Are You Exhausted From A TBI?

Are You Exhausted From A TBI?


So one of the questions we get often from our clients who are asking, “What do I do with the victim that’s a loved one who is exhausted all the time? How do I deal with that?” One of the things that we always talk about is there’s two reasons that somebody who suffers from a traumatic brain injury is exhausted. One is they have difficulty getting REM sleep. Some people who suffer traumatic brain injury can’t get REM sleep at all. They can’t get it often or sometimes at all anymore. So it doesn’t matter how long they sleep, eight hours, 10 hours, they wake up and they feel just as terrible as they did before they went to bed, and it’s a really tragic, difficult thing. So people go, “Well, you’ve been sleeping all day,” or, “You’ve been sleeping all night. You’ve slept for 15 hours. How are you tired?”

The reason is it is directly related to REM sleep and the inability to get the same type of rest that a normal person gets after they suffer one of these injuries. So that’s one of the issues for exhaustion that needs to be analyzed. You need to be able to do a sleep study. You need them to be able to send them to a sleep specialist to try and figure out if there’s a way that they can provide some type of remedy to get them to get REM sleep, so they’re not exhausted all the time. That needs to be looked into. That’s one of the best ways to deal with some of the exhaustion.

Number two is they’re exhausted because it’s what is called cognitive fatigue. That’s the scientific name for it, but what it really means is they’re basically overwhelmed all the time. Think of the hardest test you ever took and then after you finished that, you had to remember all these different numbers and things and you get to the end of the day and you’re exhausted. People with a traumatic brain injury feel like that all the time. The reason for that is a normal brain has the ability to predict what’s coming next. As you’re listening to this video, I’m talking to you and everything’s going fine. You expect me to say more words. If I all of a sudden [inaudible] … snaps your attention to me doing something that you couldn’t predict. And all of a sudden, you’re really paying attention.

What’s interesting about people with a traumatic brain injury is they don’t predict what’s coming next. That way you just felt when you heard that is exactly how somebody who suffers a traumatic brain injury feels all day long. Everything’s new for them. They have no ability to predict what’s coming next and it makes them get to the end of the day, or sometimes even by mid-morning, they’re already so exhausted because they’ve been so focused on trying to figure out what’s coming next, what’s coming next, what’s coming next that they’re hyper alert. So when they’re exhausted, they have this combination of not having enough sleep or not having enough REM sleep. It doesn’t matter how much they sleep. They can’t get that really restful, “I wake up feeling great sleep.” They just can’t get it anymore.

And number two is they’re hyper alert. They’re very unable to predict what’s coming next. So they’re always trying to compensate by paying extra attention of what’s coming. Just like I clapped and all of a sudden, you’re very, very aware of what I’m doing. They can’t predict that and therefore, they’re tired all the time. So how do you deal with those things? Generally, the best way to do it is trying to develop habits and routines that reduce the ability for them to need to think about what’s next because it’s almost like doing the dishes or riding a bike. You’ve done it so many times that you don’t cognitively have to think about it. If you can get someone who suffered a traumatic brain injury to have a routine enough that it all of a sudden goes on autopilot, you can help reduce their cognitive fatigue or their general just exhaustion because they aren’t trying to predict what’s next because they’ve done it so many times, their body basically takes over.

So the two ways to deal with the biggest issues of fatigue are one, you address sleep through a doctor or sleep specialist. And two, the cognitive thing you want to find out, “Hey, what are the areas that are the most difficult for you?” And try and come up with some habits to either let them get through it by doing it because I’ve done it so many times, or they have someone helping them doing those specific things. Those are the two best ways to try and combat some of the fatigue that they always have. It’s why, again and again, people say, “I’m just exhausted all the time after this injury. I’ve never been there tired before.” That’s why.