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Chapter 1

Introduction

Fatigue

“The awareness of a decreased capacity for physical and/or mental activity

due to an imbalance in the availability, utilization and restoration of resources needed
to perform activity.” This definition is based on a self-monitoring and self-operating
paradigm that demonstrates the important features necessary for the research of
fatigue in our centre. The nature of any symptom is entirely subjective that requires
knowing the phenomenon. In addition, resources can range from metabolic resources
and other physiological capabilities to sociocultural elements, which may also
transform the way you perceive or react to exhaustion experiences. Thus, use as well
as restore are procedures by which resources are used continuously and refined to
support all functions Fatigue arises when this mechanism is unbalanced, which is
when inadequate resources are available either leads to increased demand or
requirement or because the usage and restoration systems are compromised. "The
self-reconniving situation in which a person experiences an enormous sustained sense
of weariness and decreased physical and mental ability which is not relieved through
rest" is the definition of fatigue in the North American Nursing Diagnosis
Association. Fatigue has been characterised as exhaustion associated to low
motivation from a psychological standpoint.

Historical perspective of fatigue

Since the mid-19th century there has been significant debate on both what
comprises and what causes fatigue (Wessely, 1991). By the mid-1800s, claims were
commonly stated that higher class ladies had too weak to arise from bed (Shorter,
1993). Several women complained largely about tiredness and Muscle weakness,
although discomfort was often frequently a significant complaint. Beard, George, One
of the first Americans to speak of neurasthenia was a US neurologist Entity clinical
(Macmillan, 1976).The symptoms of neurasthenia included “general Malaise, debility
of all function, poor appetite, fugitive neuralgic pains, hysteria, Insomnia,
hypochondriacs, disinclination for consecutive mental labor, severe and Weakening
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attacks of headaches, and other manifestation”(Macmillan,1976). In the

neuropathology and psychopathology field, neurasthenia had been the exclusive
diagnosis in 1900. Diagnoses of neurasthenia and neurocirculatory asthenia, such as
these were gradually regarded as psychosomatic, have been discontinued in the early
20th century. However, exhaustion including persistent fatigue were nevertheless
identified as signs in the literature on studies (Bartley & Chute, 1947). For example,
Kepler (1942) characterize chronic weariness as a product of a western manner of
living, best thought of by "psychological" "intelligentsia" sickness, which will have
the effect of being psychogenetic or psychological. Furthermore (1944) Allen
examined 300 cases where weakness and weariness were the predominant concern.

These physical disorders were accounted for 80 percent and physical disorders
accounted for 20 percent of the cases abnormalities comprise diabetes, heart disease,
chronic infection, nephritis, anemia, and various neurological nervous conditions.

Peripheral fatigue

Peripheral fatigue has been described as a failure to endure energy or

efficiency due to “failure in neuromuscular transmission, sarcolemmal excitation, or
excitation-contraction coupling,” includes neuromuscular disorders outside the central
nerve or CNS system (Edwards, Newham, & Peters, 1991; Swain, 2000).

Central fatigue

Central tiredness is due to lack of energy and energy conservation (Fukuda et

al., 1994). In every single person this same consequences of this chronic inexplicable
weariness differ; several people have only a minor impairment; other suffer very
serious constraints (Cox & Findley, 2000). Sleep issues, overall weakness, muscular
aches and soreness, difficulties thinking or focusing, sadness, and unusual weariness
after activity were the most common symptoms reported by Nisenbaum and
colleagues (1998). As unexplained severe exhaustion persists, these findings suggest
that further somatic symptoms are likely to emerge (Nisenbaum et al., 1998).

Mental Fatigue
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Mental fatigue is a sensation which individuals might have after or during

periods of extreme intellectual processing. Tiredness or even tiredness, an aversion to
continuing with the current activity, and a loss in motivation to complete the work at
task are the most common sensations in modern society. Furthermore, cognitive
exhaustion has been linked to poor psychological - behavioral performance (Boksem
et al., 2005). Cognitive effectiveness has been demonstrated to deteriorate as a sign of
mental exhaustion.Van der Linden and colleagues (2006) discovered found tired
people experienced trouble paying attention, making plans, as well as adapting
methods in the presence of terrible consequences. Feelings of exhaustion might
emerge via subconscious cost-benefit evaluations of when to use or preserve energy
(Tops et al., 2004; Boksem et al., 2006).

Physical versus Psychological Causes of Fatigue

Current research continues to argue whether weariness is largely a physical or

psychological problem. Clinical investigations frequently concentrate on the self-
perceived sense of exhaustion (Swain, 2000). In undiagnosed chronic tiredness, such
examinations frequently show a mixed presentation of both physical and
psychological causes (Hall et al., 1994). Chronic fatigue sufferers are also far more
prevalent in patients having mental problems, according to culture research (Lawrie et
al., 1997). Pain in the limbs, bones, torso, as well as other regions of the body,
difficulty breathing, hazy eyesight, muscular weakness, and sexual disinterest have
been the most common somatic complaints in tiredness patients, according to Manu
and colleagues (1989).

Multiple components or clusters of fatigue-related symptoms are frequently

discovered in factor analytic research. Jason and associates (2002) factor assessed
fatigue-related complaints reported by 780 chronic fatigue patients but also revealed
four factors: loss of energy, physical exertion, cognitive problems, and fatigue and
lack of rest . The relative contribution of different psychologically and physically
elements (Bartley & Chute, 1947) towards the sense of general fatigue must be
investigated in fatigue especially chronic fatigue studies.

