The fatigue factor: How I learned to love power naps, meditation, and other tricks to cope with hearing loss exhaustion
Editor's note: This is a guest post by David Copithorne. He is a communications and marketing consultant who writes a popular hearing-loss blog, HearingMojo.com, exploring assistive listening technologies and other means of coping with hearing loss.
It happened again last week. After a long day that included three extended conference calls and two group meetings, I crashed. This letdown wasn't the usual worn-out feeling after a long day. It was pure exhaustion, the deepest kind of fatigue. I took a nap hoping it would refresh me, but when I woke up three hours later I was still so tired I gave up on the day. I went to bed for good and only started to feel normal the next morning after eleven more hours of sleep.
Ever since I lost most of my hearing several years ago, I've had periodic bouts of tiredness that are deeper and of a different quality than I ever experienced before. Previously, the only time I ever felt a comparable drain of mental and physical energy had been immediately after my mother died following a long bout with lung cancer. Staying up with very little sleep for most of two days and beginning to deal with the depression from the death of a loved one made me feel 100 years old. Following my hearing loss several years later, I started to experience similar episodes of complete exhaustion, but the triggers often seemed to be events no more stressful than a hard day at work or a long, noisy dinner party.
Initially, I worried that some strange neurological failure had accompanied my sudden sensorineural hearing loss. But the doctors reassured me that aside from my very poor hearing, I was fit as a fiddle. The only cause of my fatigue I could identify was the stress of struggling to understand what those around were saying and trying to function as normally as I could in a world that had suddenly become a lot more challenging. I was amazed it could take so much out of me.
Too tired to work
Of course it turned out I wasn't alone. According to research by the Better Hearing Institute (betterhearing.org) the societal costs of untreated hearing loss amount to 56 billion dollars per year in the U.S. and 92 billion euros in Europe, mainly due to lost productivity at work. And it turns out that much of the lost productivity is due to fatigue caused by coping with hearing loss.
According to a European survey done by the Danish Institute for Social Research (hear-it.org), as many as one in five people with hearing loss gives up on the job market, and of those who work almost 15 percent get so run down that they have no energy left for active leisure pursuits. Among those seeking work, the unemployment rate is 50 percent higher for people with hearing loss than for people without. And the most common reported reason for the lost productivity is exhaustion. "The communications obstacles often make the normal workday psychologically and physically demanding, making the hearing-impaired employees feel exhausted by the end of the workday," the report says. "Forty-seven percent of them say they suffer from mental exhaustion as compared to 36% among the general population, and 51% complain of occasional physical exhaustion as compared to 31% among the general population."
When I reviewed more of the scientific and anecdotal literature, I started to understand there are multiple causes of the fatigue that comes when you must cope with hearing loss in the everyday world. Taken together, they can deliver a knockout punch, creating a "perfect storm" of struggle, stress, anxiety, and depression than can cause the most profound sense of depletion and exhaustion you will ever experience.
Depression can wear you out
People who suddenly lose most or all of their hearing commonly go through the five stages of grief identified by Elizabeth Kubler-Ross in her famous book On Death and Dying. The stages are denial, anger, bargaining, depression and acceptance. Doctors will tell you that deep fatigue is one of the most common symptoms of clinical depression. The problem with hearing loss is that it's not just a single isolated event. After you experience the depression that is part of the acceptance of your initial hearing loss, there are endless additional opportunities for disappointment, and the losses you have to accept are frequent and often unexpected.
My first journey through the Kubler-Ross cycle required me to accept that most of my hearing really would be gone for good. But then I had to deal with additional situations where I repeatedly found myself in the now-familiar routine of denial, anger, bargaining, depression and acceptance. For instance, after initially accepting my severe hearing loss and adjusted to my hearing aids, I still held out hope that the distortion in my hearing that made it impossible for me to listen to music would abate. Only after months passed and there was no change did I finally start to get past my denial and understand I most likely would never enjoy music again. This realization felt like a huge and unfair theft of something most precious to me, and I got angry all over again. Then I quickly found I couldn't bargain my way out of it, so of course I got depressed.
The depression I had to go through as I mourned my loss and eventually accepted my undeserved permanent exile from the world of music (to the extent I have been able to finally accept it at all) wore me down all over again. People who are hard of hearing, especially those who are late-deafened, have to go through this cycle of grieving, mourning and accepting time and time again. Just think of the young mother who loses her hearing between the births of her first and second children and who must learn to live with the knowledge she won't hear her second baby giggle or speak her first words.
Dr. Mark Ross has written movingly in Healthy Hearing about the ongoing sense of deprivation and isolation, the "separation from the world," that people with hearing loss experience. By losing the ability to hear normal background noise -- what researchers have called "primitive" hearing -- people without hearing are cut off from something elemental that makes us feel human and whole. When Dr. Ross had an ear infection and couldn't wear his hearing aids for an extended period, he realized that the small sounds that orient you to the world, such as the road noise when driving the car or the sound of your feet scraping the carpet, are reassuring and even comforting in a way that psychologists are only starting to understand. Being cut off from these sounds can lead to an ongoing sense of isolation that is inherently depressing. Combined with the stress of not being able to orient himself in the usual ways and the additional work he had to do just to get through the day, he found his "near-deaf" experience extremely stressful and tiring.
