Heat tends to increase fatigue. It is therefore necessary to maintain some level of activity as long as possible. This may only be getting out of bed and into a bedside chair on a daily basis or brief passive range of motion exercises. Depression and fatigue may work in a mutually exacerbating synergism. Several consultative visits from the OT can give patients and families invaluable pointers, including assistive devices, on how to maintain or increase independence without increasing energy expenditure.
Insomnia tends to increase with age, is more common in women than men, and increases with illness.
Difficulties from insomnia for the person who is ill include decreased mental acuity, tiredness and fatigue, impaired interactions with others as a result of the tiredness and fatigue, propensity for emotional difficulties, and even decreased resistance to disease progression, infection, or other physical disabilities. For caregivers and family members, the decreased level of function of the patient creates difficulties during the day. If the patient wakens others during the night, then there is sleep loss on everyone's part. If the patient does not awaken others during the night, then he or she faces the long nights alone. One of the more common causes of insomnia in people who are ill is a disturbance in the sleep-wake schedule with increased amounts of daytime sleep and a concomitant decrease in nighttime sleep.