What Causes The Fatigue?

[Anoj]

Is there anything we can pinpoint to help explain to others? Perhaps to help educate other doctors? Or educate our family members, etc.?

Is this caused by lack of oxygen to the brain?

Are we worn out because of the tachy?

It is because of lack of blood circulation?

Is it positional?

I would love to be able to explain this articulately. I would also love to avoid the term "chronic fatigue," as I feel this condition (POTS/OI) is what causes my fatigue.

Thanks!

[issie]

There seems to be such a close connection to CFS I think that many on the CFS forums have a form of dysautonomia. Now which came first????? That we don't know. But, there may be some things that may help CFS and therefore would help forms of dysautonomia or vica-versa. I think keeping a watch on CFS/ME and POTS/OI there will be some very close connections to the two. Find a cure for one and you may well be on your way to a cure for the other. I don't think there is a definite answer to your questions. I'd say possibly all of the things you wonder - could be a possible answer. But, I think there's too much yet unkown to make a final, definite, absolute answer to this questions. I hope one day there will be an answer.

Issie

[klgpdx]

Here's how I have heard it explained, which seems to work for me when I explain it to people:

"Imagine jogging all day long, every day, and you can't stop even if you want to. Sounds pretty tiring, doesn't it? That's what it's like to have POTS." And then of course I have friends who run marathons, and my husband is a professional cyclist, but even athletes need recovery days.

It's not an answer to your question exactly, but it may help people empathize.

[Anoj]

thanks. i would just love to be able to explain why i can't be active in any way shape or form without hours of rest in preparation or hours of rest after the fact. even to myself. lol.

[firewatcher]

I have read several articles that postulate that the fatigue is as central as the nervous system itself. Our nervous system is hypersensitive to pain and fatigue, so that what a "normal" person would feel/respond to is bone-crushing for us. We also cannot marshall the correct bodily responses to recover properly since our bodies are always in "crisis"/fight or flight mode. There is also a non-restorative sleep aspect to dysautomia/POTS, where even if we slept all day it isn't the same as eight hours of "normal" sleep. I know that a great deal of my fatigue is from pain and circadian rhythm disruption. I am not as tired when I can sleep to my own schedule.

[firewatcher]

Best Pract Res Clin Rheumatol. 2011 Apr;25(2):141-54.

Central pain mechanisms in chronic pain states--maybe it is all in their head.

Phillips K, Clauw DJ.

Source

University of Michigan, Ann Arbor, MI, United States. kphill@med.umich.edu

Abstract

Mechanisms underlying chronic pain differ from those underlying acute pain. In chronic pain states, central nervous system (CNS) factors appear to play particularly prominent roles. In the absence of anatomical causes of persistent pain, medical sub-specialities have historically applied wide-ranging labels (e.g., fibromyalgia (FM), irritable bowel syndrome, interstitial cystitis and somatisation) for what now is emerging as a single common set of CNS processes. The hallmark of these 'centrally driven' pain conditions is a diffuse hyperalgesic state identifiable using experimental sensory testing, and corroborated by functional neuroimaging. The characteristic symptoms of these central pain conditions include multifocal pain, fatigue, insomnia, memory difficulties and a higher rate of co-morbid mood disorders. In contrast to acute and peripheral pain states that are responsive to non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, central pain conditions respond best to CNS neuromodulating agents, such as serotonin-norepinephrine reuptake inhibitors (SNRIs) and anticonvulsants.

Copyright © 2011 Elsevier Ltd. All rights reserved. PMID: 22094191 [PubMed - indexed for MEDLINE] PMCID: PMC3220875

[firewatcher]

Behav Brain Funct. 2011 Oct 27;7:46.

Autonomic nervous alterations associated with daily level of fatigue.

Tanaka M, Mizuno K, Yamaguti K, Kuratsune H, Fujii A, Baba H, Matsuda K, Nishimae A, Takesaka T, Watanabe Y.

Source

Department of Physiology, Osaka City University Graduate School of Medicine, Osaka, Japan. masa-t@msic.med.osaka-cu.ac.jp

Abstract

BACKGROUND:

Fatigue is a common symptom in both sick and healthy people. We examined autonomic nervous alterations associated with fatigue to clarify the mechanisms underlying fatigue.

METHODS:

The study group consisted of 19 healthy participants who performed a 2-back test for 30 min as a fatigue-inducing mental task session. Before and after the session, they completed the advanced trail making test (ATMT) for 30 min for mental fatigue evaluation, subjective scales to measure fatigue sensation, and underwent electrocardiography to allow assessment of autonomic nerve activities.

RESULTS:

After the fatigue-inducing task, the total error counts on the ATMT tended to increase (P = 0.076); the ATMT for total trial counts (P = 0.001), the subjective level of fatigue (P < 0.001), and the % low-frequency power (%LF) (P = 0.035) increased significantly; and the % high-frequency power (%HF) decreased compared with before the fatigue-inducing task although this did not reach the statistical significance (P = 0.170). Although LF measured in absolute units did not change significantly before and after the fatigue-inducing task (P = 0.771), and HF measured in absolute units decreased after the task (P = 0.020). The %LF and LF/HF ratio were positively associated with the daily level of fatigue evaluated using Chalder's fatigue scale. In addition, %HF was negatively associated with the fatigue score.

CONCLUSIONS:

Increased sympathetic activity and decreased parasympathetic activity may be characteristic features of both acute and daily levels of fatigue. Our findings provide new perspectives on the mechanisms underlying fatigue.