Coping is hard work
Think of the last time you took an escalator ride where the escalator was next to a set of stairs. While you were standing still, the people climbing the regular stairs next to you were working pretty hard just to keep even with you, right? Now imagine that every day you practice a little tap-dance routine for your company's talent show as you ride that escalator. Just think how much more work you would have to do if you had to walk up the stairs, practice your tap dance routine on the way up, and still get to the top in the same time it takes you on the escalator.
All this extra physical work is very similar to the extra cognitive work people with hearing loss have to do just to keep up with the normal flow of interactions that take place all day long. According to Dr. Ervin Hafter, a professor of psychology at the University of California Berkeley, the extra processing your brain has to do when you have poor hearing can create an overload that can affect your overall cognitive performance. The extra effort required to comprehend speech in noise when your normal mechanisms for filtering out background sounds are impaired can put an overload on the brain that makes it harder to perform other mental tasks at the same time. The result can be poorer performance on work-related tasks and extra work keeping up with others than if your brain didn't have to go through extra cycles trying to comprehend and communicate.
When I heard Dr. Hafter present some of the early findings of his research into cognitive functions at a recent conference, I was struck by just how hard the brain must work simply to stay even -- just as hard as the person running up the stairs must work to reach the top at the same time as the person tap-dancing on the elevator. And while I'm a firm believer in the fact that hard work builds character and fortitude, I also know it can tire you out as well. In fact, Dr. Hafter's presentation was at the end of three longs day of similar presentations and meetings at the conference, and when it was over I barely had the energy to drag myself back to my hotel room, and then I slept for twelve hours. Similarly, at work, following conference calls and group meetings that seem to relax or energize other people, I experience the most profound sort of mental and physical fatigue.
Stress: Too many "fight-or-flight" shots of adrenaline
The stress and anxiety from coping with hearing loss in everyday situations can also wear you down. When you are in a conversation but cannot keep up, especially in business, missing out on the information you need can be extremely threatening. When I first lost my hearing and would have to sit through meetings where I would lose the thread of the conversation, I would go home feeling completely inadequate and anxious. Days spent "on the edge" in this manner, along with the energy put into the planning, preparation and follow-up required just to "catch up" with the rest of the team, were extremely wearing and would cause deep fatigue.
When this kind of anxiety extends to other situations -- stress when you can't negotiate a simple transaction at the store, difficulty communicating on everyday matters with family members, or getting about safely in the car --you often end up in an extended state of "hyper-vigilance." The next time you are walking alone in a crowded city with a lot of auto and pedestrian traffic, imagine what it would be like if you could not depend on all the auditory cues you rely on to stay safe -- the sound of an approaching car running a red light even when the 'Walk' sign is on, the sound of a siren, or the sound of footsteps to one side or the other as you try to navigate a crowd without bumping into too many people or having your pocket picked. When I am walking in New York City, I need to turn my hearing aids off because they amplify the environmental noise, which drowns out any possibility of conversation and hurts my ears. That means I need to be extra careful when crossing the street or even walking on a crowded sidewalk because I cannot depend on those environmental noises to cue me. I find days spent in this mode can wear me down very quickly.
When I tried to understand the unique quality of the fatigue I would experience, I discovered what psychologists call the "fight or flight" syndrome. One of our natural defense mechanisms is rapid production of adrenaline when we are threatened. The adrenaline gives us extra energy and alertness, providing us with the tools to either confront or avoid a predator. Constant overproduction of this powerful stimulant can wreak havoc upon your nervous system. Burnout and complete exhaustion are the natural consequence.
How to fight back: Relax!
When stress, anxiety, struggle, and depression conspire to lay you out flat, what's the best way to respond? Thankfully there are ways to work through your fatigue and re-charge your batteries. There's a new art and science of relaxation techniques that can restore your energy in the quickest, most efficient way possible. Like the new faster-charging batteries you get on the new mobile phones, these techniques can recharge your energy quickly and you can avoid being knocked out by fatigue and exhaustion for days on end.
Meditation and breathing disciplines have been shown to provide real health benefits, relieving stress and restoring energy. Many say the current popularity of yoga is directly tied to people's growing need for both physical and mental restoration in an increasingly stressed-out culture. Immediately after my hearing loss, I also saw an acupuncturist. He was careful to point out that acupuncture can't correct hearing loss, but it can put help put you into the kind of relaxed, meditative state that relieves stress and restores energy.
But the solutions that have worked best for me are also the easiest -- regular aerobic exercise and preventative "power" napping. I have found that thirty to forty-five minutes of day of easy jogging relieves stress and fights depression, in part through releasing endorphins in the bloodstream, which contribute to a general sense of well being. And I discovered that taking a quick nap in the middle of the day, before I get run down, helps prevent the kind of complete depletion that would otherwise knock me out for 12-to-24 hours.
These healthy living practices may require a change in lifestyle, but the good news is such changes can be learned. Samuel Trychin, Ph.D., (trychin.com) has spent more than 20 years helping people cope effectively with hearing loss. His "Living With Hearing Loss Program" provides a comprehensive schooling in everything from how to manage work and personal relationships to how to practice proven relaxation techniques.
The biggest benefit of Dr. Trychin's services and others is the sense of perspective they give you. When I started asking questions about my own mysterious fatigue I discovered I was not alone. I discovered that others have lived through the same experiences and coped with them quite successfully. And I've even found an extra benefit -- the 20 minutes of pure bliss my family allows me, even during the busiest week managing work, school and extra-curricular activities, when I tell them it's time for Dad to take a nap.