Gender and Fatigue

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The relationship of gender upon fatigue has been studied extensively. Gender
disparities in fatigue have already been discovered in the many research, with females
being more likely to report both fatigue. As well as chronic fatigue (Nisenbaum,
2000). Females, according to several studies (Nisenbaum et al., 1998), experience
greater severe fatigue. Further, Women are indeed more than significantly more likely
as males to seek medical assistance for excessive fatigue (Cope,1992).

Unexplained Fatigue in Chronic Fatigue Syndrome

The hallmark symptom of such a condition is fatigue; most people diagnosed

as chronic fatigue syndrome have just had severe and debilitating fatigue for the at
least six months (Fukuda et al., 1994). CFS is identified as a sickness of mysterious
fatigue only when other fatigue-causing illnesses have been ruled out as the
predominant source of the fatigue. Because the fatigue is classified as "unexplained,"
some have suggested a psychological explanation, while others have provided a
number of physiological ideas to explain the condition as well as its symptoms.

Fatigue in Chronic Disease

Fatigue is becoming known as a significant symptom of several illnesses that

really can significantly impair an individual ’s ability to function but have an adverse
affect on quality of life in several chronic illnesses, such as after radiation therapy
(Bartsch 2003), systemic lupus erythematosus (SLE).According to Swain (2000),
fatigue in chronic illnesses may be caused by corticotropin-releasing hormones and
chronic stress, cytokines and immunological stimulation, central neurotransmitter
networks, and moods disorders like depression.

Individual differences

Low scores on extraversion have been recognized as a risk factor in the

development of burnout (Michielsen et al.,2003) and chronic fatigue syndrome (Prins
et al., 2006) and play a role in a role in effort–reward imbalances (de Jonge et al.,
2000). Are some people more susceptible to fatigue than others? People with
personality qualities that enhance the likelihood of overcoming the indication of
fatigue seem to be at danger, according to many research. High perfectionism (White
 5

&Schweitzer, 2000), high neuroticism (Prins et al., 2006), and poor openness to
experience are among these personality qualities (Prins et al., 2006).

When a high level of performance is required, people who have high

neuroticism outperform their low neurotic counterparts (Tamir, 2005), possibly
willing to sacrifice instantaneous gratification or well-being to enhance task
performance (Tamir, 2005).Fear of negative social evaluation, a characteristic feature
of perfectionism and neuroticism, has also been linked to high cortisol levels
(Kemeny, 2004).

Why fatigue?

The sensation of fatigue serves as a warning to slow down. Every individual's

most important resource is energy, and how it is utilized should be limited. The best
odds of survival come from efficient energy expenditure and conservation, which
causes fatigue a rapidly evolving condition.

Sleep

All mammals and birds sleep, which means they presume a state of minimal
perceptual engagement from the environment with elevated arousal threshold. Sleep is
an aerodynamic behavior characterized by physical dormancy, raised arousal
threshold and a state of quick reversibility. Sleep was once thought to be a transitional
state between waking and death. A pioneer in the field of sleep research, Allen
Rechtschaffen found that “if sleep does not serve an absolutely necessary function,
then it is the largest blunder the evolutionary process ever made”( Rechtschaffen A
(1971) The control of sleep).

There are many biological functions related with sleep, including those that
contribute to body, brain, and neuro-cognitive regeneration. Rechtschaffen elevated a
number of existing scientific concepts about the importance of sleep in a later paper
(Rechtschaffen 1998). The term "sleep" isn't used to describe a single "state of being."

Mammalian sleep is organized into cycles consist of two basic different

“states of being:” named as Rapid Eye Movement (REM) and non-REM sleep
(NREM). During non-REM sleep, Cells in different brain regions, engage in a variety
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of activities during non-REM sleep. The significant proportion of neurons in the

prefrontal cortex, just above the spinal cord, slow or stop firing, but the most of
neurons in the cerebral cortex including nearby forebrain areas only stop or slow
firing by just a minor percentage. A neuron in the awake state essentially goes about
its work on its own.

During non-REM sleep, on the other hand, nearby cortical neurons fire in a
synchronized, low-frequency rhythm. These cells are known as sleep-on neurons, and
they appear to be in charge of generating sleep. The signals that trigger the sleep-on
neurons are yet unknown, however rising body heat while a person is awake
obviously stimulates some of these cells. Because neurons act independently, brain
waves remain low in voltage. And most brain cells in both the forebrain and the brain
stem are quite active, signaling other nerve cells at rates that are comparable to — if
not greater than — those found in the waking state.

During REM sleep, the brain consumes the same amount of energy as when
you're in REM sleep, your brain activity is identical to when you're awake.. The
twitches and eye motion that give REM sleep its name are accompanied by the most
neural activity. REM sleep-on cells, which are special brain stem cells, become
particularly active throughout REM sleep and appear to be responsible for causing
this condition.

REM sleep is when we have our most vivid dreams, and it is characterized
with frequent involvement of the brain's motor systems, which are generally active
only during waking movements. The brain switches from producing neurotransmitters
that would ordinarily excite motor neurons (brain cells that control muscles) to
neurotransmitters that actively shut them down.

But these systems are not influenced by the motive neurons that control the
muscles that move your eyes, which give REM sleep its name to quick eye motions.
REM sleep also substantially affects the brain circuits that regulate the body's inner
organs. During REM sleep, for example, heart rate and breathing become erratic,
much as they do during active waking.

Sleep is regulated by circadian and homeostatic systems. For determining the

state of awareness, this is sometimes referred to as the "two process model."
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Preserving 24- hour periodicity in sleep propensity is an example of circadian

regulation, irrespective of prior slept. The brain's natural cycle is slightly longer than
24 hours, but the arrival of blue light each day "resynchronizes" it. Humans are alert
during the day (primarily in the morning) and ready for sleep at night if they have a
typical circadian rhythm.

