Fatigue fatigue fatigue, that is what people with brain injury often experience.

Everything takes effort. The energy for the whole day is often consumed completely within two hours. There are many brain injury victims who have insomnia on top of this all. Another group of brain injury survivors have an increased need for sleep. But the similarity is FATIGUE.

Mental fatigue is different from physical fatigue.
We can all understand what people mean when they're talking about physical fatigue. Feeling tired after exercising, taking a brisk walk, doing housework, or after strenuous activity etc.

But mental fatigue can be harder to explain. It is because the brain uses its informational processing abilities, either by concentrating intensely like when you learn something new or solve a complex problem, or by doing something for a long time like watching TV extensively.

Healthy people can feel mentally tired. Usually that feeling occurs at the end of a full and active day or after a long session of intense concentration, like studying for an exam. Oftentimes people notice their mental fatigue when they've become sensitive to sound. Noise from the radio becomes too distracting or an alarm going off gives them a headache. They may feel like they need to have things quiet for a while to recharge.

For brain injury victims that is many times worse. The mental energy has already been exhausted after a short time. They use more parts of the brain, because the dead area must be passed by, in the communication between brain cells.


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Neuro-fatigue is one of the most debilitating consequences of a brain injury, as it influences everything the injured person does, both physically and mentally. A person’s emotions can also become raw when they are tired.

At the beginning, the brain injury survivor is likely to find out that he or she will be tired easily after any activity, even chatting to friends or watching television, but particularly after tasks that require concentration or physical effort. This can be very depressing, particularly if the individual is aware of this change.

They will often try to push themselves to complete a task in the belief that they might overcome their fatigue. This is seldom the right thing to do as it can lead to increased fatigue in the long-term. It takes time to build up energy and stamina. Taking frequent periods of rest both in between activities and when feeling tired is essential.


More brain activity in brain injury patients


Scientists have discovered that the brain of a brain injured person works harder and uses more brain cells to process information more nerve activity is shown.

More brain areas are involved in performing normal activities than before the brain injury. That difference can be seen with PET scans. Parts of the brain that normally show little activity while performing a specific action now become actively involved in the brain's functioning after the injury.

This requires many extra bypasses and consumes more energy to complete. Therefore, the reaction time of a brain injured person is often a bit slower and it requires more energy to reach the same point. It can make someone really tired.

The definition of fatigue in the scientific literature: "the sense of a reduction in the capacity for physical and / or mental labor, caused by an imbalance in the presence, the use and / or recovery of energy that is needed to perform activities" Aaronson et al (1999)

To have brain injury is like being a top athlete. It deserves respect.


Fatigue management


Fatigue management is the starting point towards recovery. In order to manage fatigue, a person first needs to accept that they don't not have the same physical and mental stamina that they had before the accident.


Signals that the battery is running low


At some point during the day a brain injured person may get noticable signals that their battery is running low.

Signs of fatigue can be a drawn, a tense look, a pale or greyish pallor, glazed eyes, irritability and, ironically, too much activity. (the person may become restless, more distracted or more talkative and make an increased number of mistakes.)

For example, he notices that he is tired, makes more mistakes or loses concentration. These are all signs that let you know that the bottom of the battery is in sight. It's time to take a rest so that the battery can charge again.


Signals That It's Time to Rest


Pay attention to bodily signals

Do you get headaches, do you feel dizzy or feel a tension in neck and shoulders? Is the pace going down or do you make more mistakes than usual?


Check in with your thoughts and feelings

Are you feeling cranky or irritated? Have you lost interest in something you normally enjoy? Do you have feelings of hopelessness or thoughts that say "I can't take it anymore?" or "I can't do this?"

These are signs that you need to stop what you're doing and rest.

When your battery is low it can be very hard to determine if you're experiencing these signals. So, it can be helpful to ask a family member or friend if they notice any of these signs in your behavior.




Sleeping disorders


Many brain injured persons suffer from sleeping disorders as well.

It can be hard to distinguish between fatigue that comes from a damaged battery and the fatigue that comes from a sleep disorder.

Read the factsheet about sleeping issues on

Or read our page on CSAS.

Lack of sleep has a negative effect on our cognition, mood, energy levels and appetite. The average person needs eight hours of sleep a night or they will suffer from decreased concentration, energy and many other problems. These effects are multiplied many times by a brain injury.

Unfortunately, brain injury can often lead to a sleep disorder. The American Academy of Neurology reports that as many as 40-65% of people with mild traumatic brain injury complain of insomnia.

Sleep disorders can be hard to detect because people with brain injuries can also have a fatigue disorder. Although some may have problems with getting too much sleep, the usual type of sleep disorder is trouble sleeping at night, particularly problems with the timing or amount of sleep.


These people are very easily awakened, sometimes dozens of times a night. Sleep can be light and sufferers may find it very difficult to go back to sleep once they've been woken up despite feeling very tired.

Research suggests that a major cause is a disruption to normal releases of certain neurotransmitters in the brain which causes "sleep fragmentation".

There can be a variety of other causes which disrupts your sleep. Discomfort from a headace, neck pain, or back pain can make it hard to get to sleep. Depression is a common feature after a brain injury and survivors may find they fall asleep easily but wake up several hours before dawn, unable to sleep again. Anxiety and inability to handle stress are other problems that many people experience. Negative thoughts whirring through the mind will usually make it very hard to fall asleep.



References and further information



Resources: Brain injury-explanation, Rehabilitation centre de Hoogstraat, Cognitive Therapy (Joke Heins, Rose Sevat, Corine Werkhoven), stroke association of The Netherlands