prevalence of chronic fatigue worldwide. The Journal of Korean Medicine. 2012;33(2):25-33.
  2. Javed S, Zaid M, Imran S, Hai A, Patel MJ. Increased frequency of fibromyalgia among patients with chronic pain presenting to internal medicine clinics of a tertiary care hospital: A cross sectional study. Journal of the Pakistan Medical Association. 2021;71(12).

Symptoms

Fatigue can cause a vast range of other physical, mental and emotional symptoms including:

  • chronic tiredness or sleepiness
  • headache
  • dizziness
  • sore or aching muscles
  • muscle weakness
  • slowed reflexes and responses
  • impaired decision-making and judgement
  • moodiness, such as irritability
  • impaired hand-to-eye coordination
  • appetite loss
  • reduced immune system function
  • blurry vision
  • short-term memory problems
  • poor concentration
  • hallucinations
  • reduced ability to pay attention to the situation at hand
  • low motivation.

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/fatigue

Causes

Potential triggers include:

  • Viral infections.Because some people develop chronic fatigue syndrome after having a viral infection, researchers question whether some viruses might trigger the disorder. Suspicious viruses include the Epstein-Barr virus, human herpes virus 6. No conclusive link has yet been found.
  • Immune system problems.The immune systems of people who have chronic fatigue syndrome appear to be impaired slightly, but it’s unclear if this impairment is enough to actually cause the disorder.
  • Hormonal imbalances.People who have chronic fatigue syndrome also sometimes experience abnormal blood levels of hormones produced in the hypothalamus, pituitary glands or adrenal glands. But the significance of these abnormalities is still unknown.
  • Physical or emotional trauma.Some people report that they experienced an injury, surgery or significant emotional stress shortly before their symptoms began.

Factors that may increase your risk of chronic fatigue syndrome include:

Age. Chronic fatigue syndrome can occur at any age, but it most commonly affects young to middle-aged adults(between the ages of 40 and 60.)

Sex. Women are diagnosed with chronic fatigue syndrome much more often than men, but it may be that women are simply more likely to report their symptoms to a doctor.

Stress – Finding it difficult to manage stress and having added stress in your work or family life may contribute to the development of CFS.

The wide range of causes that can trigger fatigue include:

  • Medical causes – unrelenting exhaustion may be a sign of an underlying illness, such as a thyroid disorder, heart disease or diabetes.
  • Lifestyle-related causes – alcohol or drugs or lack of regular exercise can lead to feelings of fatigue.
  • Workplace-related causes – workplace stress can lead to feelings of fatigue
  • Emotional concerns and stress – fatigue is a common symptom of mental health problems, such as depression and grief, and may be accompanied by other signs and symptoms, including irritability and lack of motivation.

Common lifestyle factors that can cause fatigue include:

  • Lack of sleep – typically adults need about eight hours of sleep each night. Some people try to get by on fewer hours of sleep.
  • Too much sleep – adults sleeping more than 11 hours per night can lead to excessive daytime sleepiness.
  • Alcohol and drugs – alcohol is a depressant drug that slows the nervous system and disturbs normal sleep patterns. Other drugs, such as cigarettes and caffeine, stimulate the nervous system and can cause insomnia.
  • Sleep disturbances – disturbed sleep may occur for a number of reasons, for example, noisy neighbours, young children who wake in the night, a snoring partner, or an uncomfortable sleeping environment such as a stuffy bedroom.
  • Lack of regular exercise and sedentary behaviour – physical activity is known to improve fitness, health and wellbeing, reduce stress, and boost energy levels. It also helps you sleep.
  • Poor diet – low kilojoule diets, low carbohydrate diets or high energy foods that are nutritionally poor don’t provide the body with enough fuel or nutrients to function at its best. Quick fix foods, such as chocolate bars or caffeinated drinks, only offer a temporary energy boost that quickly wears off and worsens fatigue.
  • Individual factors – personal illness or injury, illnesses or injuries in the family, too many commitments (for example, working two jobs) or financial problems can cause fatigue.