The production of the hormone melatonin by the pineal gland in the brain at
night is a critical process assuring the working of the "biologic clock." The increase in
sleep inclination when awake and decrease while sleep are indicators of homeostatic
regulation The state of being alert. The interplay of circadian-driven sleepiness-
alertness cycles and homeostatic (sleep deficit or excessive wakefulness) variables
determines drowsiness.

Theories of sleep

Theory 1: Rest and Restoration. This theory backs up the idea that sleep is
crucial for revitalizing and restoring the physiological mechanisms that aid in body
and mental rejuvenation. According to this hypothesis, “NREM” sleep is crucial for
restoring biological mechanisms, while REM sleep is crucial for repairing mental
processes such as, Muscle regeneration, Cell regeneration, Tissue development,
Synthesis of proteins, Many significant development hormones are released.

As a result, Sleep makes possible to the body to recover and replenish many
vital components of the cells that become depleted during the day and are required for
physiological processes. This backs up the idea of permit patients to obtain enough
rest following procedures for the purpose of speed up their recovery. (EB.2011,
Ezenwanne)

Energy Conservation Theory. Sleep has been linked to the saving of energy.
According to the energy conversation theory, sleep's primary function is to decrease
energy requirements for the portion of the night and day. This idea is proven by the
fact that that during sleep metabolism of body, slows by up to 10%. When we sleep,
temperature of our body and calorie demand decline, and when we wake up, they rise,
confirming the theory that sleep aids in the conservation of energy resources
(Bechtold D 2020).
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Behavioral Adaptation Theory. The adaptation hypothesis is also known as

the inactivity hypothesis or the evolutionary hypothesis of sleep. It's one of the oldest
hypotheses to describe how sleep works. According to this viewpoint, Sleeping is an
activity that helps us to survive longer. Humans are said to have developed at a faster
rate than other animals as a result of our focus on rest. On the surface, this hypothesis
appears to make sense. The night was a hazardous place for our forefathers, and food
was scarce, thus those who walked about less at night were more likely to survive.
This led to sleep.

Bats, cats, and other species that are safe while they sleep longer than those
who are in danger when they sleep (large prey animals). An fundamental
physiological need that can only be met by sleeping and is critical to an individual's
survival (Whelehan, D 2020).

The Brain Needs the Downtime That Comes With Sleep. Many of the
negative impacts of sleep deprivation are linked to the brain. Consider some of Randy
Gardner's effects: impatience, difficulties identifying items just by touch, memory
lapses, difficulties concentrating, hallucinations, difficulties naming common items,
fragmented thinking, and paranoia. J. Allan Hobson discovered that neurons that are
very active when awake may deplete their supply of neurotransmitters and require
time to recover, but neurons that are not frequently engaged when awake require
continual stimulation.

Memory circuits and synapses must be stimulated on a regular basis or they

will weaken which might explain why sleep deprivation is linked to memory loss in
the elderly. The brain processes/edits information from the previous day during sleep.

Sleep and Gender difference

Sleep deprivation is typically linked to a number of presenting disorders and is

ascribed to a number of controllable (e.g., lifestyle) and non-modifiable (e.g., gender)
factors (Astbury J.2012).Gender is thought to have a key influence among non-
modifiable characteristics, with several researches reporting a greater prevalence of
sleep difficulties in females (Zhang B, Wing YK 2006).
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However, the increased frequency of affective disorders in females, as well as

other socioeconomic differences, has complicated the impact of gender on sleep
quality (Meadows R 2009). The relationship between sleep and mood disorders is
well established, as insomnia are some of the most common symptoms of clinical
anxiety and depression. (Benca RM)

However, it is unclear if the gender difference in sleep quality may be related

to female depression rates or other socioeconomic disadvantages, or whether it is
related to fundamental differences in sleep physiology between males and females
(Kagamimori S. 2006). Gender differences in poor sleep quality have previously been
identified for the elderly population (Zhao Q,2013), Recent research, however,
suggests that gender disparities in sleep quality exist in young people as well.

Life style and Sleep

Along with socio-demographic and emotional factors, lifestyle has emerged as

a significant predictor of sleep satisfaction and lower sleep quality in
adult individuals. Physical inactivity, alcohol intake, and lengthy computer screen
hours have all been related to an increased risk of sleep difficulties (Shochat T.2012).

However, little is focused on the impact of an unhealthy lifestyle on sleep

quality in young men and women (Martin NG.1998).

Mental wellbeing

The “World Health Organization (WHO)” defines mental health as “a

condition of well-being in which the individual recognizes his or her own potential,
can cope with the usual demands of life, can work successfully and fruitfully, and is
able to contribute to his or her community” (“World Health Organization; 2004.”).
People with good mental health are often saddened, unwell, angry, or dissatisfied,
which is a natural part of living a full life. Mental health is important. Despite this,
mental health is typically portrayed as a wholly pleasant experience marked by
pleasures and control in one's surroundings (Waterman, A. S.1993).

Several studies on mental health employ concepts that contain both important
parts of the WHO definition, namely happy feelings and positive functioning (Keyes
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CL. 2006).It divides mental health into three categories: emotional well-being,
psychological well-being, and social well-being. Emotional well-being includes things
like happiness, interest in life, and fulfillment. Psychological well-being entails loving
most elements of one's own personality, being adept at handling daily obligations,
having positive interpersonal interactions, and being content with one's own life.

social well-being refers to positive functioning and includes having something

to contribute to society; psychological well-being includes liking most aspects of
one's own personality, being good at managing daily responsibilities, having good
relationships with others, and being satisfied with one's own life; Positive functioning
is defined as having something to add to one's psychological well-being (social
contribution), Because of their effect on many parts of everyday life, basic cognitive
and social skills are viewed as a vital component of mental health (Arturo, S.,
Touchon, J).

