Worn Out, Burned Out or Vegged Out? A Guide to Understanding and Overcoming Exhaustion
Exhaustion is the silent scream of your body begging for a break. It's something we've all experienced before. But what does that mean?
The medical definition of exhaustion is a state of extreme fatigue or weariness; a loss of vital powers or inability to respond to stimuli.(1) In fact, I found it difficult to find medical definitions of exhaustion. Instead the word fatigue is the commonly used medical term.
What is exhaustion? Feeling tired is a common experience. It can be caused by disrupted sleep habits, a change in routine, or the appearance of stressors in your life. No matter the reason, tiredness can push us to our limits emotionally and mentally. In some cases, extreme tiredness sets in. How can you tell if you’re tired or exhausted?
Exhaustion, also known as fatigue, becomes a problem when it continues day to day, affecting your health and safety. Exhaustion isn’t a mental disorder. But it can be caused by anxiety, depression, bipolar disorder, neurological and sleep disorders, anemia, electrolyte abnormalities, diabetes, obesity, and/or an infectious disease or cancer.(2)
What is fatigue? Fatigue is a lingering tiredness that is constant and limiting. With fatigue, you have unexplained, persistent, and relapsing exhaustion. It's similar to how you feel when you have the flu or have missed a lot of sleep. If you have chronic fatigue, or systemic exertion intolerance disease, you may wake up in the morning feeling as though you've not slept. Or you may be unable to function at work or be productive at home. You may be too exhausted to even manage your daily affairs.(3)
Fatigue is a very common problem, and can also be a symptom of many different diseases, so if you find you are suddenly fatigued or fatigued for a period of time you should get that checked out. Fatigue is also the result of stress.
Recognizing the strengths and limitations of our modern proclivity for pathologizing, I ask, is exhaustion both medically and clinically defined?
Is there/what is the clinical definition or diagnosis of exhaustion?
The closest thing I found was Chronic fatigue syndrome (CFS) characterized by profound tiredness, regardless of bed rest. Its symptoms may worsen with physical or mental activity. CFS can happen suddenly and last for years. What causes chronic fatigue syndrome? The cause is not known.(4)
I’ll say that again. Officially, medically, the cause of CFS is unknown. That’s why it’s classified as a syndrome.
But actually the Swedes, via the British Health Service Canopi, have something to say about this, too.
What happens if we are exposed to high levels of stress without taking time to manage our wellbeing? The result can be a stress-related exhaustion disorder (ED). (5) It’s not just fatigue. Exhaustion disorder is not simply feeling ‘tired’. It is defined as ‘a clinical condition characterized by psychological and physical symptoms of exhaustion developed in response to long-term psychosocial stress’ (Grossi et al., 2015). Mental and physical exhaustion has distinct signs that impact our day-to-day functioning and ‘cognition’ including executive function, working memory, attention and processing speed (Gavelin et al 2020). If we are already in a cycle of stress-related exhaustion, are having difficulty making decisions, remembering important tasks and problem solving, then the cycle may continue without proper intervention.(6)
So, now exhaustion and fatigue have moved from being a “syndrome” to a possible “disorder”.(7)
What is the difference between a syndrome and disorder?
A syndrome is a recognizable complex of symptoms and physical findings which indicate a specific condition for which a direct cause is not necessarily understood.(8) A disorder refers to a group of symptoms involving abnormal physiological functioning, such as metabolic disorders, or a disruption in psychological functioning, such as mental health disorders. The cause of a disorder is not always known.(9)
Confused about the difference? The medical community is too. What do they have in common? The cause is often unknown.
But, what do we know? Stress and disease causes exhaustion. Stress both contributes to and is the result of disease.
More on that later, now I want to stay focused on fatigue and what to do about it.
You have probably heard the expression, “Begin again.” As it turns out while I was researching this topic, the first module in the very first course I took with Kristine Weber of Subtle Yoga called The Science of Slow addressed fatigue. (I actually didn't go looking for it, I was organizing some three ring binders and lo and behold there it was. I love synchronicity!)
Here are the cliff notes: (10)
A Holistic Approach to Fatigue
Engaging in slow, mindful yoga stands as a potent self-care tool for those grappling with fatigue, especially when combined with dietary improvements, enhanced sleep hygiene, and overall stress management. This approach aligns with Ayurveda, lifestyle medicine, and even the VA’s Whole Health philosophy. Research indicates that yoga significantly enhances fatigue, particularly in conditions like fibromyalgia and cancer.
In Ayurveda, individuals are comprised of three constitutions: Vata, marked by a thin frame, dryness, coldness, nervousness, and joint cracking; Pitta, characterized by a hot, fiery nature, athletic build, quick-mindedness, and a leaning towards frustration and anger; and Kapha, associated with solidity, a tendency towards depression, and lethargy during imbalances.
Fatigue can be envisioned through three packages: Vata, prone to weariness from excessive activity get worn out; Pitta is susceptible to burnout; and Kapha are inclined to veg out. Considering fatigue in these three ways provides insights into potential strategies for helping individuals shift their energy levels.
Consider a student feeling drained who believes or has been advised that intense, fast-paced exercise is the solution, especially for those with a Kapha dosha or experiencing sluggish fatigue. However, many individuals may actually be burned out Pitta doshas or worn-out Vata doshas.