PMID: 22032726 [PubMed - indexed for MEDLINE] PMCID: PMC3214128 Free PMC Article

[firewatcher]

Clin Sci (Lond). 2012 Feb;122(4):183-92. doi: 10.1042/CS20110200.

Neurohumoral and haemodynamic profile in postural tachycardia and chronic fatigue syndromes.

Okamoto LE, Raj SR, Peltier A, Gamboa A, Shibao C, Diedrich A, Black BK, Robertson D, Biaggioni I.

Source

Vanderbilt Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN, U.S.A.

Abstract

Several studies recognized an overlap between CFS (chronic fatigue syndrome) and POTS (postural tachycardia syndrome). We compared the autonomic and neurohormonal phenotype of POTS patients with CFS (CFS-POTS) to those without CFS (non-CFS-POTS), to determine whether CFS-POTS represents a unique clinical entity with a distinct pathophysiology. We recruited 58 patients with POTS, of which 47 were eligible to participate. A total of 93% of them reported severe fatigue [CIS (Checklist of Individual Strength), fatigue subscale >36], and 64% (n=30) fulfilled criteria for CFS (CFS-POTS). The prevalence of CFS symptoms (Centers for Disease Control and Prevention criteria) was greater in the CFS-POTS group, but the pattern of symptoms was similar in both groups. Physical functioning was low in both groups (RAND-36 Health Survey, 40±4 compared with 33±3; P=0.153), despite more severe fatigue in CFS-POTS patients (CIS fatigue subscale 51±1 compared with 43±3; P=0.016). CFS-POTS patients had greater orthostatic tachycardia than the non-CFS-POTS group (51±3 compared with 40±4 beats/min; P=0.030), greater low-frequency variability of BP (blood pressure; 6.3±0.7 compared with 4.8±1.0 mmHg2; P=0.019), greater BP recovery from early to late phase II of the Valsalva manoeuvre (18±3 compared with 11±2 mmHg; P=0.041) and a higher supine (1.5±0.2 compared with 1.0±0.3 ng/ml per·h; P=0.033) and upright (5.4±0.6 compared with 3.5±0.8 ng/ml per h; P=0.032) PRA (plasma renin activity). In conclusion, fatigue and CFS-defining symptoms are common in POTS patients. The majority of them met criteria for CFS. CFS-POTS patients have higher markers of sympathetic activation, but are part of the spectrum of POTS. Targeting this sympathetic activation should be considered in the treatment of these patients.

PMID: 21906029 [PubMed - indexed for MEDLINE] PMCID: PMC3203411 Free PMC Article

[Anoj]

I have read several articles that postulate that the fatigue is as central as the nervous system itself. Our nervous system is hypersensitive to pain and fatigue, so that what a "normal" person would feel/respond to is bone-crushing for us. We also cannot marshall the correct bodily responses to recover properly since our bodies are always in "crisis"/fight or flight mode. There is also a non-restorative sleep aspect to dysautomia/POTS, where even if we slept all day it isn't the same as eight hours of "normal" sleep. I know that a great deal of my fatigue is from pain and circadian rhythm disruption. I am not as tired when I can sleep to my own schedule.

it's interesting that you said that about sleep. my doc wants me to have a sleep study. i'm kind of annoyed that he doesn't seem to relate all of these things together. can you explain why people with POTS have bad sleep? you can PM me if necessary.

[firewatcher]

Again, there was a recent article out of Vanderbilt on this one. http://www.ncbi.nlm.nih.gov/pubmed/21509337

Dysautonomians/Dysautonomiacs can have several sleep disturbances: obstructive apnea, central apnea, circadian rhythm disruption, and many others. I know that my sleep improved dramatically once the sympathetic overdrive was better controlled. With all the norepinephrine/epinephrine running through the system, it was like trying to sleep while being chased by a bear! There was just no way, the slightest noise would wake me...if I slept at all. Make sure you get a good sleep specialist, not just some pulmonologist looking for apnea. My sleep doc is one of my favorites and also one of my best advocates. He has told me that my symptoms will probably improve once I can sleep better (once the kids leave home,) but until then things will just be rough!

[Dizzysillyak]

I found supplements that help me sleep a few years ago so I'm good there. BUT I'm still getting too tired / weak when I'm upright. I feel energized just from laying down for an hour so Imho, it seems my body doesn't deal well with hypoperfusion.

[issie]

Firewatcher, I really appreciate all the articles you listed. I have known that part of my sleep issues are due to pain and that's one reason the doctors gave me the Tramadol and Bentyl because it helps with pain. It also works on noriepi levels and lowers them (therefore you don't have as much of the fight or flight response) and it also works on serotonin and dopamine - so that is also affected. I also had a sleep study and have apnea - which is hard to deal with the cpap - but, has greatly improved my sleep (when I'm not fighting with the headgear). With central sleep apnea - your brain doesn't tell you to breathe and it's important to have something forcing you to breathe and getting oxygen to your brain. You still wake up tired a lot of the time - so it's not the complete answer to the problem. I appreciate that there are studies confirming the things I've suspected and told my doctors. If I can get out of pain and get my body to relax and breathe at night - I do sleep better. These things have greatly helped - but, still not the complete answer. I have found though that using the clonidine which affects the CNS (sympathetic system) and using magnesium at night has been of a big benefit to me. (Still working on the right strength of the clonidine though - so not got it figured out completely yet. But, seeing improvements.)

Thanks again for the articles - this will be a thread that will be printed and put in my file.

Issie