Confused about delayed increased fatigue
 

Hi All

I'm new here and have been reading the comments on this forum for a month or so and I must say this is a great resource. But I still have some unanswered questions I hope you can help with- My story

6 months ago I slipped and fell while jogging and hit my chin on concrete with much of my bodyweight behind it. It was like a boxing uppercut with concrete I suppose.

I had a week and a half off work, then started 6 hour days. It was tough at first- lots of blurry vision, headaches, waking a lot in the night for long periods. This improved a little over time but was still there after 2 months.

At 2 months I felt fairly good despite the symptoms. I was put on 7 hour days, at the same time I had someone replace all the fluoro light tubes in the office and I worked in a noisy environment for 2 days. By the end of the week I started feeling quite bad- malaise and then I had what I would call a meltdown- basically stuck in bed, tired but couldn’t sleep for days. A heavy feeling of stress- like fight or flight.

After this I had a week off work and then put on 5 hour days. Over another 2 months I got used to the 5 hours I stabilised but didn’t seem to be improving further. My sleep was still bad- waking 1 to 3 times in the night then spending a long time to get back to sleep. So I asked for some medication so I could sleep. I was given Nortriptyline, which to my surprise took away much of my headaches, anxious feelings, etc (which turns out were neck related). I seemed to sleep better. However, I started doing more too and seemed have lost my indicators for fatigue. I suddenly just stopped sleeping for days while still going to work and gradually started feeling a lot worse. The drugs weren’t hiding it any more and I had another big meltdown- no sleep, heavy stress, malaise, which took 2 weeks to recover. By this stage 1 hour of conversation would take a day or 2 to recover from

In desperation, I went to an osteopath who informed me my C1 was “locked” and C5or6(?) were out. He fixed that and it made a big difference. Headache, pain, anxiety were much improved and a much clearer perception. Although this started to a little worsen again without doing some neck exercises

So now I’m just managing on 3 hour days, 4 days a week at work. I’ve stabilised at that and seems manageable, but still not really improving. What gets me is my fatigue is really quite bad compared to the first 2 months after injury. Where i wasnt having to hold back much in the first 2 months, now i do half as much in 1 day and I'll be exhausted and on the way to a meltdown

I’m wonder if I have another meltdown, I wont be able to do anything at all. I’m not really sure the reason its got so much worse and whatever it is I want to avoid it.

I’m really confused about having such a delayed increase in fatigue. And if it was the 2 meltdowns that set me back so far, or the neck problem causing headache and poor sleep. Maybe a combination of both? I wonder if others have experienced something similar or I'm just not understanding it right.

Can over doing it cause a large increase in fatigue?

I’m grateful for any insight anyone has to offer.

DavidK,

Welcome to NeuroTalk.

I'm not surprised you got relief from the neck therapy. But, I doubt he fixed. He just improved it for the short term. Neck injuries take months to stabilize.

At the present, I think your fatigue problems are due to poor sleep. If you look at your time line, you have had a lot of poor sleep as you fatigue has gotten worse. Learning how to sleep without stressing or reinjurying your neck will be good. Neck exercises should be limited to gentle strengthening with limited range of motion for a few weeks. Anti-inflammatory meds (ibuprofen) and icing can help.

Your response to the Nortriptyline is common. It and its predecessor, amitritpyline have been successfully prescribed in low doses for insomnia and headaches from PCS.

The most important factor for you to understand at this point is quite simple. Just because you are having a good day or couple of days does not mean you can increase your activity and work load. You need weeks of those good days to improve. Lasting improvement comes when your symptoms are low.

It will be helpful to learn the early signs of impending overload. Things like struggling to focus to read, rereading a line of text, and may other minor struggles are indicators of a need to slow down and even take a break. Using ear plugs or headphones can help in noisy areas.

Feel free to tell us about any specific situations where you might be over-stimulated or pushing the limits.

My best to you.

Hey David,

Yes i had a similar experience. I physically crashed after a few months but eventually i bounced back. What you describe sounds very much as a neck problem. Some other members can give you good advise on that.

As for the nights where you cant fall asleep. Dont lay awake in your bed for approx 20 minutes. If you do get up, go drink a glas of water, sit in your sofa, or do something else that you find calming and then go back to bed when you are tired again.

It also sounds a bit like burn out. Not that it is burn out, it is injury related but the mechanism is very similar. Know that your threshold for stress and workload can be lower than before and it is easier to crash. It is good that you are working again so you can build up that threshold again. The general advise is to go back to activity as soon as someone can. Try to discuss with your workplace how much you can take and how much is too much. Your recovery comes first.
Good luck!

This all sounds very familiar to me.

I found swimming to be very helpful for my neck-related issues, I mostly do gentle breaststroke for an hour couple times a week (but started with about 15 mins and slowly increased the time).

As for fatigue - the only thing that has worked for me was to completely quit work. I've been off full time work for two years now, I'm finally able to sleep fairly well (although I still can't get that "fully rested" feeling in the mornings, mostly feel groggy).
My anxiety is very manageable now, I still have a few bad days each month, but I just try to push through them knowing that it will pass.

Couple things that still bother me are the dizziness from walking/driving and inability to work on computer/smart phones.

Lebber,

There is a difference between feeling tired and being sleepy. A person with insomnia often feels tired but does not feel sleepy. If they do not fall asleep in 10 minutes or so, they should get up and find something to occupy their mind in a non-stimulating way until sleepiness sets in. Boring TV, reruns, etc can help. They may want to take a small sip of water but not enough to trigger bladder sensations. There are known issues for dealing with insomnia and PCS.

Thanks for your replys they are very helpful.

One of the responses I seem to have to overdoing it seems to be not being able to sleep. So Mon Tues I went to work and it was a little tough coming back from holiday but I felt good after, then wed I had the day off and took it quite easy but I had a bad headache on and off for most of the day starting early morning. I felt ok other than the headache That night I couldnt sleep but the previous 2 nights I slept well. So I'm thinking did I overdo it on the first 2 days or just recently I wonder if its pain stopping me sleep, even though it felt ok when I woke...

Its really so confusing trying to read this stuff and act accordingly.

Thanks Mark (I've already read a lot of your posts so its nice to get your reply and same to Lebber)

I just made a new post about neck exercises and would be interested in opinions on it.

It does seem like i need to take notice of the subtle features, although sometimes I think I'm hitting my limit start sleeping bad but still function quite well, then crash after 4-5 days of bad sleep...???! (like 2 hours a night). Last night I got about 5h it think. I'm hoping its not 2 hours tonight. I've tried the getting up thing, it helps but not when I start falling down this hole and had a couple of nights of 2 hours.

In this situation, what is good to take to force one to sleep? I tried phenerghan once and it seemed to help... more so than amitriptyline and nortriptyline.

Very grateful to be getting your responses!

David,

Lived your story!

Don't push to hard, head injuries sort of take their own time and course as compared to a healing bone or such.

My way of handling returning to life was to test the waters and back when or if symptoms flared.

Good to see you pop in Russia!

Bud