Managing Fatigue in College - Trinity College Dublin, the ... · ‘Balancing the Books: Managing...

Balancing the Books:

Managing Fatigue in CollegeStaff and Students

Authors: Dr. Clodagh Nolan, Orla Sullivan, Claire Gleeson and Kieran Lewis

Balancing the Books: Managing Fatigue in College Staff and Students

ContentsIntroduction 1

Section 1: Understanding fatigue and how it applies to you 2

Fatigued or Just Tired 3

What is Tiredness? 3

What is Fatigue? 3

Do I experience fatigue? 4

What causes fatigue? 4

Mental Fatigue 6

Staff Fatigue 7

Student Fatigue 7

Fatigue and Stress 8

Section 2: Thinking Activity: Exploring your routine, energy level and fatigue 12

Understanding your energy levels 18

How to Estimate your energy level 18

Section 3: Pacing yourself and Maximising your energy 20

Prioritising 21

Planning and Managing Time 23

Knowing your limits: Set achievable goals 23

Simplify activities 24

Anticipateandplanfordifficulties 25

Click a section title to go to that section.

Section 1 Understanding fatigue and how it applies to you

Havedown-timetorelaxandrest 25

Multi-task 25

Setting up the right environment 26

Strategies for productive work 27

Strategies for managing fatigue during exams 27

Nourishing occupations 28

Relaxation 29

Sleep and Rest 30

Nutrition 32

Exercise 34

Conclusion 34

References 35

Notes

Poster

Foreword:

I wish to congratulate the Unilink Service in the development of their book entitled: ‘Balancing the Books: Managing Fatigue in College - Staff and Students’. College life for both staff and students can be fast paced, demanding and stressful, which in turn can lead to individuals experiencing extreme fatigue. This resource will assist those dealing with fatigue issues in a very practical and easy to use way.

This book is the result of research conducted in conjunction with the Discipline of Occupational Therapy, School of Medicine, which highlighted a discrepancy in fatigue levels between students with disabilities and the general student population. Those with disabilities were found to be experiencing greater levels of fatigue. It is therefore timely that a practical resource such as this book be available to raise awareness and understanding about fatigue and to support both students and staff in managing their own fatigue and their activities of daily living.

Trinity College, Dublin is committed to supporting the needs of both its staff and students and this book is an excellent example to assist us all in managing fatigue and to help us be successful in our occupational roles.

Declan TreanorDirector College Disability Service

Trinity College Dublin

1Balancing the Books: Managing Fatigue in College Staff and Students

IntroductionWelcome to “Balancing the Books”- an interactive fatigue booklet for Trinity College students and staff. The book hopes to raise awareness and understanding about fatigue and to support you in managing your fatigue. This resource has been developed by the Unilink Service, in collaboration with the Disability Service in Trinity College Dublin. Fatigue is one of the most common reasons why people consult health care providers and yet everyone experiences fatigue differently. Increased workloadortheperceptionofsuchhasbeensignificantlylinkedtohigherincidenceof fatigue amongst the working population (Grech, Neal, Yeo, Smith & Humphreys, 2009). Darcy, Roe, McKnight and Nolan (2013) found that students with disabilities such as physical or sensory disabilities, medical conditions or illnesses, and mental healthdifficultiesexperiencedhigherlevelsoffatiguecomparedtothegeneralstudent population.

The management of fatigue needs to be personalised, therefore this book allows you to develop strategies to suit your own needs. The format of this book is interactive and ‘Thinking Activities’ and exercises have been incorporated throughout the book to enable you to apply the information to your own life. We suggest some strategies and ideas that might be helpful, which will prompt you to problem-solve about what is going on and identify what might work for you. It might be best to choose one strategy at a time and build up experience of utilising these strategies over a few weeks.

This book is divided into three sections: Section 1 focuses upon understanding your fatigue, Section 2 focuses upon exploring your routine and your levels of fatigue and Section 3 focuses upon pacing yourself and maximising your energy so that you can achieve realistic goals for yourself and engage in the activities you want and need to do on a daily basis.

We hope that by the end of this book you have a personalised guide to managing yourfatigueandthatitenablesyoutomakedecisionsthatbenefityourhealthandwell-being.

Section 1

Understanding fatigue and how it applies to you


Fatigue can be most effectively managed when a person recognises and understands the effect fatigue has on their life. Knowledge is power and therefore this section aims to support your understanding of fatigue and how it manifests itself with you.

Fatigued or Just Tired?

Fatigue and tiredness share the same characteristic of low energy.

What is Tiredness?

Tiredness, however, is the body’s way of letting you know that you need rest, sleep or relaxation following a period of activity and exertion from which the body usually recovers. Fatigue, on the other hand, can occur with no obvious connection to physical activity and can establish itself steadily over time. Unlike tiredness, fatigue may not respond to sleep and rest (Khambatta & Jevon, 2011).

What is fatigue?

Therearemanydifferentdefinitionsoffatigue,howeverforthepurposeofthisbookfatigueisdefinedas:‘anoverwhelmingsenseofexhaustionanddecreasedenergy for physical and mental activity, despite an adequate amount of sleep’ (AdaptedfromtheNursingDiagnosis-DefinitionsandClassifications,2011).

Fatigue is associated with stress- related situations, chronic (long-term) conditions and recovery from illness, injury, and trauma. The phenomenon of fatigue is subjectively experienced and therefore it is hard to measure and understand. As a result, fatigue is often misunderstood and misinterpreted by people. Types of fatigue can vary from person to person. Fatigue can be physical, cognitive (mental), or emotional, or often a combination of these. Remember everyone will experience fatigue to differing levels, as everyone’s experience of fatigue is unique and personal to them.

