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  • Why investigate? Part 10: Fatigue – Enter the Sandman

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    Continuing Professor Martin Langham's 'Why investigate' blog series, colleague Bobbie Enright turns to the topic of fatigue, looking at the causes and preventions, how it can impact on our work and how we can manage it.


    Martin has managed over the course of his blogs to open our eyes to the world of Human Factors (HF) and, in particular, the area of HF within the medical world. What hasn’t been touched on yet is the topic of fatigue. Why am I mentioning this dreaded word, you ask. Well, unfortunately it impacts all of us. In fact, I would be prepared to bet a lot of money that we have all experienced fatigue at some point. And I will point out that I am not a gambling person, so hopefully that indicates to you how certain I am, but also unfortunately points out the prevalence. 

    Right now we’re all under a great deal of strain; we hear the media talking about stress and mental health and workload. Some people are having flashbacks to the war with references to ‘doing our bit’. In fact, my 94 year old grandfather is adamant that I have it worse right now living through this time than he did living and serving through the war period. In our conversations I have disagreed with him, but upon reflection I can see his point.

    We live in an instant age, we’re not used to sitting and waiting. Working from home means that despite being remote from our colleagues, we are still accessible. That work pressure still exists and, arguably, it is greater than ever. We are separated from our colleagues, our friends and our families.

    Of course not all of us are working from home. There are those of us who are still attending the workplace. But again, this is no longer the same; our colleagues cannot come close to us, our words are slightly muffled, we realise how much we rely on lip movement to understand speech. We realise we are removed from others, we realise our workload has multiplied and we realise we are drowning. 

    But, before our heads go under… This stress, this anxiety, this impact on our mental health – perhaps it has a cause we haven’t considered. Perhaps the cause is something we thought was a symptom. Perhaps we are fatigued.

    So, what is fatigue exactly?

    Let’s stop bandying this word around and actually get to grips with it. We can attempt to define it, look at some symptoms, some causes and hopefully you can learn some tips on how to deal with fatigue.

    I should give a disclaimer here – I am not a fatigue expert and it would be arrogant for me to state that. However, I do work within the field of Human Factors. I look at how we as humans interact with the world around us and how we can make that better and safer. I look at what impacts on our ability to do well and a consequence of fatigue is that our performance in our tasks declines. Suffice to say I have made it my business to learn.  

    Fatigue, unfortunately, doesn’t have one single definition. But I’ll attempt to give it a go. Fatigue is a subjective feeling of extreme tiredness. It is likely to have a gradual onset and may come from mental or physical exertion or alternatively be caused by a medical condition (diagnosed or not).

    Our task performance and decision making abilities are negatively impacted. Concentration decreases and our mind is foggy. It is not the same as finishing an intense gym workout and wanting to lie down. You may not realise you are fatigued as we are very good at ignoring our bodies trying to tell us something is wrong.

    Across the western world, high levels of fatigue are significantly associated with excessive mortality rates and it is increasingly being recognised as strongly associated with poor long-term quality of life and negatively impacting on our work ability. Essentially, it is being recognised as a problem in more than one aspect of our lives.

    How do I know if I’m fatigued?

    Well that is a good question and, as we’ve said, fatigue is a subjective feeling. The warning signs I experience can be different to those experienced by somebody else or the degree to which I experience symptoms could be different.

    Some key signs are frequent blinking, struggling to keep your eyes open, tiredness that doesn’t improve after sleep, constant headaches, blurred vision, being prone to irritability, slower reflexes and thinking, micro-sleeps, impaired decision making and muscles feeling achy and/or weak.

    There are some signs where it is important to see your doctor. Lifestyle or work demands are often the cause of fatigue, but where fatigue could be connected to a medical issue it is always worthwhile seeking professional advice. These are generally symptoms such as vomiting, shaking or shortness of breath, but depression is also commonly linked to fatigue. 

    If I’ve noticed the signs can I work out what caused it?

    As mentioned above, fatigue can be linked with medical conditions. Obesity, insomnia, depression, anaemia, low general health can all be causes of – and conversely symptoms of – fatigue. Some medications can also list fatigue as a side effect.

