Treating CFIDS & Fibromyalgia

Lifting the Fog: Treating Cognitive Problems

www.cfidsselfhelp.org

(Fourth in a series on treatment options for major symptoms of CFS and fibromyalgia. Other articles discuss fatigue, pain, and poor sleep.)

By Bruce Campbell

Most CFS patients and many people with fibromyalgia experience cognitive difficulties, often called “brain fog” or “fibro fog.” These problems include confusion, difficulty concentrating, fumbling for words and lapses in short-term memory. 

Cognitive problems are sometimes treated with stimulants, such as Provigil or Modafinil, but these medications may produce a push/crash cycle. In the words of one patient, "Taking stimulants is like borrowing energy you don't really have. You feel better while you're on it, but when it wears off, you crash." This article outlines 15 non-drug strategies for lifting the fog.

Match Response to Cause

Like the symptoms discussed in other articles in this series, brain fog can have several causes. Use the strategies for those causes that apply to you.

1. Overexertion: Cognitive difficulties can be caused by overactivity and can be reduced by living within the limits imposed by your illness. As one person in our program said, “Brain fog helps me to recognize when I’m outside my envelope. Even if I don't feel tired, the fact that I can’t think clearly tells me that I am beyond my limit. My response is the same as that for other symptoms: rest and pacing.” You may be able to limit the duration of brain fog by responding to it as soon as you notice it. A rest of 10 or 15 minutes is enough for some patients.

2. Poor Sleep: The problems associated with fog are found in people who are sleep-deprived. Getting restorative sleep can help limit cognitive problems.

3. Stress and Emotions: Stressful situations and strong emotions can trigger or intensify brain fog. This effect occurs whether the emotion is positive or negative. If an experience triggers adrenaline, it is likely to cause cognitive problems. You can reduce fog by avoiding stressful situations, learning how to relax in response to stress and by training yourself to mute the production of adrenaline.

4. Multi-tasking: Many patients experience fog when they try to do more than one thing at a time, such as reading while watching TV or talking on the phone while fixing dinner. The solution: do one task and postpone the other.

5. Over-stimulation: Patients are often sensitive to noise, to light or to sensory input coming from several sources at the same time, for example a TV in the background while you are trying to talk on the phone. Solution: move to a quiet place and avoid distractions.
 

6. Hunger: Fog may be triggered by lack of nutrition. Solution: when you experience cognitive difficulties, ask yourself when you last ate and whether eating something now would help.

7. Medication side effect: Confusion can be a side effect of some medications. If you think this might apply to you, check with your physician. Also, discuss with your doctor the use of medications to increase attention and concentration.

Other Ways to Minimize Brain Fog

Consider the following additional strategies, which may also help limit your brain fog.

1. Pick Your Best Time: Most of us have better and worse times of the day. Do your most important tasks and the ones that require concentration and mental clarity during the hours you are sharpest. The best time of day varies from person to person. For many CFS patients, that time is mid-afternoon to early evening. Many fibromyalgia patients find mornings the best. The important thing is that you find the time that works for you.

2. Postpone, Switch Tasks or Cancel Activities: If you’re not thinking clearly, you can postpone a mentally-challenging task or switch to a simpler task. As one student said, “When I’m too tired and foggy to think, I put things off until the next day and get extra rest instead.” You can also use the presence of brain fog as a signal to cut back. As another student said, “If I’m pretty far gone, that’s a sign that I need to cancel some activities.”

3. Use Lists and Other Reminders: Write out your tasks for the day on a “To Do” list. Organize your house and possessions so that they give you built-in reminders. For example, you might keep your medicines where you dress, so you will see them and remember to take them when getting up in the morning and getting ready for bed at night. Use Post-It notes in prominent places to jog your memory.

4. Use Routine: Reduce fog by living a predictable life with routines: doing the same things everyday in the same way. For example, always put your keys in your purse when you arrive home. If your fog is thickest in the morning, put out your clothes the night before.

5. Organize and De-Clutter: For those who are sensitive to sensory overload, organizing your house and removing clutter can be a way to control brain fog. One student reported that she has simplified even her clothing, saying “I have only two colors of socks, one type of shoe (I keep a go-to-town pair and an ‘everyday’ pair) and one sandal and one dress shoe. I wear only two color pants and have only about 6 tops that I trade out. I never freak about clothes. The decisions here almost don't exist.”

6. Reframe: Brain fog can be frightening and embarrassing. Many students have told us that they have learned to speak reassuringly or lightheartedly to themselves and to others at times when they lack mental clarity. One said her favorite thing to say to others when she makes a mental slip is "I'm practicing for Alzheimer’s.”

7. Do Something Physical: Physical activity is relaxing. It can increase energy and clear your mind. Activity includes exercise and other things such as laughing, singing and deep breathing. One patient said, “The harder I try to control my fog the worse it gets… The very best brain fog reliever for me is to laugh - long and hard - good belly laughs. I also find deep breathing is good. When I sing, I find it also releases the tension that causes brain fog.”

8. Plan Your Response: Deal with the confusion of brain fog by preparing your response ahead of time. Develop rules to guide you when you're feeling lost. For more, see "Personal Guidelines for Managing Chronic Illness."

Multiple Strategies

Like other symptoms, brain fog is something best addressed by using a combination of strategies. When we have asked people in our groups to describe what they do to combat cognitive problems, we get lists that can be ten items or more. Here are two examples.

My brain fog is worst when I'm exhausted, so I try and stay within my energy envelope. The fog episodes have greatly diminished since I learned that. My den and paperwork had deteriorated to chaos when I was sicker, and over the last several months I've gotten organized again. Now I don't misplace things and can find whatever I need without stress. This orderliness helps to prevent my panic and fog. And when I'm too tired and foggy to think, I put things off until the next day and get extra rest instead. If I stay on top of things at home and work, I rarely have to do something immediately. I use self-talk too, saying "this too shall pass" or "nothing catastrophic will happen if I don't do this right now."  That keeps me from going into panic mode and meltdown. I'm mentally sharpest in the morning before I get really tired, so I schedule all my brain-heavy activities in the morning and leave the simple tasks for afternoon. I also nibble some protein every couple of hours, and that makes a huge difference in my brain power.

I believe that the way I organize my life helps me reduce the amount of brain fog I experience and its effects. I try to live a routine and predictable life. Also, I keep an orderly physical environment, so I am not over stimulated by clutter and know where things are. Also, I determined that mid-afternoon to mid-evening were my best times of day for thinking, so use time of day to my advantage. Because brain fog is so disorienting and so frightened, I use self-talk to help me. I say things to myself like, "You don't have to balance your check book now; why not do something you can succeed at now and come back to the check book later?"