Common workplace issues that can cause fatigue include:

  • Shift work – the human body is designed to sleep during the night. This pattern is set by a small part of the brain known as the circadian clock. A shift worker confuses their circadian clock by working when their body is programmed to be asleep.
  • Poor workplace practices – can add to a person’s level of fatigue. These may include long work hours, hard physical labour, irregular working hours (such as rotating shifts), a stressful work environment (such as excessive noise or temperature extremes), boredom, working alone with little or no interaction with others, or fixed concentration on a repetitive task.
  • Workplace stress – can be caused by a wide range of factors including job dissatisfaction, heavy workload, conflicts with bosses or colleagues, bullying, constant change, or threats to job security.
  • Burnout – can be described as striving too hard in one area of life while neglecting everything else. ‘Workaholics’, for example, put all their energies into their career, which puts their family life, social life and personal interests out of balance.
  • Unemployment – financial pressures, feelings of failure or guilt, and the emotional exhaustion of prolonged job hunting can lead to stress, anxiety, depression and fatigue.
  • Physically or mentally taxing work
  • Boring or repetitive tasks
  • Sustained tasks
  • Stress (from any cause)
  • Shift work (particularly night shifts)
  • Compressed or long workdays (and workweeks)
  • Poor lighting
  • Extreme temperatures
  • Constant noise
  • Vibration

Health factors in fatigue and poor sleep

On top of those workplace factors may be health concerns that can also contribute to poor sleep and fatigue:

  • Sleep disorders such as insomnia or sleep apnea, which affect as nearly a third of Canadian adults
  • Vitamin deficiency
  • Chronic fatigue syndrome, thyroid, or heart problems
  • Diabetes and cancer
  • Depression

Studies suggest that psychological factors are present in at least 50 per cent of fatigue cases. These may include:

  • Depression – this illness is characterised by severe and prolonged feelings of sadness, dejection and hopelessness. People who are depressed commonly experience chronic fatigue.
  • Anxiety and stress – a person who is chronically anxious or stressed keeps their body in overdrive. The constant flooding of adrenaline exhausts the body, and fatigue sets in.
  • Grief – losing a loved one causes a wide range of emotions including shock, guilt, depression, despair and loneliness.

Complications

Chronic fatigue syndrome. Fatigue(Problems with memory or concentration,Sore throat,Headaches,Enlarged lymph nodes in your neck or armpits,Unexplained muscle or joint pain,Dizziness that worsens with moving from lying down or sitting to standing,Unrefreshing sleep,Extreme exhaustion after physical or mental exercise

  • absent-mindedness,
  • accidents,
  • chronic tiredness or sleepiness.
  • decreased awareness,
  • Depression
  • distraction during complex tasks,
  • dizziness.
  • errors
  • headache.
  • ill-health and injury
  • impaired decision-making and judgement.
  • Increased work absences
  • lack of attention,
  • Lifestyle restrictions
  • loss of awareness in critical situations.”
  • memory lapses,
  • moodiness, such as irritability.
  • muscle weakness.
  • poor judgment,
  • reduced ability to process information,
  • reduced coordination.
  • reduced decision-making ability,
  • reduced productivity.
  • reduced vigilance,
  • slowed reaction time,
  • slowed reflexes and responses.
  • Social isolation
  • sore or aching muscles.
  • underestimation of risk
  • Depression
  • Disrupted sleep

Prevention

consider these tips for managing risk of workplace fatigue:

  • Balance workload and schedule enough staff
  • Consider temperature, light, and ergonomics in the design of your workplace
  • Rotate jobs or try other strategies to relieve boredom
  • Give your staff tools to recognize fatigue risks and to develop healthy sleep habits
  • Monitor employee fatigue as a form of impairment
  • Promote mental health supports such as an Employee Assistance Program and online resources such as Workplace Strategies for Mental Health
  • Promote physical activity and exercise; consider a stretching program or break-time walking program
  • Consider workers’ sleep needs and recognize the risk in shift scheduling:
  • Where possible, schedule employees to work day shifts
  • Restrict consecutive day shifts to five or six days and night shifts to four days
  • Give workers at least two consecutive days off
  • Make schedules consistent, and provide frequent breaks