If Your Brain Feels Foggy And You're Tired All The Time, You're Not Alone

In recent weeks, Dr. Kali Cyrus has struggled with periods of exhaustion.

"I am taking a nap in between patients," says Cyrus, a psychiatrist at Johns Hopkins University. "I'm going to bed earlier. It's hard to even just get out of bed. I don't feel like being active again."

Exhaustion is also one of the top complaints she hears from her patients these days. They say things like, "It's just so hard to get out of bed" or "I've been misplacing things more often," she says.

Some patients tell Cyrus they've been making mistakes at work. Some tell her they can "barely turn on the TV. 'All I want to do is stare at the ceiling.' " Others say they are more irritable.

While some people who had Covid-19 report brain fog and fatigue as lingering symptoms of their infection — what's known as long COVID — mental health care providers around the U.S. are hearing similar complaints from people who weren't infected by the virus. And many providers, like Cyrus, are feeling it themselves.

This kind of mental fog is real and can have a few different causes. But at the root of it are the stress and trauma of the past year, say Cyrus and other mental health experts. It's a normal reaction to a very abnormal year.

And while many people will likely continue to struggle with mental health symptoms in the long run, research on past mass traumas suggests that most people will recover once the coronavirus pandemic ends.

"We know that the majority of people tend to be resilient," says Lynn Bufka, a psychologist with the American Psychological Association. "They may have struggled during the time of the challenges but generally come out OK on the other end."

In the meantime, Bufka and other experts say that there are things we can do now to fight the mental fog and exhaustion.

How stress and sleep are linked

"Exhaustion can be a symptom of many things," says Cyrus.

For one, it can be a symptom of stress.

"We know from other research that people will talk about fatigue as something that they experience when they're feeling overstressed," says Bufka.

A recent survey by the American Psychological Association found that 3 in 4 Americans said that the pandemic is a significant source of stress.

Millions of people have lost loved ones, have become ill themselves and/or have lost income as a result of the pandemic. The threat of COVID-19 alone has been stressful for most people, as has all of the upheaval that the pandemic has brought, says Bufka.

Stress "keeps our mind vigilant and our nervous system vigilant, and that uses more energy," says Elissa Epel, a psychologist at the University of California, San Francisco. That's one reason that prolonged stress can leave us feeling drained.

Another way that chronic stress makes us feel exhausted is by interfering with sleep, says Bufka. "When we're feeling stressed, our sleep can get disrupted, which naturally leads to feelings of tiredness and exhaustion," she says.

"We really rely on sleep to recover each day," explains Epel. "And so for many of us, even though we might think we're sleeping the same number of hours, it's not the same quality. It doesn't have the same restorative ability, because we're getting less deep sleep, and we think that is tied to this chronic, subtle uncertainty, stress."

Chronic stress also triggers low-grade inflammation, she adds.

"We have this inflammatory response when we're feeling severe states of stress that can last. It's subtle, it's low grade and it can absolutely cause fatigue and a worse mood."

A year of anxiety, grief and trauma

The fatigue and fog so many are feeling now also could be symptoms of other mental health issues that flared over the last year, says Dr. Jessica Gold, a psychiatrist at Washington University in St. Louis. "After this long, most people have had some degree of anxiety, depression, trauma, something," she says.

As studies have shown, rates of anxiety and depression in the population have gone up during the course of the pandemic.

Long-term anxiety can also exhaust the body, says Gold.

"We evolved as creatures, people that run from predators in the animal kingdom, right? To have anxiety as a way to predict and run from threat," she says.

When we're anxious, our hearts race and our muscles tense up as we prepare to fight a predator or run from it. But "you can only run a 100-yard dash for a short amount of time. Not a year, and not a year where they keep moving the finish line," says Gold. "We can't do that. Eventually our muscles and our body say, 'No, I'm tired.' "

The rise in symptoms of anxiety and depression, which include exhaustion, is a predictable response to the trauma of the pandemic, says Dr. Sandro Galea, dean of the School of Public Health at Boston University.

"The definition of a trauma is an event that threatens people's sense of safety and stability," which this pandemic is, he adds.

Nearly all of us are grieving the loss of life as we knew it, says Dr. Jennifer Payne, director of the Women's Mood Disorders Center at Johns Hopkins. "We're just in a completely different world right now," she says. "A lot of things are not going to go back to the way they were. And so that causes grief and is a normal reaction to a big change."

However, the trauma is much bigger for individuals directly affected by the pandemic, says Galea. That includes those who've lost loved ones, lost a job or housing, struggled with child care, or have had COVID-19 themselves — some of whom report continuing to experience exhaustion that's thought to be associated with the viral infection.

Some people have been hit so hard — and are so worn down — that "they are having trouble coming back from this," says Cyrus, the Johns Hopkins psychiatrist, whose patients are mostly people of color and/or queer. Black and Latino communities in particular have been disproportionately affected by the pandemic and its fallout.

And people in these communities will likely struggle with more mental and physical health issues in the long run, notes Galea, and need access to mental health care and greater support to recover.

Steps to take now

For many people, the relaxing social activities that can help buffer against stress and anxiety — like seeing friends or going out to dinner — are not yet reality, due to uneven vaccination rates. So what can we do now to help recharge?

Payne, of Johns Hopkins' Women's Mood Disorders Center, encourages people to keep in mind all of the usual things that help during stressful times: exercise, a healthy diet, going outdoors and limiting news consumption. And engage in relaxing activities often, like a hobby you love, listening to or watching something funny, or reading books you enjoy.

If these diversions aren't working for you now, she recommends trying a change of scenery if you can.

For Payne, who lives in Baltimore, that meant staying at her parents' home in West Virginia for three nights.

"It was not a very exciting trip, but we got away and it was a completely different environment. And I didn't have any projects around the house that I could do other than reading or listening to a podcast, sleeping, eating," Payne says. "And that was really, really renewing for me."

However, Cyrus, who is also at Johns Hopkins, says some of her patients say their normal coping strategies aren't working.

That's because we are running on an emptier gas tank than usual, she says. "Your coping strategies that might be able to refill you a certain percent, [but now] you're starting lower. So it's not quite getting you where you need to be."

If that's the case for you, try changing up your routine, Payne says. "If you're walking every day and that's no longer helping, you try biking."

Self-care is important, notes Gold of Washington University. "Take the vacation time you need," she recommends. "Make sure that you're taking care of yourself in the short and long term."

And, she adds, "there's no wrong time to go talk to someone." If you can't get an appointment with a therapist, talk to a friend or co-worker, she suggests.

"I think that because so many people are struggling with this and because it is so normal, everybody has something to say," says Gold. "If we could just get to the point where we could be talking about the stuff more openly, we'd feel a lot less alone."

Feeling more connected can help ease some of our stress and related exhaustion.

Also, Payne encourages trying to find things to be grateful for. Research shows that gratitude journaling lifts your mood and is good for your mental health.

"We can always find things to be grateful for," says Payne. "It's springtime and the days are starting to be beautiful and the trees are blossoming, and really thinking about that and admiring the trees, for example, can make you feel really grateful."

Acceptance and self-compassion will also help, notes Gold. "We have to be able to give ourselves a little bit of grace," she says. In other words, accept that you might not work as efficiently or get as much done right now.

For most of us, the brain fog will likely fade away when we are able to resume some normalcy in our lives, say Gold and others.

"Most people are resilient to traumatic events, and we should always keep that in mind," says Galea of Boston University. "Most people bounce back fairly quickly once the trauma resolves."

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