Tiredness, fatigue, and exhaustion

If you fly for a living, you're likely to be intimately familiar with fatigue. Irregular schedules, long duty days, short layovers and time zone changes are features of working aloft that contribute to fatigue . As one flight attendant quipped, "They don't call them 'red-eye' flights for nothin'!"

But is there a difference between tiredness and fatigue? And when does fatigue turn to exhaustion? Some new research from Canada, published in the current issue of Oncology Nursing Forum, may have implications for crews who are feeling burned out from fatigue.

An article on News-Medical.net reports on the new study carried out by Dr. Karin Olson, a professor from the Faculty of Nursing at the University of Alberta. Dr. Olson says that, indeed, there are differences between tiredness, fatigue and exhaustion, and that it is important to learn to recognize and pay attention to those distinctions.

Olson has studied fatigue in six ill and non-ill populations: shift workers, recreational long distance runners, individuals with cancer in active treatment or palliative settings, and individuals diagnosed with depression or chronic fatigue syndrome. Having worked with cancer patients for many years, she saw how serious fatigue was and the impact it had on the patients' quality of life. Some patients even withdrew from a potentially curative treatment saying they were "too tired."

"The kind of fatigue experienced by individuals with cancer is different from the feeling that you or I have at the end of a busy week," said Olson. "Interestingly, when you start looking at other populations, such as people with chronic illnesses or shift workers and take a broad view, the descriptions of fatigue are the same. Thus, while the reasons for fatigue may vary, the kinds of adaptations required may not."

Dr. Olson has created new definitions for tiredness, fatigue and exhaustion and argues that they represent various points on an energy continuum.

The amount of energy a person has influences how easily he can adapt to stress that comes his way.

Individuals who are tired still have a fair bit of energy, so although they may feel forgetful, and impatient, and experience gradual heaviness or weakness in muscles following work, this is often alleviated by rest.

Fatigue, on the other hand, is characterized by difficulty concentrating, anxiety, a gradual decrease in stamina, difficulty sleeping, increased sensitivity to light and the limiting of social activities once viewed as important.

Individuals with exhaustion report frank confusion that resembles delirium, emotional numbness, sudden loss of energy, difficulty both in staying awake and in sleeping and complete social withdrawal.

Not understanding the difference between tiredness, fatigue, and exhaustion may lead to use of inappropriate remedies that could end up causing more harm than good. For example, while exercise appears to help those who are tired, it may decrease the ability to adapt in individuals experiencing fatigue and exhaustion.

Likewise, Dr. Olson says, "long-term use of caffeine and other stimulants should also be avoided by people experiencing fatigue and exhaustion, as these substances 'fool' the body into thinking it has more energy available than it really does."

"The important thing is to try to prevent or at least delay the progression from tiredness to fatigue and then from fatigue to exhaustion," said Olson.

Of her research, Dr. Olson says, "We're a long way from having all the answers but this study was a start. It has provided us with a great foundation for future research among individuals with cancer and other groups ranging from 'burned out' workers to recreational athletes and people with chronic diseases."

I would add pilots and cabin crew to that list.