Emotional regulation, or the ability to detect, express, and moderate one's own
emotions, is also considered a key component of mental health (1989). It has been
hypothesised as a stress adjustment mediator (Schwartz, D 2000) and clinical and
neuroimaging investigations have found a relation between inappropriate or
inadequate emotional regulation and depression (Choate, M. L. (2004). Alexithymia
(the inability to recognise and express one's own feelings) is a factor that raises the
chance of mental and physical health issues (Helmers, K. F., & Mente, M.).

People may communicate and connect more successfully if they have

empathy, or the capacity to feel and comprehend what others are feeling without
establishing a boundary between themselves and others.,as well as predict others'
actions, intentions, and feelings (Decety, J., Smith, K. E., Norman, G. J., & Halpern,
J. (2014)).

Empathy deficiency is not only a risk factor for violence and a symptom of
antisocial personality disorder, but it also has a negative impact on at all levels of
social interactions. Flexibility along with the capacity to handle adverse situations are
also considered vital for maintaining mental health ,The ability to change a plan of
action in the face of unanticipated obstacles or setbacks, adjust one's own thoughts in
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light of fresh facts, and adapt to changes that different life epochs or contingent
conditions may need is referred to as flexibility.

Flexibility is a significant element of various mental illnesses, like obsessive

personality disorder and delusional disorder obsessive personality disorder and, and
can cause a lot of discomfort for someone who is going through a lot of changes in
their lives (Klanker 2013). The fundamental capacity to function in social roles and
engage in meaningful interpersonal relationships is an important component of
mental health that contributes to resilience against distress; however, social exclusion
and stigmatization very often impair social participation, so any definition of mental
health that includes this dimension must avoid "blaming the victim" and carefully
evaluate (Heinz 2004)

Gender and mental well-being

Job stress is highly correlated to mental well-being and it has varying affect on
both gender as one consider found that female have more satisfaction oftheir male
colleagues (Cooper et al., 1989). Evidence proposes that male and female doctors
carry out distinctive parts inside their works, e.g. “Clinical versus psychological role”
(Branthwaite & Ross, 1988).The socialization speculation expresses that females are
associated to manage pressure instrumentally, while females are associated to
communicate feeling and look for social help (Ptacek et al., 1994).

This is inspired by the enormous contrasts in pervasiveness of mental misery

that arise between these two ages (E. Fitzsimons 2017). For example, in this associate,
12% of young men and young ladies at age 11 years have huge enthusiastic issues as
revealed by guardians, which stays as before in young men (12%) however
increments to 18% in young ladies at age 14.

Self-revealed burdensome manifestations demonstrate that 9% of young men

and 24% of young ladies at age 14 have high burdensome side effects (Fitzsimons
2017). Rescorla found that feminine adolescents reported male adolescents had
greater levels of total emotional discomfort and depressive symptoms than female
adolescents. (Rescorla LL, et al.2007).

Theories of well-being
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Hedonism Theories. Hedonism identifies the good life with the pleasurable
life. According to psychological or motivational hedonism, our actions are dictated by
our impulses to maximise pleasure and minimise misery. Applied to well-being or
what is good for someone, this shows that pleasure and suffering are the sole elements
of well-being (Roger Crisp 2017).

As indicated by its ancient roots, hedonism has long looked to be an evident

plausible stance. Because pleasure looks lovely to most people, well-being, or what is
good for me, might be considered to be organically tied to what seems pleasant to me.
The hedonist belief that one's life goes better if it is more joyful (and less painful).

Parfit distinguishes two sorts of hedonist thinking. According to limited

hedonism, pleasure and suffering are two distinct sorts of experiences, and one's life
would be better if it had more of the former and less of the latter. In its place, he
advocates choice hedonism. According to this viewpoint, if one's life has more of the
experiences that one desires, it will be better. The degree of a pleasure, according to
this viewpoint, is proportional to the degree of one's desire to have that experience.

Desire Theories. According to the principle of pleasure satisfaction, the well-

being of an individual is improved if its wishes are met. In the 19th century, these
theories arose with the rising concern for the welfare economy. Perfit believes that we
solely take into account our own life wishes. He calls this philosophy of success.
American physicist R. Crisp formulates three fundamental wish fulfillment
hypotheses (Crisp, R., 2006). Simple idea of the fulfillment of wishes implies that a
person is more satisfied by his existing desires in a certain period and that if all human
desires are fulfilled, a better life is believed.

The fundamental difficulty with this idea is that a person's aspirations opposed
their long-term goals at some time in his life. The proponents of these ideas retain the
science of how well-being is conditional upon the fulfillment of our needs, but take
the causes of the wants not into consideration. Moreover, wish fulfillment theories do
not show why particular wants are helpful to a person. Furthermore, those theories do
not address what are often termed flawed or unproductive wishes, even though the
implications are well known.
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Objective List Theories. Objective list theories are normally recognized as

theories that enumerate elements that constitute goodness that do not consist of simply
pleasure or want fulfillment. The list stated contains ideas such as compassion, moral,
rational action, child education, knowledge and awareness of genuine beauty,
according to Derek Parfit's scientific perspective (Parfit, D. 1984).

In the list of the works carried out James Griffin contains the components of
human existence such as independence, talent and liberty, understanding, joy and
profound personal connections (Griffin, J. 1986). Life, knowledge, aesthetic
experience, friendship, practical reasonableness, and religion, according to John
Finnis should also be included in the list (Finnis, J.198).