Tiredness

Body’s way of letting you know that you need rest, sleep or relaxation

following a period of activity and exertion

Responds well to sleep and rest

Fatigue

Exhaustion and decreased energy for physical and mental activity, despite an

adequate amount of sleep

May not respond well to sleep and

rest


Do I experience fatigue?

Fatigue can be a major symptom in health conditions such as chronic fatigue syndrome(CFS)orMyalgicEncephalomyelitis(ME),fibromyalgia,andneurologicalconditions such as multiple sclerosis and arthritis. Fatigue can also be experienced bypeoplewithmentalhealthdifficultiessuchasdepressionoranxiety.Likewise,mentalhealthdifficultiescanimpactonapersongettingapropernight’ssleepwhich further impacts on fatigue levels. Fatigue can also be experienced by major transitions in life such as bereavement and grief. It has been suggested that the prevalence of fatigue is increasing in the developed world as a result of modern lifestyle behaviours (Khambatta & Jevon, 2011).

What causes fatigue?

The causes of fatigue are still not wholly understood. However, most cases of fatigue may be attributed to three main areas: lifestyle factors, medical conditions, or psychological problems.

Fatiguecanbecausedorintensifiedbypoorlifestylefactorssuchaspoornutrition,sleep, alcohol and caffeine use, and lack of sleep. Others suggest that fatigue emerges as a result of a Western lifestyle (Dawson, Noy, Harma, Akerstedt, & Belenky, 2011) where people have too much to do and not enough time to do it- they suggest this level of over-activity can trigger fatigue. Fatigue can also happen if you have been doing too little.

In some cases, fatigue is caused by the body’s response to the demands of a physical illness, such as a physical disability or medical condition. For example, in multiple sclerosis, weakness or stiffness in the arms/legs this can mean that activities can require more energy to complete so energy runs out quicker. Illnesses such as chronic fatigue syndrome can emerge after a viral infection in the body. It is important to remember that living with a disease or medical condition can be inherently stressful, and stress in turn can contribute to fatigue.

Furthermore,fatiguecanbeacommonsymptomofmentalhealthdifficultiesorpsychologicaldifficulties,suchasanxiety,depression,post-traumaticstressdisorderand bi-polar disorder.

As you can clearly see, there are many causes of fatigue, and a person’s fatigue maynotbecausedbeasinglefactor,andmaybeintensifiedbyothers.Thecombination and variance of contributing factors means that fatigue levels can vary from day to day and within the day.


Thinking Activity

What does fatigue mean to you?

Would you describe your fatigue as being?

cognitive,

physical

emotional

or is it a combination of these?

In your opinion is your fatigue caused by?

Please tick the boxes that apply to you below:

Lifestyle factors

Such as:_________________________________________________________________

Medical Condition

Such as:_________________________________________________________________

PsychologicalDifficulties

Such as: _________________________________________________________________

From the list below, can you identify what may have contributed to your fatigue?

Please tick the boxes below that apply to you:

Poor sleep

Bad weather

Heat

Too much to do

Poor nutrition

Worry

Feeling not good enough

College work

Rushing

Stress


How do you feel when you experience fatigue?

Please tick the emotions below that you experience when fatigued:

Frustration

Annoyance

Sadness

Feeling Fed up

Worried

Stressed

Angry

Other __________________________________________________________________

Mental Fatigue

Mentalfatiguecanincludesuchthingsasdifficultyinconcentration,memory,and attention and a general feeling of sluggishness. Often people experience disorganisation, disjointed thinking and can be easily distracted and forgetful. Peoplemayalsoexperiencedifficultyindecisionmaking,problem-solvingandcreativethinking.Somemayhavedifficultyinfollowingthroughoninstructionsandfail to give close attention to detail resulting in mistakes in work.

Thinking Activity

Can you identify from this list how your mind reacts to fatigue?

Please tick the boxes below that apply to you :

Poor concentration

Difficultyrememberinginformation

Difficulttogetdowntostudyortasks

Poor recall

Indecisiveness

Agitated

Poor endurance and mental stamina

Difficultyproblem-solving


Disorganised/dis-jointed thinking

Other:

Staff Fatigue

<If you are a student please skip to the section on Student Fatigue.>

As a staff member, travelling to work, family and personal commitments and the increased intensity of work environments, can lead to fatigue. Fatigue is a common, almost universal feature of modern life (Dawson, Noy, Harma, Akerstedt, & Belenky, 2011).

Fatigue affects psychomotor and cognitive functions as well as mood and motivation and it has been linked to decreased vigilance (ability to detect and respond to unpredictable events), reaction times, memory, decision-making, information processing, and psychomotor co-ordination. Fatigue at work can impact on your level of productivity, making the list of things to do the next day even longer. Fatigue can also lead to clumsiness and a greater risk of injury or accidents.

One thing people may do when they are not at work is that they may “ruminate” (think about work-related issues and events). You may be thinking about tasks left uncompleted, about a problem that needs to be solved, about relationships with colleagues, or negative events at work. These types of worries can make you feel fatigued by interfering with sleep (Querstret & Cropley, 2012).

Student Fatigue

College can be an exciting time for you as a student; getting to meet lots of new people, embarking on new learning and getting to try out loads of new activities. However, college can also be a stressful place, with having to do assignments, meet deadlines and juggle college life with social events, work or household tasks. College opens up a world of freedom, not previously experienced by young adults, and with this it can pose some challenges in trying to manage and juggle all these tasks and responsibilities. One of the life-style habits that essentially may change the most is altered sleeping patterns and sleep routine, which may impact on your fatigue.

