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Why Am I Still So Tired?

By Heather Millar

woman

It’s been two years since I finished active treatment, and yet I still feel that sometimes a phantom has sucked all my energy into the netherworld.

I get up every morning at about 6:45, prepare my daughter’s breakfast and lunch, make sure she’s got everything in her backpack, nag her to brush her teeth and her hair. Then, as soon as she’s out the door to drive to the bus stop with my husband, I go back to bed to nap for a half hour. OK, sometimes I nap for a whole hour.

I never used to do this! I’ve always been a morning person, the annoying sort who jumps out of bed ready to go for a run, to start work, to weed the front yard, or whatever. Now? Not so much. I’ve never been able to stay up at all hours, but I consoled myself by remembering all that I could accomplish in the early morning.  Now, it seems I can’t get up early either.

Cancer has made me a bed hog.

This week, on the local breast cancer listserv I follow, I was reminded that I’m not alone in this.  In a thread about fatigue, one woman who’s eight years past diagnosis complained that she’s still tired. So did a woman two years post treatment, like me, and of course, all the women who are slogging their way through surgery, chemo and/or radiation right now.

It’s not surprising that patients get tired during treatment. But why does that fatigue linger on for so long, for years and years post treatment? Apparently, it has to do with our “autonomic nervous system,” the nerve wiring that helps us do all kinds of things unconsciously, like breathing, or maintaining blood pressure or keeping the heart beating. This autonomic system has two parts: The “sympathetic” nervous system is responsible for the “fight or flight” response. The “parasympathetic” nervous system controls the opposite kinds of situations: resting, sleeping and so on.

As you might imagine, the sympathetic system is an energy hog.  After all, fighting and/or fleeing take energy! The parasympathetic system, responsible for rest, conserves energy. In healthy people, the two remain in balance and energy remains at normal levels.

But, in breast cancer patients and survivors experiencing fatigue, a 2011 study by Ohio State researchers found, the parasympathetic system has gone into overdrive, causing lingering tiredness. Researchers found that women complaining of decreased energy had higher levels or norepinephrine, a stress hormone, and higher variations in their resting heart rates, another indicator of stress.

The idea is that the profound stress of cancer treatment puts the body into a never-ending, albeit unconscious, “fight or flight” mode. Even if you’re not aware of it, your body may be going through its own background version of post-traumatic stress syndrome, as in “I didn’t fight off that scary threat that was chemo, so who knows what new threat might be just around the bend?”

There’s a whole literature on the possible biomarkers of cancer-related fatigue, of course. You can find a pretty understandable overview here, in the Google books version of the medical text Handbook of Cancer-Related Fatigue: What Does the Research Say?

The upshot is that stress, whether recognized or unconscious, is bad for your health. Studies have linked stress to cancer, to heart disease and many other afflictions. And we all know that cancer treatment is stressful.

If you’re struggling with fatigue, the book 100 Questions and Answers about Breast Cancer suggests conserving energy by spreading activity into small bursts throughout the day. Try to do tasks while seated. Ask for help with the most high-energy chores, like laundry.

And do everything you can to help yourself defuse stress. The Susan G. Komen Foundation has a very good overview of stress-reducing meditation techniques here. WebMD features a Stress Management Health Center, including 10 stress-reduction techniques here.

One of my fellow survivors reported that when she was at a meditation retreat, resting and thinking with few demands and meals provided at predictable times, she felt energized. When she returned to her normal, hectic life again, she felt overwhelming tiredness.

It’s a paradox, isn’t it, that when our lives most demand energy, the stress of those demands saps our energy?

At various stressful times in my life, I’ve taken time out to meditate. I guess it’s time to remember how to breathe deep.

Has cancer treatment made you tired? How did you fight the fatigue?

 

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