The relationship between chronic fatigue and insomnia

Chronic fatigue syndrome is a challenging disorder to deal with because research has yet to determine the cause of chronic fatigue syndrome to any specific medical cause. Moreover, along with being a severely impairing disorder by itself, chronic fatigue can also lend itself to other comorbid challenges.

One common comorbid condition of chronic fatigue is insomnia – difficulty falling asleep, staying asleep, and/or waking up too early – with unrefreshing sleep being a big part of chronic fatigue. Studies have found that approximately 90% of people with chronic fatigue syndrome also present with unrefreshing sleep (Mariman et al., 2013).   

It’s important to recognize that fatigue and insomnia are very interrelated and – when left unchecked – can lead to greater symptoms of both problems because of how they affect one another. At the same time, understanding this cycle can identify potential solutions to tackling both fatigue and insomnia.

The vicious cycle between chronic fatigue and insomnia

When we are constantly tired, our body naturally pulls for rest. We may reduce our physical activity, spend less time with friends and more time on the couch or the bed, and take naps when possible.

Although this makes perfect sense given how exhausted we may feel, there are a couple problems with this resting approachthat affects our sleep and how we feel. First, our ability to develop deep sleep is based on the build-up of sleep pressure. Sleep pressure is built throughout the day, and we build more when we are active and awake. High sleep pressure is what gives us restorative and refreshing sleep.

Unfortunately, when we spend the day resting, we build-up significantly less sleep pressure, which has significant effects on our ability to produce high quality sleep. We get trapped in a cycle of shallow sleep that makes us more tired the next day.

Moreover, we often think of energy like a battery (where the more active we are, the more energy we use), but energy is more like a generator. Sometimes, we have to give a little to get a little. But when we spend the whole day resting, our generator has no input to create momentum.

The relationship between insomnia and fatigue can also lead to further problems. For example, it may lead to muscle atrophy, which can affect chronic pain, and lack of positive reinforcement in everyday life, contributing to depression.

Breaking out of the fatigue-insomnia cycle

Fortunately, research cognitive behavioural therapy has been found to be helpful for both chronic fatigue and chronic insomnia (e.g., Malouff et al., 2008; Wu et al., 2015).  Below, I discuss a few strategies from CBT that can be employed to tackle chronic fatigue and insomnia to break this cycle.

1. Built up sleep drive. Increasing sleep drive, or pressure to sleep, will increase the amount of deep restorative sleep. This may have a beneficial impact on fatigue and support overall recovery. Sleep drive can be built by reducing amount of time spent resting prone (i.e., lying down), reducing naps, and generally trying to stay a bit more active throughout the day.

2. Gradually scheduling activities. Although it can be incredibly tough in chronic fatigue, scheduling activities in a gradual way can be helpful to get the generator going in terms of energy. This can be done in a slow and steady manner, beginning with activities that feel manageable (e.g., light yoga, short walks, stretches) and moving up to more challenging tasks. SMART goal setting can be a helpful way to add activities into your life in a specific, achievable, and time-bound manner.

3. Fatigue management strategies. Beyond activity, there are also many other factors that go into fatigue management. Examples include keeping to a consistent rise time, getting regular light exposure, staying hydrated and eating a balanced diet, and avoiding substances. Here’s a post on fatigue management if helpful!

4. Tackling self-defeating beliefs. Our thoughts can be our worst enemy when it comes to mustering up the energy to engage in activities associated with daily living. A grad student at our lab is an expert in fatigue and one of her main findings is that the way we perceive a task directly affects our energy levels. For example, let’s say you’ve been watching a lecture for 2 hours. The professor then says to the class “the lecture has just 5 minutes before the end”. You’d probably feel pretty energetic to know that because you perceive your resources to pay attention to 5 more minutes to be sufficient. On the other hand, if the professor said that the lecture still has 2 more hours, you might feel significantly more exhausted, because you don’t feel like you can handle that much more dry lecturing!

This can also apply to specific thoughts about chronic fatigue. For example, if our thought is “I can’t do this. I’m too tired”, we will naturally focus on our feelings of tiredness, which only seek to exacerbate these feelings. Using thought records to tackle these negative thoughts or mindfulness practices to lessen the impact of these thoughts may be helpful strategies from a cognitive perspective.

Concluding thoughts

Fatigue and insomnia can be a very challenging set of symptoms to deal with because our motivation is fighting against us. Both insomnia and fatigue pull for rest, but the problem is that excessive resting can lead to further problems. Accepting that fatigue may be a constant challenge while making a commitment to engage in a lifestyle that supports you in being able to manage this condition.

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Best wishes,