Emotionalexhaustionandlackofachievementhavebeenfoundtosignificantlycontribute to burnout in the student population (Neuman, Neuman & Reichel, 1990). Often students struggle with emotional fatigue, exacerbated by avoidance-behaviours such as procrastination, and negative perfectionism. Perfectionism is something that most people can relate to and for the most part can help us to reach our potential. Negative perfectionism refers to when it gets you stuck, and when it makes you anxious or highly stressed. It can also lead to the belief that if you don’t complete something ‘perfectly’, others will have a lower perception of


you. Often students place high expectations on themselves and allow no room for failure or mistakes. Sometimes people refuse to acknowledge their need to slow their pace or accept outside help. Some students get caught up in this cycle of events.

In a Trinity study conducted by Darcy, Roe, McKnight and Nolan (2013), it was foundthatsignificantdifferencesexistedbetweenstudentswithdisabilitiesandthe general student population on levels of fatigue. Students with a disability were more likely to experience more clumsiness and coordination problems, more difficultyinpacingthemselvesandstruggledtomaintaintheeffortrequiredwhenparticipating in more physically demanding activities. They also experienced a higher degree of physical discomfort and needed to rest more often and for longer periods of time compared to the general student population. Students withadisabilitywerealsofoundtobelessalert,haddifficultypayingattentionforlongerperiodsoftime,wereunabletothinkclearly,haddifficultymakingdecisions,werelessmotivatedtodoanythingthatrequiredthinking,haddifficultyorganising thoughts when doing things in college or at home, and found their thinking was slowed down compared to their peers.

Fatigue and stress

Thehormonesadrenalineandcortisolplayasignificantroleinincreasingenergylevelsinstressfuloremergencysituations,the‘fight-or-flightresponse’whichyou’veprobablyheardabout.Theusualexampleis a person crossing the path of an angry lion. In these emergency situations, thebrainandbodypreparesyouforaction(fightingorrunning!)inanumberofways; including increasing the availability of glucose (energy) and increasing blood supply to the big muscle groups.

Khambatta & Jevon (2011) explain during chronic stress, the body is physiologically put into this overdrive. When the stress reaction continues, there is a counter effect that leads to fatigue. Digestion in the body tends to work less well, and the immune system can be weakened which leads to infections. A compounding factor is our lifestyle, where we are busy running around the place, getting what we need to do, done. Therefore we have a tendency to increase our caffeine, tea and sugar intake. This can result in less energy.

Thinking Activity

How much tea, coffee, or sugar have you consumed in the last twenty four hours?

Can you identify what caused you to consume these things at those times? Did you need it?

Did you feel better afterwards?


Stress and worry is exhausting. Unresolved issues and incomplete jobs or projects can drain your energy. They can monopolise our thoughts and attention, distract us from the here and now and make us feel less productive. Experiencing low mood can lead to feeling lethargic and lacking in energy and in a similar way, fatigue can lead to low mood. It can be harder to problem-solve and plan ahead when you’re feeling low, and so fatigue can often worsen. Experiencing fatigue itself can be stressful and leave you feeling frustrated by not being able to get things done. It is important to identify the source of stress and try to rectify it, use the diagram below to enable you to identify your sources of stress.

Thinking Activity

Identify what is stressing you

In order to be able to deal with stress, it is important to try and identify where the stressiscomingfromandfindthebestapproachtomanageit.

What is the stressor or the problem?

Please tick the boxes below that apply to you:

Deadlines

Exams

Reading

Poor Diet

Family issues

Relationship problems

Missed tutorial

Too much work to do

Financial concerns

Other:

StressCan you...

1 ...Remove or reduce the

cause of the stress

2 ...Change attitude

3 ...Engage in occupations that nourish

you


Can you:

remove or reduce the stress

change your attitude

engage in occupations that nourish you

If you can’t change the stress: another option is to:

Change your attitude

Can you view it differently?

Or can you accept it or let it go?

A helpful way of examining and changing your thoughts and attitudes is the ABC method (White, 2005).

A B CAnticipated Event Beliefs/Thoughts Emotions/Behaviour

What is the event/reason that I’m stressed?

“I have three exams next week”

What do I think about it?

“I’m going to fail because I haven’t studied enough”

Have a look at your “self-talk” that is destructive – are you saying things to yourself that minimise your worth and are inaccurate statements of where you are?

How do I feel about it? How am I acting?

“I feel anxious and unsettled and I’m acting a bit erratic”

Challenge B and C.

What can be an alternative?

“It will be a challenge, but I am familiar with previous exam papers, I just need to continue on with what I’m doing”

“I understand why I’m stressed. I’ll do one more good hour and then I’ll take some time out this evening”

Thinking Activity


Positive thinking can help you cope with a problem by letting you see your strengths and resources, and maintaining perspective with your priorities. One of the key elements in managing fatigue is taking a positive approach and accepting that things may not go so well. Often things don’t work out as we anticipate them, andthatcanbefrustrating.Trytobeflexibleandpositivewhenthishappens.

For example:

“I am sooo tired, but I really need to do my clothes washing”.

This could be changed to:

“I am tired. So my priority is to take a short rest and I can do my clothes washing later”.

Trynottocompareyourselftoothers,appearancescanbedeceptive!

Section 2

Thinking Activity: Exploring your routine, energy level and fatigue


Now, that we have explored what fatigue is, it is important to focus upon your fatigue and how it relates to your daily activities and oc-cupations. Some activities that we do require a lot more energy than others, this exploration will enable you to reflect upon the level of energy you use in relation to your activities. What you do on a day to day basis and how important these activities are for you?

