"I'm Tired, Too!"

If you have a chronic lung disease, such as COPD, you are probably familiar with feeling tired. But the word “tired” likely doesn’t even describe how you feel. The unrelenting exhaustion of chronic illness, or fatigue, is difficult to put into words but can be a very real part of life with lung disease.

Fatigue can be frustrating because, not only may you be lacking the energy to take part in all desired aspects of your life, but people around you who do not have a chronic illness might not understand why you make the choices you do to conserve energy. When you share how exhausted you are with others, you may be met with the phrase, “I’m tired, too,” or “We’re all tired sometimes.” But feeling fatigued from chronic lung disease is more than just feeling sleepy or lacking energy after a night of poor sleep.

The Dangers of Fatigue

Fatigue refers to general tiredness and lack of energy. However, it is important to note that fatigue is more than just “feeling tired.” "Fatigue is a daily lack of energy, lethargy, brain fog, weakness, heaviness, tiredness, that is not relieved with sleep,” says American Lung Association Volunteer Medical Spokesperson Jamie Garfield, M.D. “Fatigue can be long lasting and severe. Whereas tiredness is common, and everyone experiences it at some point, it is predictable, and it is relieved with sleep.”

Chronic lung disease, such as COPD, can cause extreme fatigue because your body is working so much harder to accomplish basic bodily functions like breathing compared to those without lung disease. COPD-related fatigue, for example, can be caused by factors such as oxygen deprivation, overall reduced strength and endurance and complications or comorbidities such as heart failure or depression.

Fatigue is the second most common symptom patients with COPD report; however, it remains underdiagnosed and undertreated. This is unfortunate because over time, chronic fatigue can impact physical and mental well-being. Feeling fatigue can interfere with your ability to perform daily tasks such as cooking or dressing and enjoy the fun activities in your life.

“Fatigue can affect quality of life,” says Dr. Garfield. “[Fatigue can impact] the ability to exercise and to be active, to be productive and to work, to think clearly and to have [good] mental health.” Dr. Garfield describes chronic fatigue, saying that some people may experience shortness of breath, pain, headaches or even digestive problems. “Chronic fatigue is often misdiagnosed as depression,” she says, “but it is its own entity.”

How to Manage Fatigue

Chronic disease-related fatigue can be difficult to manage because this kind of exhaustion won’t be fixed with a cup of coffee or even a great night’s sleep.

However, there are ways to manage your fatigue:

• Engage in a healthy lifestyle:
  Although it may not seem like it, regular exercise can help keep your strength and endurance up and help limit fatigue. Exercise can also help slow the progression of bothersome symptoms from chronic illnesses such COPD. In addition, making sure to have a healthy diet and drink plenty of water are also key to keeping fatigue at bay.
• Try breathing exercises:
  With your chronic lung disease diagnosis, you may be referred to pulmonary rehabilitation. These breathing professionals can help you with breathing exercises—such as belly breathing and pursed lips breathing—to increase lung function and reduce fatigue. Or you can watch our online videos to demonstrate the skill.
• Plan ahead:
  If you know you will be participating in activities that will cause you great fatigue, plan ahead. You can schedule rest breaks into your day, bring supplemental oxygen if it is prescribed and look into options for transportation if you need to reduce your physical activity. With a plan in place, you can take steps to ensure fatigue won’t ruin your day.

Dr. Garfield says, “treatment for chronic fatigue should focus on symptom relief.” Specifically, she says “education, stretching, breathing exercises, physical therapy including pulmonary rehab, diet and exercise, meditation and pain control when appropriate.”

Spoon Theory

Despite your best efforts, there may be days when fatigue gets the best of you. Patients with COPD often refer to these as good days and bad days but acknowledging a likely reason for these differences can help put things in perspective. Chronic illness can be exhausting, both physically and mentally, and that is not always easy to explain to other people.

One way you can help others (and yourself!) understand chronic illness-related fatigue is through the “Spoon Theory.”

The spoon theory is from a personal story written by Christine Miserandino, who explains her energy related to her chronic illness through the metaphor of having a certain number of “spoons” which represent energy. For example, someone without a chronic illness may have 10 spoons per day, while someone living with COPD may only be living with five spoons per day. In addition, for someone with chronic lung disease, certain activities may take more spoons of energy to complete than someone with normally functioning lungs.

If you find your friends or family are having a hard time making sense of your fatigue, explaining your energy levels through the Spoon Theory can make it easier to understand. And, when your loved ones understand what you’re feeling, they may be able to help more.

Dr. Garfield echoes this, saying that fatigue can feel isolating and discouraging. "Family members can support their loved ones who have been diagnosed with fatigue . . . in the form of being educated on the diagnosis, [motivation] and acceptance. For others, support is help,” she says. She encourages those who have a loved one living with chronic lung disease-related fatigue to “ask your loved ones what they need because everyone is different.”

To learn more about chronic lung diseases such as COPD, visit Lung.org/lung-disease