1. Fatigue and IBD Debbie Pullen Liaison Mental Health Nurse Liaison Psychiatry

2. Background IBD affects 3.6 million people worldwide & 240,000 in the UK Fatigue is common in IBD Leading concern for IBD patients- during remission 40% of people affected Multifaceted, unpleasant, distressing Subjective and poorly understood Fatigue is poorly managed

3. Definition of fatigue An overwhelming sense of unrelenting tiredness, lack of energy or feeling of exhaustion that is not relieved following rest or sleep

4. Reasons for fatigue Pain Anaemia due to malabsorption of vitamins and minerals Sleep disturbances – many causes! Side effects of medication eg steroids which can make people feel “wired” or other medications which cause drowsiness

5. Reasons for fatigue cont Changes in mood eg depression Stress levels Disease activity eg inflammatory processes cause fatigue

6. Managing fatigue Compare energy to a battery Healthy person = charged battery Need to ration energy Need to learn how to increase energy eg relaxation Relying on emergency supplies

7. Consider how you are spending your energy Physical, emotional, mental, social Tasks depend on many things – where/when you do it, previous experience, people present etc

8. Patterns of energy use Demonstration of boom and bust

9. Pacing and grading Pacing activities across the day to minimise energy use Intersperse activity with frequent rest Know when to stop – stopping distances Need to break activities down into smaller parts to make them easier Mix and match

10. Process of grading is to increase activity levels Progress is up a staircase not a hill Takes time so be patient

11. Managing energy Look at ways at either reducing demand or improving supply

12. Improving supply Need to look at increasing activities that are fun or give a sense of achievement Ignore the guilt!

13. Decreasing demand Demands from family, work, running a house etc Also come from pressure of meeting own standards or expectations May need to ask for help Work Professional Financial support and benefits Self management programmes

14. Managing sleep Practise good sleep hygiene set routine get up if cant sleep Manage environmental factors (noise, light, have change of clothes or bedding at hand etc) Exercise (not too late)

15. Sleep Write down troubling thoughts Carry out relaxing activities Avoid caffeine and alcohol Don’t use computer or TV in bed Avoid napping in day Avoid looking at the clock

16. Improving energy Keep active and consider exercise Consider diet Don’t stop doing activities you enjoy although may have to modify Prioritise tasks but be realistic ie don’t take on too much Plan your week to allow rest periods

17. Set simple realistic goals Minimise stress Practise relaxation Consider learning breathing techniques, mindfulness, yoga, relaxation CDs etc.

18. Reflective Group Activities

19. Where to access help? If you feel you are in need of help for any aspect of your mental health you can access counselling and therapy services through your GP. Just visit them and ask to be referred If you feel you are not coping with IBD at all and would like help – liaison psychiatry can be accessed through your local IBD nurse