Explanatory objective theories of well-being, on the other hand, define a

fundamental element that unites all of the concepts in the list and explains how and
why they affect well-being. The majority of contemporary objective theories are
explanatory (Kitcher, Philip.1999). Perfectionism is one of the most influential
explanatory objective ideas. According to these beliefs, the key factor that binds
things on a list together is their contribution to human nature enhancement. As a
result, perfectionist theories motivate people to work hard to enhance their skills.
People are imposed things that are helpful for them on the one hand, but do not match
with their own wishes or values on the other side, according to a reasonable critique
of objective theories. These beliefs ignore the fact that everyone is unique and that
various conditions might have varying effects on them.

Factor affecting mental wellbeing

Studies on stress and job happiness have discovered that distinct work stresses
and job satisfaction have inverse connections (Richardson 1991). For example, a
study revealed that four work stressors job demands and patient expectations,
interruptions at home and work, and practice administration were associated with a
higher risk mental health. And interference with family life were associated with work
dissatisfaction and mental health problems (Cooper et al., 1989). Working in a
stressful setting can have a detrimental influence on mental health.

Reluctance to establish and maintain adequate peer relationships during adoles

cence has been linked to lower selfworth, depression (Hansen et al., 1995) and suicide
 14

(Bearman & Moody, 2004). As a result, one of the most powerful markers of current
and future psychological well-being in teenagers is the quality of peer connections
(Bukowski, 1995).

Relationship between sleep and mental well-being

Sleep length has been linked to mortality and psychopathology in studies, but
it is uncertain if sleep is also linked to psychological well-being. Both (Zohar et al.,
2005) examine the relationship between sleep duration and emotional responses to
difficult and stressful situations. Although acute sleep length effects may be linked to
emotional repercussions, an individual’s usual sleep length duration may also be
linked to eudemonic aspects of well-being.

The majority of this research has focused on sleep problems as potential risk
factors for chronic physical and mental illnesses. Several studies propose that sleep is
effective conceived of as a resource of stress management (Drake et al., 2003;
Hamilton et al., in press) and self-regulation, which is consistent with the view that
sleep is a resource (Zohar et al., 2005).

Hamilton and colleagues discovered, as, that the quality and length of sleep
shielded chronic pain patients against emotional disturbance caused by pain and
stress. Similarly, Zohar and colleagues looked at how sleep affected medical residents'
training (Zohar et al., 2005).Sleep quality has been a growing public health priority;
with poor sleep quality linked to an increased risk of mental issues, according to
extensive studies. Normal sleep quality is a critical physiological issue for humans,
but poor sleep quality can lead to major psychological issues.

When sleep quality deteriorates, depression and anxiety develop. (Hamilton et

al. (2005) imply a link between sleep and psychosocial functioning. Sleep
disturbances, particularly insomnia, have been associated to anxiety in multiple
studies (Reynolds et al., 1984). In one case, for example, According to a research, 42
percent of those with severe insomnia had excessive blood pressure.

Poor sleep quality is a symptom, and it is characterized by difficulty falling

and staying asleep (Mellinger et al., 1985). Sleep quality has been a growing public
health emphasis; with poor sleep quality linked to an increased risk of mental issues,
 15

such as depression and anxiety (Hickie, I.2010). Sleep deprivation is now a common
condition among young people, affecting about 10% of the adult population (Karp,
J.F.2018). Maintaining a decent quality of sleep is widely believed to be highly
important for any individual, healthy or ill, because it greatly contributes to physical
and mental health, as well as personal productivity (Barsevick, A. 2004).

Relationship between fatigue and sleep

Fatigue and poor sleep quality were shown to be closely linked. Several
factors may play a role in the link between MS fatigue and poor sleep. (Kaminska,
2011).Increased amounts of inflammatory cytokines or brain lesions may impair
sleep-related circuits. Sleep apnea, which is frequent in MS patients, can cause
tiredness and sleep disturbances. (Trojan, D. A. 2012).

Higher tiredness scores were linked to lower physical and mental summary
scores, according to Benedict et al (Benedict, 2005). In a group of children and
adolescents, Hinds et al1, verified the link between fragmented tiredness sleep and
greater daily weariness, implying a cycle in which sleep disruptions contribute to
increasing daily weariness, leading to longer but less effective sleep periods.

Although the specific nature of the link between exhaustion and sleep-wake
disruptions is unknown, pediatric cancer patients who have had more overnight
awakenings have reported more weariness and longer but less efficient sleep
(Hockenberry M et al 2007). The length of time one should sleep depends on the
social situation as well as personal attributes (Kim, J. 2013). Insufficient sleep length,
on the other hand, causes daytime drowsiness, exhaustion, impaired attention, irritable
behaviors, and rage; long-term sleep deprivation has been associated to cardiovascular
disease and mental illnesses (Koo, D. L., & Kim, J. 2013).

Fatigue and well being

Fatigue has a significant impact on people's well-being and affects their entire
quality of life. In university students, mental weariness is linked to a worse sense of
well-being and poor academic achievement. In terms of both resources and obstacles,
daily life activity may be regarded an intrinsic component of well-being. The degree
of satisfaction with one's level of job activity, as well as one's level of physical and
 16

social activity, has been found to be closely associated to well-being (Netz et al.
2005).

Job factors and individual variances can impact both weariness and a bad
work-life balance, whereas exhaustion is linked to lower positive well-being. It means
that a demanding and rigorous routine causes weariness, which has a negative
influence on one's health. Unlike weariness, which is usually eased by rest, fatigue is
defined as a persistent feeling of physical and mental depletion that is not quickly
relieved by rest (Ream and Richardson, 1996). Fatigue has been defined as a health
symptom that can affect cognitive skills including focus, memory, and decision-
making (Linden, et al., 2003).

