When experiencing end-of-life, it can be challenging to manage fatigue. We provide suggestions on what can be done to help.

Fatigue is a feeling of extreme tiredness and lack of energy.

For people who are well, fatigue is often resolved by a good night’s sleep. But when you are ill, this may not be the case and you can wake in the morning feeling just as exhausted as you did when you went to bed. It can be very difficult to explain to those around you why you feel so tired despite rest and sleep.

Signs of Fatigue

• Feeling as if you have no energy and could spend the whole day in bed
• Feeling irritable and being unusually short tempered with family and friends
• Difficulty completing simple daily tasks, such as washing and dressing
• Shortness of breath on light exertion
• Difficulty concentrating
• Not enjoying the things you usually do, such as walking, reading or socialising with friends

It's not always possible to know what causes fatigue or why the symptoms may persist. But listed below are some common causes.

Common causes of fatigue

• The body using energy to fight disease
• Treatments such as chemotherapy, radiotherapy, surgery and medications. Immunotherapy in particular can cause fatigue that stays long after treatment is complete
• Disturbances in eating and sleeping habits
• Fatigue can be a symptom of anxiety or depression that accompanies illness
• Prolonged inactivity; reduced fitness

Advanced illness may cause fatigue due to:

• Psychological stress
• Pain
• Medications having a sedative effect
• Symptoms of severe illness such as vomiting and breathing difficulties
• Lack of nourishment. Efforts to eat and drink well may be only partly successful

• Tell your nurse or doctor - There may be something they can do to help and they may need to check for illnesses such as anaemia. They may also ask for permission to refer you to a physiotherapist or occupational therapist as they can offer more specialist advice.
• Rest and sleep - Try not to rest and sleep too frequently during the day. Try to go to bed at the same time each night and make sure your bed and pillows are as comfortable as possible.
• Increase your activity - Try to stay as active as you can without doing too much. You may feel as if you have no energy, but some moderate exercise such as walking around the garden will improve your circulation and this may help you to feel better.
• Improve nutrition - Drink plenty of fluids and eat a well-balanced diet. Energy-giving foods are also important. So try to eat food that is high in energy (e.g. potatoes or sweet food). If you cannot face normal-sized meals, eating little and often may be better for you.
• Look after yourself - Relaxation may help with feelings of stress and tension and may help to increase energy levels. If you are finding it difficult to manage, tell your doctor or nurse.
• Plan ahead and establish your priorities - Set yourself realistic, achievable goals.
• Have a warm drink before bed - This may help you to sleep. Be sure to avoid caffeine.
• Consider accepting help when it is offered - Also make sure you spread activities over a period of time rather than trying to do them all at once.
• Place chairs around the house - Sit and rest when you need to.
• Shower when you can - Have a shower every other day and on alternate days, or have a wash at the bathroom sink – this often requires less energy.
• Tell your family and friends how you are feeling - This will also let them know you may not be able to do all the things you are used to doing. This will allow them to help you with activities and jobs that you would still like to do.

Always remember that fatigue is a very real symptom that requires attention. It may be more difficult to quantify than other symptoms, but it is important it is not ignored. There are a variety of ways to manage and address fatigue that can significantly improve the quality of your life.

If you have benefited from this information and would like to share it with others, then please do – we want more people to feel comfortable facing the issue of palliative care.