Do a self-check

As staff and students, we can get caught up in striving to be perfect, trying to do it all, and the result can often be that we get ourselves worked up, which is not conducive to getting what we want done. This can make us feel worried or worn out. Sometimes we need to take the time to step back from ourselves to examine our thoughts and behaviour.

Ask yourself questions like:

Does this really need to be done today?

Am I letting somebody down?

Why am I working late?

Am I being productive?

Do I need to change how I work or study?

What are my expectations? What are the expectations of others?

Do I need to talk to somebody and get some support?

Thinking Activity

Thinking Activity: Exploring your routine, energy level and fatigueSection 2

Instructions

This section aims to explore what you are doing over the course of a day and how much energy you are required to use and your fatigue levels. Please follow the instructionsbelowtofillinthechartoverthecourseofoneday,youmaywishtodothis for a week in order to get a better picture of your activities, your fatigue levels and your energy.

• Take note of the activities in your day by listing them in the chart on the next page against the time in which you did them.

• Rate the following on a scale of 1-10

• Level of Fatigue (LOF); where 1 is no fatigue and 10 is high levels of fatigue

• Importance of the activity (Imp.); where 1 is not important and 10 is very important

• How well you were able to engage in the activity (Eng); where 1 is not able to engage and 10 is very well able to engage

• Please add any other information that you feel is relevant under the comment section

• Possible reasons for fatigue such as mood, diet...

• Ways that you feel fatigued such as lack of energy, inability to concentrate, dizziness...

• Complete the review section.

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engage in the activity?

Comment

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Review of Your Daily Routine

List what activities were of most importance (Imp) in your day; activities that were identified from 6-10 in the chart?

It is important to engage in activities that have a high priority, please see the headings listed below that will help you to develop prioritisation skills and will aid you in engaging in these tasks.

Prioritisation & Planning

Delegation

Effective Study

List what activities you felt you were least able to engage in?

You may be able to develop skills by using this book to better be able to engage in tasks, please see section on:

Strategies for productive work

Simplifying tasks

List the activities that you ex-perience high levels of fatigue during (LOF) (activities that were identifiedasgreaterthan5)

You may be able to develop skills by using this book to maximise your energy levels and pace yourself, please see section 3.


Review of Your Daily Routine

List what activities were of most importance (Imp) in your day; activities that were identified from 6-10 in the chart?

It is important to engage in activities that have a high priority, please see the headings listed below that will help you to develop prioritisation skills and will aid you in engaging in these tasks.

Prioritisation & Planning

Delegation

Effective Study

List what activities you felt you were least able to engage in?

You may be able to develop skills by using this book to better be able to engage in tasks, please see section on:


Simplifying tasks

List the activities that you ex-perience high levels of fatigue during (LOF) (activities that were identifiedasgreaterthan5)

You may be able to develop skills by using this book to maximise your energy levels and pace yourself, please see section 3.

How well do you feel that you manage your fatigue on a scale of1-5?

1 2 3 4 5

Not well Very Well


Understanding your energy levels

Some people conceptualise energy as a battery, consider a smartphone bat-tery for example. When you completely drain the battery, you can do very little with the phone and it takes a long time to charge fully again. If you keep an eye on your phone battery, and keep it topped up fairly regularly, you run into fewer problems. Have you felt you’ve pushed yourself too hard and then paid the price? Remember that fatigue is different to tiredness. Whereas tiredness tends to respond to rest, often people who experience fatigue tend to take longer to recover after aperiodofover-activity,andsomepeoplemayexperiencea‘flare-up’oftheirsymptoms.

This idea is illustrated in the Overactivity-Underactivity Cycle

(NHS, 2006).

Doing too much

Increased Fatigue

Longer period of

rest

Decrease in productivity

Need to catch up

This cycle explains how people who experience fatigue can get caught in a cycle which exacerbates their symptoms. Doing too much in a day can completely drain your battery and lead to increased fatigue. This in turn means that a longer period of rest will be needed to recover, which causes a decrease in productivity. This drop in productivity can cause stress and a feeling of needing to work harder to catch up or compensate, and so they take on too much and the cycle repeats itself.

How to Estimate your energy level

If you experience fatigue, it is recommend that you estimate your level of energy for that day, and the energy required for the activities that you need to do. It is suggested that you stay within the limits of your estimated energy.


If you expend more energy than you estimate you have, you are likely to be over-doing it, and risk a ‘crash’. If you expend less energy than you estimate you have, maybe you are under-active and that is contributing to your feelings of fatigue? Ask yourself honestly: am I working myself too hard? Am I working myself hard enough? What is your body telling you?

It is important to have a balance between what you need and want to do, and what your body is letting you do; try achieve a balance through the activities you engage in

Conserving Energy

• Freezing healthy, homemade meals to be reheated, rather than having to cook every day

• Good Sleep pattern

Using up energy

• Going on a night out

• Staying late in the library

• Going to the Gym

Thinking Activity

Sometimes it can be useful to see your energy visually, for example as blocks of energy(representedinthefigurebelow).Eachblockrepresentsenergyandwhenyou engage in an activity you will be using up this energy as well as generating new blocks of energy, for example: swimming will generate energy but will con-sume 2 blocks. Preparing a meal will use 2 blocks however, if I use a readymade meal I might use ½ a block. Try and break down your use of energy into blocks and seehowmuchyouuse!

