Fatigue & insomnia

“Am I losing my mind?” —
What you can do about fuzzy thinking

by Marcelle Pick, OB/GYN NP

Where are my glasses? It’s on the tip of my tongue! Did I turn off the iron? Am I losing my mind?

How often do thoughts and questions like these race through your mind? All of us experience forgetful, fuzzy moments, particularly during periods of high stress, and increasingly so as we grow older. I see many women at my practice who are alarmed at lapses of attention or memory, and they are frequently embarrassed to admit how bad it can get — particularly when the results compromise safety.

Many of these women are caring for aging parents with Alzheimer’s disease or other forms of dementia, and they fear that the fuzziness they’re experiencing is just the tip of some terrible iceberg for them as well. Others have children with an ADHD diagnosis and wonder if they may have it, too. Most of them are concerned that their mental lapses will only get worse. I hear versions of If I’m this forgetful now, what’s it going to be like in ten years? all the time. In my experience, women (and men!) fear the mental symptoms of aging as much or more than the physiological changes.

But for the large majority of women under 70, there’s simply no reason to. Episodes of difficulty with word retrieval, an inability to focus, or feeling overwhelmed by a rush of thoughts and ideas are common signals that your body is overburdened and not getting the support it needs — and this includes how well you are coping with stress. Fuzzy thinking is one of several symptoms that may develop during perimenopause and menopause due to changing hormones, but problems with memory and attention can also be related to other physiological imbalances that respond well to simple changes in nutrition and lifestyle. So don’t let fear or shame of your wandering mind keep you from taking stock of what’s really going on — and then doing something about it.

Let’s discuss how.

When is fuzzy thinking serious?

Less often than you might think. Current medical thinking brackets lapses in cognitive function within two extremes. On the minor side, you have a temporary state of mental deterioration that is a direct result of a traceable behavioral pattern or situation — sleep deprivation, low blood sugar, illness, falling in love, childbirth, poor eating habits, and acute stress are a few examples. In this scenario, clarity returns when the “crisis” is over. On the more severe side, you have mental lapses that do not get better with time and self-care and that may indicate onset of an underlying serious mental or physical condition, including but not limited to clinical depression, bipolar disorders, schizophrenia, ADHD (also known as ADD), dementia, Alzheimer’s disease, post-traumatic stress disorder, or brain trauma or disease. Obviously the more serious neuropsychiatric conditions are topics of scientific research and get more press, so we hear more about this end of the spectrum.

As a result it’s easy to veer into catastrophic thinking when it comes to your own cognitive symptoms — but let me reassure you that developing a spontaneous degenerative mental condition at mid-life is usually the exception, not the norm. And in the case of ADHD, there’s technically no such thing as adult onset ADHD (although it’s possible that your symptoms were overlooked during childhood). Of course, if you have a family or personal history of a clinical disorder, or recently have experienced significant trauma, it makes sense to call your health care practitioner and discuss your concerns. If your friends and loved ones are worried for you and mentioning their suspicions, it can’t hurt to listen and get more information. There are many tests available that can put everyone’s minds at ease.

What is far more likely is that you fall on the minor side of the scale. And while your symptoms may be causing you a great deal of anxiety, it is more beneficial to think of them as signals asking you to pay more attention to your whole health picture. Rather than drown those calls out with drugs or shame, take them as a sign to sit up and take notice. At our practice, we assess fuzzy thinking in the context of many other biochemical and emotional issues — a great deal goes into maintaining an agile mind! — beginning with the simplest possible explanation first.

Stress and overscheduling — the brain foggers

Women are fantastic multitaskers. We are hardwired to spin many plates in the air at once — and make dinner while we’re at it. And while this is a most admirable trait and quite possibly a good reason our species continues to thrive, it can come at a cost — particularly in today’s fast-paced, information-dense and stress-saturated culture.

If you think of your brain as a filing cabinet and information as folders downloaded, filtered and filed by your short and long-term memory systems, we are living in a time when the cabinet is just plain stuffed — and the older you are the more jammed your filing cabinet becomes, especially if you have not been taking care of yourself. This doesn’t mean you can’t learn new things (in fact, learning new skills is a proven way to stretch your file cabinet capacity). It just means that it’s easier for the newer files to slip through your short-term memory filter and get discarded than it is to pack them into storage.

Distraction and overscheduling are also key players. If you are constantly thinking of ten things at once, rushing hither, tither and yon and barely remembering to breathe, your brain may choose to take a holiday whether you want it to or not. Spacing out and shutting down are very real coping mechanisms for chronic stress.

Chronic unremitting fatigue and mental lethargy can also be the result of overburdening your adrenal glands. Our adrenal glands evolved to function in short but limited bursts, switching the central nervous system (including our brains) into full-alert mode to pump out cortisol in response to sudden threats, then returning to resting phase. In this situation (and when you are insulin-resistant, which I discuss below), the brain calls upon cortisol for instant energy rather than the slower, but more sustaining glucose. When a woman’s adrenal glands are overtaxed with no prolonged periods of quiescence, there are huge implications for your brain function. Prolonged exposure to cortisol actually damages brain neurons and reduces your ability to think clearly and efficiently.

Reducing overt stress, both emotional and environmental, and learning positive coping mechanisms are terrific therapy for the brain, and your lifestyle and daily schedule may be the first place to start when thinking about what may be causing your mental fog.

Better sleep on it

Another lifestyle factor within your control is how much sleep you get, and the quality of that sleep. While we do not yet understand all the reasons why both too little sleep and too much sleep can be detrimental to our health, it is sleep deprivation — ranging from minimal to dramatic — that is the more pervasive problem in our culture. We all know that when we are running on empty we just don’t think well.

If your “to-do” list is keeping you up late at night, or if you are drinking excessively in order to relax, your REM sleep may be deficient, and a valuable part of information processing occurs during REM sleep. Go too long without it and you will feel the disembodied mental effects directly — as anyone who has pulled one too many all-nighters can attest.

You may think you’re functioning “normally” for days at a time on limited sleep