It is seen as a severe health issue for parents of usually developing (Tardive

dyskinesia) children (Fisher, et al., 2004; Ward and Giallo, 2008), and has been
associated to impaired cognitive clarity and impaired daily functioning(Fisher and
colleagues, 2004). It has even been linked to emotional problems including
depression, worry, and stress (Ward and Giallo, 2008).Occupational tiredness is
caused by stresses such as job qualities or personal qualities (Fan, J. and Smith, A.P.
2017).

Work-life balance and positive well-being have also been found to be affected
by such pressures (Smith, A.P. (2016). While occupational stress and shift work are
being linked to increased weariness, poor work-life imbalance (also known as work-
life conflict), social support, and personality have been proven that act like buffers
among exhaustion with positive well-being. (Smith, H.N. (2017).

While occupational stress and shift work have been reported to be associated
with a high level of fatigue, negative work-life balance (Donaldson, S.I. (2001), and
impaired positive well-being (Smith, A.P. (2017). Previous research has shown that
tiredness is highly linked to well-being dimensions (Jackson, 2017) and that tiredness
mediates the effect of physical workload on quality of life (Schwartz, A.L. 1999).

The association between employment and personal traits and weariness and
well-being, on the other hand, is uncertain. Various studies on work and tiredness
discovered that job specification influence wellbeing and worklife balance(at work
and outside of work), along with occupational weariness (Fan, J., and Smith,
 17

A.P.2017) (Fan, J. and Smith, A.P.2017). High workload, poor job management and
support, noise and vibration exposure, and shift work are examples of employment
characteristics that influence both tiredness and well-being.
 18

Rationale

The primary objective of this study is to discover the impact of fatigue on sleep and
mental well being among university students. Fatigue is feeling of tiredness and lack
of energy that many people experience from time to time. It isn’t the same as simply
feeling drowsy or sleepy. Being sleepy may be a symptoms of fatigue, but its not the
same psychological functioning, life satisfaction ability to develop and maintain
mutually benefiting relationships. .Research clearly links sleep duration to
psychopathology and mortality, however it is unclear whether sleep also relates to
dimensions of psychological well-being. Findings of many research shows physical
fatigue have negative impact on mental health .And mental health is closely related to
feeling of self worth or well-being. Because physical health is related to ones
emotional stability, which leads to mental well-being. Studies indicate the positive
relationship e thing. There are many causes of fatigue including Lifestyle Factors,
physical health conditions and mental health issues. Several researches show that
disturbance in sleep may induce fatigue in human beings. There is a significant
correlation between fatigue and disrupted sleep or abnormal sleep cycles. A
significantly high probability of a relationship between the presence of fatigue and
abnormal sleep cycles or disrupted sleep was found. Mental well-being relates to
person’s between the sleep and psychological well-being .The current study allows
the community to improve their knowledge about effect of the fatigue on sleep and
mental well being among university students.

Objectives

The existing research was conducted to examine the impact of fatigue on sleep
and mental well being.More specifically,existing research was conducted in order to
attain following goals

1. To evaluate the fatigue among university students.

2. To investigate the sleep among university students.
3. To measure mental well being among university students.
4. To investigate the relationship between fatigue sleep, and mentall well being among
university students.
 19

5. To elaborate the role of demographic on study variables.

Hypothesis of Study

To achieve the objectives,the following hypothesis has been formulated and tested
in the presenting study

1. There will be the positive relationship between the fatigue and sleep

2. There will be the negative relationship between the fatigue and mental well-being
3. There will be negative correlation between fatigue and mental well-being
4. There will be positive correlation between high sleep and mental well-being

Operational definitions

Fatigue

The self-reconniving situation in which a person experiences an enormous

sustained sense of weariness and decreased physical and mental ability which is not
relieved through rest"

Mental Well-being

Mental well-being provides individuals to gain awareness about capabilities,

overcome with the life stress, work in a productive and fruitful way, and make
contributions to the community (Rya& Deci, 2010).

Sleep

The quality of sleep can be characterized as sleep satisfaction, integration of

aspects of initiation, maintenance, quantity of sleep, and regeneration when we are
awakened (Kline Christopher, 2013 & Deci, 2010).
 20

Conceptual Framework

The present study aimed at investigating the the effect of fatigue and sleep on
mental well-being of university students.

(Predictor) (Out come)

Quality of sleep
(-)

Fatigue

(-)

Mental well
being
 21

Chapter II

Method

Research Design

The existing study conducted by using creational research design. The present
study is based on survey research method. The purpose of the study is to see the
impact of fatigue on sleep and mental wellbeing among university students.

Sample

The sample of present study consisted of three hundred participants.

Purposive sampling technique was used to collect data from participants (N=300).
The respondents were man (n=150) and women (n=150). Demographic variables such
as age, gender, education, residence, family system, marital status and number of
children were also measured. The sample ranged of age from 18 to 25 years. The data
was collected from different areas of Sargodha.