    Our age and lifestyle also impact the likelihood of fatigue. Younger members of the population are more likely to experience non-medical fatigue, and drug and alcohol use increases the risk across all age groups. Our need to juggle the multiple daily responsibilities – bills, kids, pets, commuting, laundry, food prep, etc – also causes fatigue. This is important to remember because it is so easy to judge ourselves for struggling to do all of this and to decide to get up early and get tasks done, forfeiting sleep and rest. We don’t necessarily realise that this creates a vicious cycle where we find it harder to cope and take longer to finish tasks because we are fatigued so we deprive ourselves of rest in order to get things done ad infinitum.

    Of course work factors do also positively correlate with the likelihood of fatigue, particularly if you are a shift worker or your role involves long driving hours, e.g., train/bus/HGV driver/pilot. You can imagine that this is due to the stressful demands of the role, which is absolutely correct. But interestingly, when we are experiencing underload we can also experience fatigue because our brains essentially ‘switch off’, e.g., driving on a long, straight, empty stretch of road.

    Well it’s all good knowing I’m fatigued, but what can I do about it?

    Let’s talk coping mechanisms – when we start to flag we often use coping mechanisms to keep going. Sugary foods and drink and caffeine are some of the things we automatically reach for. We see our favourite TV characters grab an energy drink or a coffee to keep them going as they study for exams/cover another shift/track down the bad guy, ad nauseam. Unfortunately these coping mechanisms only give us a short burst before we feel just as fatigued as we did before, if not worse – in fact, how often do we see the above characters crash at the end of the episode after they’ve relied on coffee!?

    This doesn’t mean you can’t have a coffee, etc, it’s rather just a flag to remind ourselves that it doesn’t solve the problem and we need to think about our behaviours. If we have a coffee too late in the day, we could then struggle to fall asleep afterwards. However, if we use the coffee as a break earlier on in the day it not only acts as a stimulant, but the act of consciously taking a break from our task to get the coffee can be beneficial. Similarly, getting some fresh air benefits us by stepping away from our task and going outside – a mental and physical break.

    However, what we should really be doing is trying to prevent ourselves from reaching the point of fatigue so we’re not reliant on stimulants or coping mechanisms. Having a routine is important. This is something we provide for our children and instil in them for years and seem to promptly forget once we reach adulthood. Going to bed and getting up at the same time each day creates a ‘defence’ against fatigue because our bodies have an expectation of what is required. This is of course assuming we have allowed sufficient time to sleep – this differs for everyone, but I am firmly in the ‘needing 8 hours sleep’ camp. Usually, getting between 7 and 9 hours sleep is recommended.

    Including regular exercise into our daily lives is equally as important. This helps to keep our bodies healthy and helps with attaining quality sleep.

    Diet should also be mentioned. The types of food we eat doesn’t just impact our general health, but it impacts on our ability to rest and sleep as well as feeding our brains. If we don’t eat enough nutritious food we can struggle to concentrate and eating large or heavy meals before bed can negatively impact our sleep.

    Unfortunately, there’s nothing we can really do to prevent fatigue entirely. There’ll always be a time when we experience it to some extent, but knowing what tends to trigger your fatigue will definitely help you to avoid it to the most part.

    Are you still awake?

    At this point I think I should ask the question "Are you still awake?" You may have noticed that there can be something quite soporific about the topic of fatigue – and yes I have yawned during the writing of this – although I think this would take many further blogs to attempt to delve into the psychological implications here.

    There should be no expectation for us all to become experts of our own fatigue and the causes and preventions. But we need to allow ourselves to acknowledge that we’re struggling and attempt some introspection as to the cause. Because remember, our fatigue could be related to our lifestyle or it could be related to a medical issue. Realistically, we probably do notice our fatigue and combat it successfully, but this is likely often on a subconscious level as just a part of our everyday lives. Hopefully the above insights can help you manage fatigue effectively day-to-day.

    Read the other blogs in this series

    About the Author

    At present, Bobbie works in the Bus Industry bringing Human Factors into health and safety but has worked alongside Martin Langham on and off for the past 10 years. Within her health and safety role, she is currently creating a Fatigue Risk Management System in conjunction with TfL. 

    Outside of work, Bobbie has picked up a new hobby of climbing which is her nod to attempting to including exercise in a daily routine.

    She holds a BSc in Psychology and an MSc in Human Factors.

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