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Section 3

Pacing yourself and Maximising your energy


Having explored what fatigue is and how it relates to you as well as examining the energy level you have for activities, this section will now focus on how to pace yourself and conserve and maximise your energy. You can choose to pace yourself by engaging in one or all the strategies listed below:

• Prioritising

• Planning and managing your time

• Knowing your limits

• Set achievable goals

• Simplifying activities

• Anticipating and planning for difficulties

• Having down time to relax and rest

• Multi-tasking

• Setting up the right environment

• Strategies for productive work

• Strategies for managing fatigue during exams

• Nourishing occupations

• Sleep and rest

• Nutrition

• Exercise

Prioritising:

Prioritisingwhatyouneedandwanttodoisthefirststepinmanagingyourenergyandyourself on a daily basis. As human beings our natural tendency is to jump in and try to do itall,howeveryoumayhavealotofcommitmentsandhavedifficultysaying‘No’.Othersfindithardtogetstartedandorganised.Ifyoustrugglewithprioritising,youmightbeginlotsofthings,buthavedifficultycompletingthem,resultinginlotsofthingshalf-done.

Naturally, our priorities can change daily, depending on what needs to be done, and what needs to be done most urgently. Have a quick think about what your more long-term priorities are. Is it doing well in college, developing skills for the workforce, promotion, looking after your health, spending time with family and friends? Are these priorities related toyourvalues?Andareyourvaluesreflectedinyourdailyactivities?You’llprobablyfindthatyour“bigger”prioritiesinfluenceyourdaytodaychoices.Youmayalsofindthatthethings you really care about do not always feature in your daily activities, due to other demands on your time.

Pacing yourself and Maximising your energySection 3

Thinking Activity

Keep track of all your activities you do each day by using the chart below and ask yourself are these important on a scale of 1 to 10 (1 being not at all important and 10 being extremely important).

The activities I did today Are these important and a priority?? Rate on a scale of 1 to 10 (1 being not at all important and 10 being extremely important).

Bringing the children to school

Washing my clothes

Cooking a meal

9

5

8

From the list above, ask yourself these questions:

Can anything be eliminated?

Can anything be delegated to somebody else if possible?

Can anything be deferred to another time?

What keeps you healthy and well? Do they feature in there?

Then look at how you scored each activity and then chose what is most important to you (anything your scored above 6) and remember that they are the activities


you want to engage in. Use a sticky note like the one below to priortise your day to day tasks.

Sometimes you have to prioritise by saying ‘NO’ to a commitment. By establishing the list above you will be able to say ‘NO’ to anything receiving a score of 1 to 3.

Planning and Managing Time

Now that you’ve ascertained your priorities, the next step is to plan how you can achieve them.

Often when people have activities that they need to complete, they write a ‘To-Do’ list and this can be helpful for prioritising the most important things and for getting these little things to remember out of your head and onto a sheet of paper. It can also feel great as youtickthemoff!To-Dolistsaregoodforsomepeopleinthattheyfocus on what you have to do. Sometimes if you experience fatigue it’s important to consider and plan additional details beyond what you are going to do for example: when you’re going to it, and how you’re going to do it and with whom you are going to do it with.

Somepeoplefindithelpfultolookatthemonth,week,ordayaheadusingatimetable, time planner, or diary.

Planning is an important skill in managing your fatigue.

Knowing your limits: Set achievable goals

Sometimes we have so many things to do, that it’s hard to know where to begin. We can set ourselves up for failure by expecting too much of ourselves. Sometimes it’s helpful to spend a few minutes slowing down, thinking about your actions, and deciding what the most productive way forward is for you. Often it can be helpful to bounce ideas off a friend or family member. Others can help you stay accountable to what you want to get done, as well as alerting you if they think you might be too hard on yourself or planning on overdoing it.

Smaller

Steps

Introduction

Middle

Conclusion

Books

Journal Articles

Colleagues

Friends

Set my clock

After 200 words take a break

By end of the week

By week 2

By week 3

What resources, supports and strategies do I have that will

support me to do this

How will I remind myself

to stay on track? How will I reward myself?

When you are going to do it,

and with whom you are going to

do it

Goal:2,000 word

essay


Itcanbedifficulttounderstandyourlimitsuntilyouhaveoversteppedthemand experienced the consequences. Where recovery from normal exertion and tiredness is relatively swift, for the person with fatigue, recovery takes much longer as energy levels have to be built up again. It’s important to remember that fatigue can be unpredictable in nature and so you might not be able to do as much as planned. Remember on bad days, it’s okay to do less activity than planned for that day.

Simplify activities

Being organised sometimes helps us to break activities down into smaller chunks. Tasksimplificationisabigideainfatiguemanagementandmeansbreakingthingsdown so that less energy is needed. How can I reduce the energy demands of the task?

Examples of ways to save energy may include:

Have a place for your study materials, close to where you usually study so that you don’t need to carry things around.

Try to only carry essential items in your bag, to reduce the weight. Carrying around weight is tiring.

Plan your activities so that you don’t need to walk distances, this may be as simple as doing all the “upstairs” things before going “downstairs” in a morning, or eating lunch close to your next lecture.

Get help when you need it. Sharing the workload saves energy. If someone is photocopying materials, ask them to do a copy for you, and if you are photocopying, do a copy for that person.

When you are doing things, make sure your body is in a comfortable position and is as supported as much as possible. Sitting is less tiring than standing.

Thinking Activity

Try to simplify an activity that you found tiring in the fatigue exploration section using the strategies above.

What strategies did you use to simplify your activity? Please identify them below:

1.

2.

3.

Manypeoplewithfatiguefindbeingabletoswitchbetweenactivitiesusefulifoneactivity becomes tiring. When activities are broken down, it is easier to switch from one to another.


