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Managing Chronic Fatigue Syndrome and Fibromyalgia

7. Treating Cognitive Problems

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Most people with CFS and many people with fibromyalgia experience cognitive problems, often called "brain fog" or "fibro fog." The problems include being forgetful, feeling confused, difficulty concentrating and the inability to speak clearly.

Cognitive problems have a variety of causes, including:


  Overexertion   Being too active, living "outside energy envelope"  
  Fatigue   Hard to be alert when tired  
  Poor Sleep   Fogginess created by not getting restorative sleep  
  Over-stimulation   Too much sensory information or info from multiple sources  
  Multi-tasking   Doing more than one task at the same time  
  Stress   Stress increases CFS/FM symptoms generally  
  Medications   Side effects include confusion and grogginess  


Like the other symptoms discussed in this section, brain fog is best addressed by using a combination of strategies and by developing new habits. The strategies below are focused on combating cognitive problems, but your efforts to control other symptoms will also help you control fog.

For example, because the problems associated with fog are found in people who are tired and those who are sleep-deprived, reducing fatigue and getting restorative sleep will help reduce cognitive problems.


Cognitive problems are sometimes treated with stimulants, such as Provigil (modafinil), but these medications can produce a push/crash cycle. Here are 13 non-drug strategies for lifting the fog.

1. Take a Rest Break. Cognitive difficulties can be caused by overactivity. As one person in our program said, "Brain fog helps me to recognize when I'm outside my energy envelope and need a break." A brief rest may be enough to end the fog for some people. For more on the power of rest, see the article Nurture Yourself with Pre-Emptive Rest.

2. Avoid Over Stimulation. If you are sensitive to noise, to light or to sensory input coming from more than one source at the same time (for example, trying to have a discussion with the TV on), limit sensory input by turning off the TV while talking, moving to a quiet place and avoiding distractions.

3. Do One Thing at a Time (Avoid Multi-Tasking). Many people with CFS and FM 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: instead of multi-tasking, do only one thing at a time. To avoid interruptions, teach family members to wait by saying things like "I'm [fixing dinner, talking on the phone, etc.] right now, but I'll help you as soon as I'm done."

4. Control Stress. Stress can trigger or intensify brain fog. You can reduce fog by avoiding stressful situations, by learning how to relax in response to stress and by training yourself to mute the production of adrenaline. For more, see the chapter on controlling stress or the articles in the stress management archive of our website.

5. Do a Medication Check. Confusion can be a side effect of some medications. If you think this might apply to you, check with your doctor about adjusting the dosage levels of your drugs or changing to other medications. Also, discuss with your doctor the use of medications to increase attention and concentration.

6. Use Lists and Other Reminders. Write out your tasks for the day on a To Do list . Use Post-It notes in prominent places to jog your memory. Organize your house and possessions so that they give you built-in reminders. For example, 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.

7. Organize and De-Clutter. If you find your physical environment overwhelming, organize your house and remove clutter. For how to ideas, see the article "Illness and Housekeeping."

8. Use Routine. Reduce confusion by living a predictable life with routines: doing the same things every day 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.

9. Pick Your Best Time of Day. Do the tasks 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. Find the time that's best for you.

10. Postpone, Switch Tasks or Cancel Activities. If you're not thinking clearly, postpone jobs that are mentally challenging, switch to a simpler task or take a break. As one person in our program said, "When I'm too tired and foggy to think, I put things off until the next day and get extra rest instead."

11. Do Something Physical. Physical activity can increase energy and clear your mind. Activity includes exercise and other things such as laughing, singing and deep breathing. For some people, fog may be triggered by lack of nutrition. For them, eating counteracts mental fuzziness.

12. 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. If thinking you have to do something leaves you flustered, try slowing down. For more on reframing, see Chapter 31.

13. Plan Your Response. Deal with the fact that brain fog is confusing by planning your response ahead of time. Develop rules to guide you when you're feeling lost, so you have standard, habitual responses you can fall back on. For example, you might decide to respond to fog by lying down or by switching to a less demanding task.

Using Multiple Strategies

Like the other symptoms discussed in this section, brain fog is best addressed by using a combination of strategies and by developing new habits. 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 longer. Here is one person's description of how she handles cognitive problems.

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.

Over the last several months, I've gotten organized. Orderliness helps to prevent 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.

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.

6. Fighting Fatigue  Up  8. Finding Limits: The Energy Envelope