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Video Blog: CFS and ME Treatment – The 4 Types of Tiredness

Welcome to this week’s video blog. We hope that your New Year is developing in the ways you hoped and that you are following through with any New Years resolutions? We are very excited about this week’s first video as it is on a topic that we know clarifying has been immensely valuable for a great number of patients. It is covering “The 4 types of tiredness,” and understanding these is absolutely critical to knowing what treatments are going to be most valuable, and also being able to support yourself in the best way possible day to day by knowing what actually your body needs. You can watch the video here, and please do comment with any feedback below.

Tags: cfs treatment, chronic fatigue syndrome, M.E., me treatment, tired, tiredness, video blog

Psychology, Video Blog | Alex Howard | January 23, 2010 10:25 pm

16 Comments

By Mary Courtney, January 25, 2010 @ 9:24 am

Your video on the four types of tiredness has given me a new handle to figure out what to do with myself. It is very well explained, straightforward and practical. Thank-you for this.
By sarena, January 25, 2010 @ 11:59 am

Really helpful video – reminded me that a) I’m still getting caught up in that Helper mode (!) and need to let go again and b) have lacked enough variety recently which, with other challenges around me, would have uplifted me more. So thank you!
By Andrew Porter, January 25, 2010 @ 6:49 pm

With reference to being wired and tired, I have found, with my viral induced M.E. with a very strong bias towards chronic viral infection, the drug based approach to overcoming my insomnia fails totally, as there are simply no drugs available that are remotely powerful enough to overcome the problem except for one, a general anaesthetic. In fact, I feel significantly better after a general anaesthetic, and wish that I could have a general anaesthetic every evening. In addition, any form of antidepressant drug makes me feel really ill, and they all do the same thing, make my insomnia significantly worse! All I can indicate from what I have been through is to avoid all NHS doctors, get the correct tests done privately, in my case an EEG recording that showed a major Deltawave deficiency, something that is not associated with depression, and then get the correct treatment, whilst avoiding anything that even remotely links to the NHS.
By Bettina Teichmann, January 26, 2010 @ 4:25 pm

It would be lovely if every GP had a training session with Alex or Anna to learn about the “4 kinds of tiredness” so they would be aware of them and ask patients targeted questions. “Tiredness symptoms” as in my clinical notes from 11/08 says very little! I have experienced all of the types mentioned throughout my illness and I am just so pleased that I had an early diagnosis and was “educated” early on. Fortunately my “tired but wired” days are behind me and I am mainly tired because my body still needs more rest to repair and build up as it is not 100% recovered and also because I try to do more things, doing activities I had avoided for quite a while. But I do sleep well now! Without painkillers and muscle relaxants and I still have the same osteoarthritis in my neck and a slip of my lumbar vertebrea with associated osteoarthrits, which the doctors wanted to blame every symptom on! I also weaneed myself off HRT and have not become more tired again! And my muscle weakness has not returned again!
Environmental tiredness: Before I was able to just go off on a nice walk or do some yoga I used to have a hot shower with music blasting out of the loudspeakers in the bathroom, sometimes it was gentle classical music. Then I would change the water to cold for a minute, takes quite some determination in beginning,marching in the shower on the spot counting to 60, then hot again, cold again, hot, 3rd time cold and finish with about 3 minutes of hot. (Dr. Perrin, the osteopath, agrees with that and a German physician from possibly turn of last century, Dr. Kneipp) Really good for circulation and painrelief in head, neck, back, arms and legs..
By Joanna Hordern Curzon, January 27, 2010 @ 11:53 am

Thank you so much – clear and hugely helpful, and I realise that I had fallen into the ‘I-am-tired-so-must-rest’ trap for every time I felt tired, in whatever way. Awareness is key! (as ever) though I’m not quite sure how you unpeel the layers if you’re tired in all four ways at once …
By Alison, January 27, 2010 @ 1:27 pm

Techie help please?

I cant get this video to play.
I only get the wee box on the corner with the coloured square, circle and rectangle.

Thanks
By Alison, January 28, 2010 @ 1:46 am

Ok, got it.
needed to update the adobe thingy.

Thanks to Alex and team for your inspirational blogs and free info.
By Michelle, January 28, 2010 @ 6:10 pm