Anticipate and plan for difficulties

Planning ahead for a busy day or stressful event can support the management of energy.Haveyoueverfoundithardertodothingsifyou’restressedorflustered?Avoid rushing, and give yourself plenty of time. Rushing takes up a lot of energy and increases stress.

Ifyouplanahead,italsoallowsyougreaterflexibilitytorollwithyourfatigue.Youmay need to start work earlier and take it at your own pace so that you’re not pushed into a period of over-activity.

Have down-time to relax and rest

In managing fatigue, rest is essential. Set limits to your activities, and schedule rest. Posture and movement is also important, be aware that maintaining a poor posture or staying in one position for long periods takes up lots of energy.

Multi-task

If you plan ahead, you may see what tasks can overlap, or how you may approachthingsinthemosttime-efficientway.Doyouwanttospendtimewithafriend, and also do your grocery shopping or go for a walk? Can you combine the two? Can you tackle similar things together?


Thinking Activity

Use the Weekly Planner below to plan a week that is realistic for you. Insert your college commitments/work hours. Remember to include travel time.

NB. Schedule in rest and leisure times.

Mon Tues Wed Thurs Fri Sat Sun

9am

10am

11am

12pm

1pm

2pm

3pm

4pm

5pm

6pm

7pm

8pm

9pm

10pm+

Setting up the right environment

Tasks can be simpler if what you need is close at hand. Sometimes a cluttered workspace can be distracting. Keeping things organised, so that notes are easy tofind,canbehelpful.Considerwhereyouworkbest.It’softenrecommendedto keep the temperature cool but comfortable and to have some fresh air


circulating. Think about putting things around you that will motivate you (To do lists, inspirational quotes, previous positive feedback?).


• Focusonthetasknotthetime!Stayinginworkorinthelibraryforhoursmightmakeyoufeellikeyouaredoingwork,butfocusedworkisfarmorebeneficial.If you work/study in short bursts, you can get a lot more done.

• Consider your concentration level. What are you able for? What type of task are you best suited for? If you’re feeling your mental energy is low, could you doamoremundaneorpracticaltaskse.g.Findingbooks,filingnotes,watchinga related documentary, making a phone call?

• Be familiar with your documents/reading list. When you have a subject or topic to read about or study, try to prioritise the most important text and read by scanning the contents page, or scanning a chapter, before you start into a long block of reading. Keep the focus of your reading written down to redirect youifneedsbe,andfrequentlyhighlightspecificinformationyouneedthatwillguide your search.

• Sometimes working at the computer can hold us back. We can feel more easily distracted, and sitting for too long in front of the screen can affect our comfort. Can you get some of your more creative or planning tasks done with a pen and paper (e.g. brainstorming a topic), think of using a diary? And use the computer when you have more of an idea what you have to do.

• Know your learning style and roll with it. Tap into ways of learning that suit you best so you can use you energy learning in the most effective way for you. Check out the VARK learning styles questionnaire, and the strategies available based on your results. (Fleming 2011)

• Break down a larger piece of work into smaller steps. This can help you better estimate how long it might take you to complete, and give you a focus for each time you sit down to study.

• Schedule breaks and stick to them. If you get distracted by looking at a clock orphoneforthetime,tryusingacount-downoreggtimer.Somepeoplefinda mini-break (quick stretch or walk) helpful after about half-an-hour. Use your breaks to hydrate yourself, move around a bit (this helps you focus), or to reward yourself for what you’ve completed.

• Youmayfindyourselfmakingexcuses,gettingintoabadmood,andfeelingdiscouraged. Say to yourself “I’ll feel better when I handle this”. It can keep you motivated and balanced.

Strategies for managing fatigue during exams

Managing your fatigue through the exam period is particularly tricky, especially if you have a lot of exams in a short period of time.

It is important that your energy levels are not low before an exam, because that will make the exam much harder. The two or three weeks before the exams are probably the most important times to manage your fatigue and make sure that youaregettingenoughrest.Itwillbefarmoredifficultforyoutodowellinan


exam if you are very fatigued because you have crammed – it is likely to be better if you are less tired and therefore able to write what you know.

Manage your energy within the exam itself. Most exams are several hours long. Some students with disabilities are entitled to extra time in exams, soaskyourDisabilityOfficerandtutorifyouareindoubt.Usetheextratimewisely– that means taking a break every hour. The break may only be short, but try to moveslightly,andrestyourbodyandmind.Thefiveminutesorsoeachhourmayseem like a “waste of time”, but is much less of a waste than getting half way throughanexamandnotbeingabletofinish.Practice“switchingoff”andrestingforfiveminuteswhenstudyingsothatitwillbeeasierontheexamday.

After an exam, it is likely that you will be very tired. Take a break and rest. Some peoplefindithelpfultodosomeformoflightexercisetorelievetiredmuscles.

Thinking Activity

Are any of the above strategies useful for productive work or study, if so, jot them down here so you won’t forget!

1.

2.

3.

Nourishing occupations

Engage in occupations that nourish and relax you.

Engaging regularly in occupations or activities that are purposeful and meaningful for you contribute to your health and well-being, and your sense of self.

Thinking Activity

Identify what nourishes you?

As well as thinking about what is draining you, think about what nourishes you? From the list below, tick the activities that nourish you or make you feel better, laugh and relax.

Spending time with others


Power naps

Mental/emotional stimulation

Meditation

Sunlight

Mindfulness

Watching a movie

Chatting with family

Going for a meal

Painting your nails

Making a nice meal

Taking a walk

Spending time alone

Reading

jogging

Time in the gym

Other

Do you engage in these nourishing activities each day?

Yes

No

Ifyouansweredyes;greatkeepengaginginthem!Ifyouansweredno,tryandincludethisactivityinyourdailyroutine.Gohavefunandnourishyourself!