Inclusion and Exclusion Criteria

University students are included in my study since I selected teenagers as the

sample of my research. Individual’s that are not on that list are exclusion of my study.
 22

Table 1
Frequencies and Percentage of Participants (N=300)
f %
Demographic variables
Age
18-20 122 40.7%
21-25 178 59.3%
Education
BA 69 23.0%
MA 118 39.3%

MSC 113 37.7%

Residence
Rural 156 52.0%
Urban 144 48.0%
Gender
Man 150 50%
Women 150 50%
Family system
Joint 129 43%
Nuclear 171 57%
No of children
1-2 110 36.7%
3-4 129 61.3%

Table 1 shows the demographic characteristics of the sample of the pilot

study. Tables show frequency of boys and girls with the relevance to their gender,
education & family system. Results indicated that frequency of men (f =150, 50.0%)
and women (f =150, 50.0%) are equal. Education is another variable which divide
sample into BA(f =23.0%), MA (f =39.3%) and MSC (f =37.7%). Family system is
variable which divide sample in to joint (f=43%) nuclear (f = 57.No of children is
another variable which divide into 1-2 (f =36.7%) 3-4 (f =61.3%).
 23

Instruments

Chalder Fatigue Scale (Trudie Chalder et al.,1993 )

11 item scale was used that measures fatigue by measuring both positive and
negative feelings about the self. Cronbach alpha for this scale is α =; .86-.92.
Response format was4-point Likert scale ranging from 1 =less than usuall, 2 =more
than usuall, 3 =more than usuall, 4 = much more tha usuall,. There are 5 reverse-
coded items in this scale, these items are 2, 5, 6, 8 and 9. Higher score indicate higher
self-esteem and low score indicate less self-esteem.

Pittsburgh Sleep Quality Index (Buysse, et at., 1989)

9 items scale was used. Cronbach alpha for this scale is α = .69. Response
format was 4 point Likert scale in which 1 = Not during the past month, 2 =Less than
once a week. 3 = Once or twice a week 4 =Three or more times a week. There were
no reverse coded items in this scale. Low score on this scale indicate good quality of
sleep. Whereas high score indicates poor sleep quality.

Warwick-Edinburgh mental wellbeing scale (Tennant et al., 2007)

14 items wellbeing scale was used that relates to an individual’s state of

wellbeing Cronbach alpha for this scale is α =; .89. Response format was 5-point
Likert scale ranging from1 = none of the time, 2 = rarely, 3 = some of the time, 4 =
often, 5 = all of the time. There were no reverse coded items in this scale. A higher
Warwick Edinburgh mental wellbeing scale score indicate higher level of mental
wellbeing and low score indicate low level of mental wellbeing.

Procedure

After taking permission from department data collection was started from
various areas of Sargodha city. The research ensure the participants, that this is an
academic research and results will be used to only for academic purpose. Then
participants were presented with an information sheet about the study which gave a
through explanation about the aims of the study, the level of possible personal
discomfort, sensitivity and the approximate time it took to the finish the questionnaire
booklet. Ethical protocol was maintained: participants were assured of the
 24

confidentiality and anonymity of their information, and their right to withdraw at any
stage of research. After motivating them those participants who showed their willing
to participate in the study, they were given brief instruction to complete the scales and
provide the information on demographic sheet. The researcher remains present and
vigilant during the completion of the scales and in case, if the participants face any
sort of difficulties during the completion of the scales or other understanding of the
questions, researcher address their queries in appropriate way and answer their
questions. After the completion of the scales the researcher paid special thanks to the
participants, because of the voluntarily participation in the study without taking any
tangible incentive. The researcher appreciates that their participation is worthy
contribution in the knowledge of psychology.
 25

Statistical Analysis

Analysis for descriptive statistics, pearson correlation and regression was

used through IBM-SPSS. For reliability analysis was run which provided Coronbach
alpha. To measure the differences, t-test was also run
 26

Chapter III

Results

Table 1
Frequencies and Percentage of Participants (N=300)
f %
Demographic variables
Age
18-20 122 40.7%
21-25 178 59.3%
Education
BA 69 23.0%
MA 118 39.3%

MSC 113 37.7%

Residence
Rural 156 52.0%
Urban 144 48.0%
Gender
Man 150 50%
Women 150 50%
Family system
Joint 129 43%
Nuclear 171 57%
No of children
1-2 110 36.7%
3-4 129 61.3%

Table 1 shows the demographic characteristics of the sample of the pilot

study. Tables show frequency of boys and girls with the relevance to their gender,
education & family system. Results indicated that frequency of men (f =150, 50.0%)
and women (f =150, 50.0%) are equal. Education is another variable which divide
sample into BA(f =23.0%), MA (f =39.3%) and MSC (f =37.7%). Family system is
variable which divide sample in to joint (f=43%) nuclear (f = 57%) .No of children is
another variable which divide into 1-2 (f =36.7%) 3-4 (f =61.3).
 27

Table 2
Corrected Item Total Correlation Chalder Fatigue Scale (N=300)
Item No r
CF1 .38
CF2 .45
CF3 .467
CF4 .59
CF5 .46
CF6 .50
CF7 .44
CF8 .46
CF9 .54
CF10 .41
CF11 .59
Note.CF=chadler fatigue

Table 2 shows the item total correlation of Chalder Fatigue Scale. Results
shows that all 11 items of chalder fatigue scale has high positive correlation.38 to .59
with the total score of this scale.
 28

Table 3
Corrected Item Total Correlation of Pittsburgh sleep quality index (N=300)
Item No r
QS1 .37
QS2 .46
QS3 .47
QS4 .48
QS5 .47
QS6 .52
QS7 .45
QS8 .45
QS9 .53
QS10 .42
Note.QS=Quality of sleep

Table shows the item total correlation of Pittsburgh sleep quality index
Scale. Results shows that all 10 items of sleep quality index scale has high positive
correlation.37to .53 with the total score of this scale.
 29

Table 4
Corrected Item Total Correlation of Mental wellbeing Scale (N=300)
Item No r
MW1 .481
MW2 .496
MW3 .444
MW4 .474
MW5 .478
MW6 .362
MW7 .460
MW8 .414
MW9 .434
MW10 .409
MW11 .310
MW12 .384
MW13 .424
MW14 .318
Note.MW=mental well-being scale.