Slow practices offer a distinct approach compared to gym workouts or fitness-based yoga, working to decrease sympathetic activity in the autonomic nervous system and boost the parasympathetic activity, known as the rest and digest response.
Fatigue serves as the body's plea for more rest, a signal often overridden in Western culture. Slow, mindful practices actively respond to the body's needs, countering fatigue and exhaustion. These practices possess the potential to shift the brain and nervous system, inducing neuroplastic changes distinct from “relaxation activities” like drinking alcohol or watching Netflix.
The Nervous System
The nervous system operates through the sympathetic and parasympathetic systems. The sympathetic system, located close to the spine, acts like a light switch, instantly triggering the body's stress response. On the other hand, the parasympathetic system, situated nearer to the organs, functions more like individual phone calls, allowing for specific switches to be activated at a more gradual pace. It sends messages when we chill out that it’s now okay to digest food or eliminate waste. Unlike the rapid on-and-off response of the sympathetic system, the parasympathetic system engages in a slower, more deliberate manner. This highlights the effectiveness of yoga practices that unfold gradually, providing the time needed to stimulate the parasympathetic response and promote a gradual, holistic relaxation.
The Vagus Nerve, Cranial Nerve 10 (the largest nerve of the parasympathetic nervous system)
“It basically does two things. The first that it helps us to tend and befriend ourselves and others and that's typically in the ventral part of the vagus nerve which is above the diaphragm and then the dorsal part of the vagus below the diaphragm is where we get into that rest and digest response.”
Tend and Befriend → Rest and Digest
In essence, the process of Tend and Befriend requires time, consciousness, and intentional effort, primarily engaging the front brain. This leads to the profound Rest and Digest response, deeply embedded in the system, less responsive to mere cognitive shifts. Operated by the parasympathetic nervous system, also known as the social engagement system, it represents an evolutionary mechanism for fostering safety and balance in the nervous system.
During moments of stress, seeking downtime becomes crucial, especially when it involves pleasurable and interactive activities with trusted individuals, inducing the Tend and Befriend response. Whether through shared meals, laughter, dancing, or yoga, these experiences contribute to a sense of safety, allowing the nervous system to transition into relaxation mode.
This mode can also be achieved independently through practices like yoga postures, nature walks, prayer, meditation, breathing exercises, or connecting with one's higher power or supportive presence. Yoga, in particular, serves as a powerful avenue to cultivate the Tend and Befriend response, promoting self-love, compassion, and kindness, ultimately reaping benefits for the nervous system.
t's crucial to distinguish active Tend and Befriend from numbing out with substances and TV. Practices such as mindful breathing and slow movements actively stimulate neuroplastic changes. While we can consciously invest in nurturing Tend and Befriend, the Rest and Digest response operates deeply within the brain, primarily in the brainstem and midbrain. We can't just tell our body to digest its food. Embracing the Tend and Befriend approach serves as the pathway Rest and Digest.
Exercise and “Innercise” and Unique Benefits of Tend and Befriend
Practicing tend and befriend regularly is like “innercise. I call this resilience yoga, and it's quite different, but also complimentary –there is certainly crossover with exercise. Where as exercise is about building strength and flexibility and stamina, “innercise” is about building a relationship with your nervous system, increasing tend and befriend response, improving physiological balance and increasing mental health. The goal of cardiovascular exercise is fitness. The goal of innercise tends to be creating greater nervous system resilience. And as I said these things certainly cross over, but they also have some unique properties, and it's very important to understand the difference between fitness and slow mindful exercise because the research is continuing to show there are unique benefits.
Practice Points for Fatigue
Start where someone is and move toward a more energized state.
Start from supine.
Move slowly and gradually to standing poses.
“The pause is as important as the pose.”
Focus on gently increasing inhales (but never longer than exhales) or pausing at the top of inhales.
Spinal extension poses and lateral bends can be useful, but get there slowly.
Endnotes:
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. S.v. "exhaustion." Retrieved November 27 2023 from https://medical-dictionary.thefreedictionary.com/exhaustion
In September 2022, BJPsych Open published, “Exhaustion disorder: scoping review of research on a recently introduced stress-related diagnosis” with the aim to “create the first comprehensive synthesis of research on exhaustion disorder to report on the current state of knowledge”, concluded, “More research is needed to build a solid knowledge base for exhaustion disorder. International collaboration regarding the conceptualisation of chronic stress and fatigue is warranted to accelerate the growth of evidence.”Lindsäter, Elin et al. “Exhaustion disorder: scoping review of research on a recently introduced stress-related diagnosis.” BJPsych open vol. 8,5 e159. 24 Aug. 2022, doi:10.1192/bjo.2022.559, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9438479/
https://canopi.nhs.wales/eight-signs-of-exhaustion-that-you-shouldnt-ignore/
DSM-5 definition of mental disorder: A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or development processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities.
Calvo, Franz et al. “Diagnoses, syndromes, and diseases: a knowledge representation problem.” AMIA ... Annual Symposium proceedings. AMIA Symposium vol. 2003 (2003): 802. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1480257/#:~:text=A%20syndrome%20is%20a%20recognizable,cause%20is%20not%20necessarily%20understood.
https://www.painscale.com/article/syndrome-condition-disorder-or-disease
“The Science of Slow.” Subtleyoga.com.