Relaxation

Regular relaxation can lead to decreased tension, lower blood pressure, and


a slower heart rate. It can also promote good sleep patterns. Experiment with differentrelaxationtechniquesuntilyoufindoneortwothatworkforyou.Relaxation is an active skill that requires development through practice. Practice relaxation techniques before bed such as yoga, deep breathing, mindfulness, or progressive muscle relaxation and others; these may help relieve anxiety and reduce muscle tension.

Ifyouarestillexperiencingdifficultyrelaxingthenseeksupportfromfriends/familyor a recognised professional.

Sleep and Rest

The brain requires sleep for energy stores to be replenished. Not enough sleep, too much sleep, or poor quality sleep can cause or contribute to your feelings of fatigue. There can be many reasons whygettinggoodqualitysleepisdifficultincluding:

• Concernsandworriesthatmakeitdifficultto‘switchoff’anddriftintosleep.

• A packed schedule with little time available for sleep, for example, working late and getting up early.

• Being less active, which can alter sleep patterns

• Symptoms of your illness, e.g. pain, having to get up to go to the bathroom, or side-effects of medication.

In this section, we’ll look at some general tips and strategies for a good night’s sleep and ask you to consider your own sleep routine.

Here are a few general rules of thumb:

• Attempt to get 6-8 hours of sleep a night.

• Fix a bedtime and awakening time and stick to it as much as possible. This can be tricky to achieve, however your sleep cycle will become more regular.

• Don’t go to bed hungry or full as either can hinder sleep. Although you shouldn’t eat too much right before sleep, certain foods promote sleep. These include the amino acid L-tryptophan, found in milk, turkey, and tuna; and carbohydrates, such as bread and cereal.

• People sometimes think that alcohol helps sleep. While alcohol has an immediate sleep-inducing effect, a few hours later as the alcohol levels in your blood start to fall, there is a stimulant or wake-up effect.

• Regular exercise (3-4 times per week), particularly in the afternoon, can help deepen sleep. People often report that they sleep better after an active day. Strenuous exercise within the 2 hours before bedtime, however, can decrease your ability to fall asleep.

• Trytoleaveyourworriesbehindwhenyougotobed.Somepeoplefindit


useful to assign a “worry period” during the evening or late afternoon to deal with these issues. It might be helpful to write thoughts down. If you’re worried about getting your work done, make a to-do list for the next day to assure yourself you have enough time to accomplish what needs to get done.

• Keep an eye on your TV and computer use as not only can the screen light be alerting,butwecanendupspendingfarmoretimeonthemthanwerealise!

Assess your sleeping environment:

• Is your bedding comfortable?

• Is your room at a comfortable temperature and well ventilated? Most experts agree cooler temperatures work best.

• Does your sleeping environment calm you? Or should you de- clutter a bit?

Thinking Activity

What helps me go to sleep?

A sleep routine that involves doing the same things before going to bed each night can help you wind down. What helps you go to sleep? Here are a few ideas, but most importantly add in your own.

Winding down:

• Try to wind down rather than going straight from studying to sleep

• Reflectonandmaybewritedownthepositivesfromtheday-whatdidyouachieve?

• Make the morning time easier- do some simple things like packing your bag and choosing your clothes for the next day.

• Engage in a relaxation exercise

• Read a book or something light.

• Chat with family, friends, or housemates

• Dim the lights if you can, or switch off the main light.

• Light a scented candle

• Have a warm caffeine-free drink like camomile tea

• Close your eyes and listen to music

• Others:


Still can’t sleep? What next?

It’s very frustrating to be lying awake trying to sleep, but try not to put pressure on yourself to sleep. If you’re wide awake after twenty minutes or so, get out of bed and start a light not-too-interesting activity. What sort of things could you do?

Thinking Activity

Are any of the above strategies useful? What do you think are the strategies that will support your sleep, jot them down here so you won’t forget!

1.

2.

3.

Nutrition

We all know that good nutrition is a major contributor to a healthy body and mind. With what we manage on a day-to-day basis, sometimes we can be less mindful of what we put into our bodies. It can sometimes feel quicker and easier to skip a meal, or grab a take-away. Maintaining a healthy lifestyle is a key factor in managing fatigue. How do you incorporate nutrition into your daily life?

Thinking Activity

Over the last 24 hours think about what, when, and how you have eaten.

Knowing what you know about nutrition and diet, can you analyse your typical diet? Is there room for improvement? Are you drinking the recommended two litres ofwaterandgettingyourfive-a-day?Oftenweknowwhattheexpertrecommendations are, but then do we actually heed them?

Thinking Activity

Can you identify foods that made you calm? Foods that stimulate you? Foods that made you feel good? Foods that maybe made you feel a bit sluggish?

There is a bundle of information out there about good nutrition. Here are some general rules of thumb:

• Drink plenty of water to remain hydrated. Invest in a water bottle to bring to college.

• Be careful with caffeine. As a stimulant, caffeine acts on the brain and nervous


system. In small doses, it can make you feel refreshed and focused. After the initial energy burst, it can sometimes leave a great feeling of fatigue. In large doses, you are likely to feel anxious and have trouble sleeping.

• Check your vitamins and mineral intake. For energy, eat foods rich inBvitamins(e.g.wheatgerm,fish,greenvegetables,wholegrains,mushrooms, and eggs) and Vitamin C. Consider taking a multivitamin and multimineral.

• You’vehearditbeforebutwe’llsayitagain,eatbreakfast!Sometimesit’shelpful to have it somewhat prepared the night before, even if it’s some fruit on the table to trigger you to have a breakfast.