Thank you guys for the helpful and free advice – it is easy to think when you’ve had ME for years that you’ve heard it all and know it all, but it is really helpful to be reminded to rethink how you are managing your illness on a day to day basis. It’s tough, and for myself I find it easy to fall back into patterns of being harsh with myself, to try to push forward as you always would have done before when you were well, but this illness requires a different kind of determination which includes empowering yourself to make different choices and leave behind limiting self beliefs that for some reason you must be all things to all people first and foremost, and then you must achieve as much as is humanly possible just to be grateful that you don’t have something worse – though on some days that’s hard to imagine. One of the keys to unlocking at least one of the doors to this illness is to embrace being kinder to yourself without guilt, whether that be resting when you need to or in fact doing something no matter how small when your body needs to too, and not being afraid that it may make us feel worse, to try it, we can always make another choice…to stop. Just that small thing, to allow oneself the choice, is very empowering. I’m sure I’m not the only one who often falls into the trap of automatically using available energy first to attend to the basic things which maintain independence – bathing, feeding, household chores, listening to friends and family – at least if you can’t do anything physically for them, you can at least listen to them right?. That only when those things are achieved can you turn to more relaxing ways of using the little energy you have…except you’ve done too much and you don’t have any energy left even to sleep – maybe that strikes a chord too. The reduced rate and pace at which you are able to operate on every level I think incorporates all the 4 types of tiredness – it is certainly difficult emotionally to accept that where you could once do so much more, now you have no choice but to pace yourself, and I personally find it very difficult to stop that ego voice within from overtaking to push on and do more. That kind of thinking only keeps you in the cycle of this punishing illness when the type of tiredness you are experiencing needs rest. Equally that kind of thinking can be helpful if you are wired and your body is telling you to do something. The key as in everything is balance and as you guys say, learning to listen to what your body needs when it needs it, and making a choice there and then to listen and change tack, to give yourself permission to make the best choice for you. And if you can do that without too much effort, well done!. For myself I am still learning to make different choices, to choose to use my available energy on activities which uplift or relax me without feeling like I must earn them, to try to read a little at a time, to have a long soak, to use a massage mat (when by body and skin doesn’t hurt too much to lie on it), to limit how long I speak to someone to suit me at the given time or even to dare to switch off the phone for an hour, very gentle exercise to keep the body from curling up and giving up, and also to get out and be with other people in other environments, even for a very short while, even if it is difficult to get around, our minds and bodies need that too. Where we may have been able to fit all those relaxation activities into a day before getting ill, we may be lucky to fit them into a week or even a month now, but it’s so important to include those “be kind to yourself” activities or give yourself permission to swap them in to replace a chore if your energy level doesn’t allow you to embrace both. Which is all quite difficult to get your head around after 40-odd years of being an “I can do it all – I can achieve anything if I put my mind to it” personality. One analogy I have found very useful is to think of your energy as marbles in a bottle, allocating each marble a particular activity, which includes ones for basic needs like sleeping, eating, bathing etc which all still require energy from the body, plus all your favoured relaxation activities as well as physical ones….and try to allocate an equal amount of your available energy to each one….and then pace them out over an amount of time that suits your particular levels, which may be a day, a week, a month etc, but you may find that it helps to break it down in this way to understand exactly where your energy is currently being spent and you may also find that you may want to adjust it to better suit your recovery. This may fit in with the point that Anna makes about doing something like resting and then doing something else that suits your particular type of tiredness at the time.

I hope I’ve contributed something useful here, and thanks again to Alex and Anna.
By Anu Gautam, February 15, 2010 @ 7:11 pm

I can definitely identify with these types of tiredness. I can think of another, or maybe it’s an extension of physical tiredness. Would call it “feeling weak type tired” and find that eating something nutritious helps and in these instances, would prioritise this over resting. Can anyone think of any other types of tired? xx
By Anu Gautam, February 15, 2010 @ 7:13 pm

ps. really liked Bettina’s shower solution!
By Pauline McLeod, February 16, 2010 @ 9:00 pm

Found this really helpful. My tiredness was mainly tired and wired but was concerned that I had suddenly become so physically tired and couldn’t keep my eyes open. Niki mentioned it as being emotionally tired because of the trauma that is happening in my family. This has explained it more, and it makes so much sense. I am the one that is ‘listening’ and have been taking on my family’s emotions. This was really helpful. Thank you for the STOPS, Meditation and EFT techniques that have really helped my wired and tired feelings.
By Helen Smith, February 20, 2010 @ 5:02 pm

Yes this is useful. I would like this translated into hard text. Is there anywhere on the websites I can access this. I have been doing Tai Chi for 4 years now and feel very over stimulated and wired with it. My Tai Chi teacher has a number of sets reflecting different states, ie insomnia, energy etc and I have tried to explain the different strategies that need to be adopted because of the different types of tiredness or energy. For example, she is reluctant to let me do a set for insomnia even although I have explained that this can be a big issue for people with fatiguing illnesses and that it may, in fact, be helpful. So if I can get this in a text format that would be good otherwise I will try and get the link for the video to her.
By Alex Howard, February 20, 2010 @ 7:28 pm

Hi Helen,
The 4 types of tiredness is also covered in this article: http://www.freedomfromme.co.uk/blog/?p=375
Hope this helps,
Warmly,
Alex
By Lucy, May 1, 2010 @ 7:39 pm

Thank you. These are very useful definations. So is ‘wired and tired’ like when you haven’t slept enough, or you’ve done too much the day before, and you are physically exhausted and in pain? I’ve found that when I’m physically exhausted I can’t really relax because I feel too ill.
I’m also glad you mention environmental (situational?) tiredness. I get that a lot – when Im bored and in my frikkin flat all day -and it’s def more than just a sleepy/lazy feeling – its a physically/mentally drained type thing. Do healthy people get this too? Is this a cause of the more painful wired and tiredness?
By anna duschinsky, May 4, 2010 @ 8:26 am

Hi Lucy,

I wanted to just clarify things for you; so wired and tired is in fact when your nervous system is on hyper alert, and in what we call the maladaptive stress response. This does not necessarily mean that you have ‘done too much’ – because your system can get into stress just as easily when you are doing nothing, but running anxiety patterns! So we always say it is not ‘what you do’ but ‘the way that you do it.’. In this state refreshing sleep will be a challenge, and pain and exhaustion are going to be heightened.
The situational tiredness is as you describe – and can cause a tired/wired feeling because being bored and frustrated is stressful!
People in a healthy state do not suffer with these in the same way, and the states do not have the same impact.
I hope that clears things up!
Warm Regards
Anna Duschinsky
By Lucy, May 29, 2010 @ 9:47 am

Oh okay, thank you Anna. I think I am probably in ‘wired and tired’ quite a lot, except maybe when Im meditating or maybe absorbed in a film or something.