FACING & FIGHTING FATIGUE: A PRACTICAL APPROACH

FACING & FIGHTING FATIGUE: A PRACTICAL APPROACH
Benjamin H. Natelson, MD
New Haven: Yale University Press, 1998
211 pages, paperback, $15.00
ISBN: 0-300-07401-8

Reviewed by Lynne Lamberg

Fatigue is a mysterious symptom, impossible to see, and hard to assess. Its causes are legion. Stress leads the list, according to Natelson, a professor of neurosciences at the University of Medicine and Dentistry-New Jersey Medical School. Diabetes, infections, anemia, cancer, low or hypothyroid disorder, chronic fatigue syndrome, fibromyalgia, AIDS, mitral valve prolapse, and multiple sclerosis are among the many specific illnesses that cause fatigue.

Depression and anxiety, alone and in combination with other illnesses, also foster feelings of weariness. Lack of sleep produces sleepiness, not quite the same as tiredness, although many people find it hard to distinguish these two states and use the terms interchangeably. Fatigue is among the ten top reasons people visit their physicians, Natelson says. Women complain of fatigue twice as often as men.

Though sleep would seem the ideal remedy, people who experience fatigue often have trouble sleeping, too. They commonly complain of tossing and turning at night and awakening unrefreshed.

To improve sleep, Natelson advises not eating close to bedtime, cutting back on alcohol and caffeine, breaking the habit of taking sedative drugs, and practicing good sleep hygiene, such as avoiding erratic hours.

Once behaviors become habitual, he notes, their role in instigating a new symptom is easy to overlook. If you have had a martini before dinner every night for years, for example, you may not consider alcohol as a possible cause of a recent sleep disruption. Yet the body's ability to deal with alcohol lessens with age. Limiting alcohol to a single glass of wine per day for two weeks, he suggests, should help clarify its impact, if any, on your sleep.

Natelson provides a smorgasbord of additional suggestions to lighten fatigue. As a general antidote, he suggests exercise. Fatigue and added effort may seem incompatible. But the body of a sedentary or frail person perceives normal daily activities as exercise, he points out, thus adding to fatigue. By engaging in an aerobic exercise program, a person improves fitness, and thereby reduces fatigue.

Managing your time intelligently, Natelson says, also can reduce fatigue. Sick persons often do better at this than those who are healthy: they learn to marshal their limited amount of energy to do only their most important tasks. Natelson also describes techniques for relaxation, and surveys potentially useful medications. His book is a useful introduction to a complex topic.