• Cook your own food. Spending a bit of time cooking a food for a few days can be a great time saver. It’s very handy to be able to have some of your own home-made ready meals in your fridge or freezer. Learn how to make your own soup; it’s very easy and a great way to get your greens.

• Try to maintain a healthy weight as being over or under-weight can increase fatigue.

Thinking Activity

Are any of the above strategies useful to you? How do you think you could improve your diet? Jot your ideas down here so you won’t forget!

1.

2.

3.

Exercise

Thehealthbenefitsofregularexercisearewellrecognised.Regularphysicalactivityispositivelyassociatedwithbeneficialhealthfactors,suchasweightcontrol, and decreased risk of heart disease; and established links indicate lower levels of anxiety, depression, stress, and leads to a better feeling of wellbeing. (Bray & Born, 2004). Low activity levels cause under-used muscles to become deconditioned,whichmeansthatstaminalevelsandfitnessarereduced.Asaresult, everyday activities are more physically demanding and therefore consume more energy and fatigue is increased. It may seem counterintuitive, but engaging in regular vigorous activity may help reduce the feelings of fatigue and may help increase energy during the day and help you sleep at night.

Exercise encompasses any activity that involves physical movements with even a slight increase in effort. Some people are more interested in exercise than others, but it can be helpful for you to have some kind of active outlet. If you don’t exercisemuch,builditupgraduallyandseehowyoufindit.Ifexerciseseemslikeachore,seeifyoucanfindawaytomakeitmorefunandeasiertostickto-forexample try exercising with a friend?

Thinking Activity

How can you incorporate exercise and activity in a way that will suit you?

Conclusion

This book has offered you the opportunity to explore fatigue and how it relates to you. We hope that you now have a better understanding of how fatigue impacts upon your day to day activities and how best to maximise your energy. Keep your personalisedfatigueguidehandyandusethestrategiesyouhaveidentifiedtohelp you to be successful in your role as a staff member or a student.


References

Bray, S., & Born, H. (2004). Transition to University and Vigorous Physical Activity: Implications for Health and Psychological Well-Being. Journal of American College Health,52,4,181-188.

Darcy, A., Roe, S., McKnight, F., & Nolan, C. (2013). Fatigue in College Students. Trinity College Dublin: Unpublished Thesis.

Dawson, D., Noy, I.Y., Harma, M., Akerstedt, T., & Belenky, G. (2011). Modelling fatigue and the use of fatigue models in work settings. Accident, Analysis and Prevention,43(2),549-64.

Fleming, N. (2011). A Guide to Learning Styles. http://www.varklearn.com/english/page.asp?p=questionnaire

Grech, M.R., Neal, A., Yeo, G., Smith, S., & Humphreys, M. (2009). An examination of the relationship between workload and fatigue within and across consecutive days of work: is the relationship static or dynamic?. Journal of Occupational Health Psychology. 14(3), 231-242.

Khambatta, C. & Jevon, N. (2011). Fatigue: The Essential Guide. Peterborough: Need2Know

Neumann, Y., Neuman, E., & Reichel, A. (1990). Determinants and Consequences of Students’ Burnout in Universities. Journal of Higher Education, 61, 1.

NHS. (2006). Over Activity and Under activity Cycle. http://www.bacme.info/document_uploads/POD_Docs/Activityman.pdf

NANDAInternational(2011).NursingDiagnosis-DefinitionsandClassifications,2012-2014. Wiley-Blackwell.

Querstret, D., & Cropley, M. (2012). Exploring the relationship between work-related rumination, sleep quality, and work-related fatigue. Journal of Occupational Psychology.17(3),341-53.

White,S.(2005).StressmanagementandM.E.:ashortpracticalguideonstressmanagement and ME, Chronic Fatigue Syndrome, Post Viral Fatigue Syndrome. MansfieldWoodhouse:Mentor.

My Personal Fatigue Management Strategies

Note: Now you have the opportunity to make your own chart with the information that you have read in this book. The objective istodesignitsothatyoucanfillitoutandstickitonyourwallsothat you can easily access the strategies you have designed for yourself to pace your day and maximise your energy.

Pleasefillintheboxesprovidedwiththestrategiesthatyouthinkwill work for you in managing your fatigue including the activities that you need and want to do.

Fatigue: What it means to me?

How do I know when I am fatigued?

What triggers my increased levels of fatigue?

The emotions I experience when I am fatigued?

How my body reacts when I am fatigued?

How my mind reacts when I am fatigued?

Ways I can manage my FatigueUseful strategies to support my sleep and rest:

Useful strategies to better manage my diet and nutrition:

Useful strategies to enable me to engage in exercise:

Useful strategies to support my productive work/study:

My nourishing occupations that make me feel good:


6am-7am

7am-8am

8am-9am

9am-10am

10am-11am

11am-12pm

12pm-1pm

1pm-2pm

2pm-3pm

3pm-4pm

4pm-5pm

5pm-6pm

6pm-7pm

7pm-8pm

8pm-9pm

9pm-10pm

10pm-11pm

11pm-12am


Morning

Afternoon

Evening

My energy chart:Colour in the boxes below in green, orange and red indicating your levels of energy across the week.

Green- Most energy Orange- Some energy Red-Very little energy

Use this table below to plan out your week. Include all the activities that you need and want to do based on your energy levels above.

November 2013Authors: Dr. Clodagh Nolan, Orla Sullivan, Claire Gleeson & Kieran Lewis

© Copyright: Unilink Service, Trinity College Disability Service

AcknowledgementsThe Unilink Service wishes to thank the Equality Fund in TCD for supporting the development of this book.

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