Table 4 shows the item total correlation of mental well-being Scale. Results
shows that all 14 items of mental wellbeing scale has high positive correlation.318 to
.481 with the total score of this scale.
 30

Table 5
Psychometric Properties of Variables (N=300)
Range
Variables N M SD α Potential Actual Skewness Kurtosis
CF 300 19.54 2.020 .818 11-44 14-25 .298 .088
QS 300 26.53 6.482 .795 10-40 16-41 .974 -.161
MW 300 47.82 10.802 .801 14-70 26-70 .733 -.538
Note.CF= Chalder Fatigue ;QS=Quality of Sleep; MW = mental wellbeing

Table 5 shows mean and standard deviation of the study variables. It also
shows internal consistency index (alpha coefficient) for all scales used in thy study.
The results showed that all the scales of the present study are internal consistent.
Reliability analysis indicates the reliability coefficient of fatigue, sleep and mental
wellbeing scale is .81, .79, .80, and respectively, which shows satisfactory internal
consistency. The values of skewness and kurtosis were less then ±2 which indicated
that data is normally distributed on all variables.
 31

Table 6
Pearson Correlation among Study Variables (N=300)
Variables 1 2 3
1.Fatigue - -.075** -.016**
2. Sleep .225**
3.Mental wellbeing -
** p<.01

Table no 6 show Pearson correlation among study variables. Findings

indicated that fatigue has significant negative correlation with quality of sleep(r =-
.075, p < .01) and with mental wellbeing (r = -.016. p < .01). Findings indicated that
quality of sleep has significant has positive correlation with mental wellbeing (r=
.225**,p<.01).
 32

Table 7
Multiple Linear Regression Analysis Showing Impacts of Fatigue and Sleep
Outcome: Sleep
95%CI
Predictors Model B LL UL
(constant) 31.200 24.034 38.366
CF -0.75 -.604 .126
R² .75
F 1.66*
Note.Chalder fatigue ,*p<0.05

Table 7 shows the multiple regression analysis with fatigue as predictor and
sleep as outcome. The value of R2 was -0.75 which indicated that sleep explained
75% variance in fatigue with F= 1.66, p<.05. Findings revealed that fatigue negatively
predicted sleep.
 33

Table 8
Multiple Linear Regression Analysis Showing Impacts of Fatigue and Mental
wellbeing
Outcome:Mental Well
being
95%CI
Predictors Model B LL UL
(constant) 48.474 37.542 61.490
CF -.014 -.696 523
R² .16
F .079**
Note.CF=Chalder Fatigue **p=.01

Table 8 shows the multiple regression analysis with fatigue as predictor and
mental well being as outcome. The value of R2 was .016 which indicated that fatigue
explained 2% variance in mental well being with F= 390.8, p<.001. Findings
revealed that fatigue positively predicted sleep.
 34

Table 9
Mean, Standard Deviation and t-Values for women and men area on fatigue Sleep
and mental wellbeing
Women Man
Variables M SD M SD t(298) p LL UL Cohen’s
d
CF 59.07 13.580 58.08 12.648 -.66 .50 -3.98 1.975 0.0754
QS 23.40 2.98 23.42 3.11 .04 .96 -.677 .712 0.0065
MW 50.39 11.413 45.25 9.519 -4.2 000 7.528 -2.75 0.48911
Note.CF=chalder fatigue, QS= quality of sleep, MW=mental well being

Table 9 showed mean differences across gender, Findings indicated significant

mean differences on mental well being with t (298) =-4.2, p<-.001. The value of
Cohen’s d was 0.48 which indicate small effect size. Results revealed that women
exhibited higher scores on fatigue(M= 59.07, SD= 12.64) as compared to men (M=
58.08, SD= 12.64). Results revealed that men exhibit higher scores on quality of sleep
(M= 23.42, SD= 3.11) as compared to the women (M= 23.40, SD= 2.98). Results
revealed that women exhibits higher scores on mental well beinge(M=50.39, SD=
11.41) as compared to men (M= 45.25, SD= 9.51).
 35

Table 10
Mean, Standard Deviation and t-Values for Rural and Urban area on fatigue Sleep
and mental wellbeing
Rural Urban
Variables M SD M SD t(298) p LL UL Cohen’s d
CF 33.42 6.667 34.26 7.150 -1.046 -003 -2.4 74 0.12
QS 27.06 2.937 27.54 3.320 -1.313 .995 -1.1 23 0.15
MW 45.99 4.29 46.40 4.36 -.799 -.056 -1.3 59 0.09
Note.CF=Chalder fatigue, QS=Quality of sleep, MW= Mental-wellbeing

Table 10 Findings indicated significant mean differences on fatigue with t

(298) = -003p <-.01 The value of Cohen’s d was 0.12 which indicated small effect
size. Findings indicated significant mean differences on mental-wellbeing with t
(298) =-.056, p <-.05.The value of cohen’d was 0.12 which show small effect size.
Results revealed that urabn areas exhibited higher scores on chadler
fatigue(M=34.26, SD=7.150) as compared to rural area areas (M=33.42, SD=6.667).
Results revealed that urban areas exhibited higher scores on Quality of
sleep(M=27.54, SD=3.320) as compared to rural areas (M=27.06, SD=2.937).
Results revealed that urban areas exhibited higher scores on Mental-wellbeing
(M=46.40, SD=4.36) as compared to rural area (M=45.99, SD=4.29). The value of
Cohen’s d was 0.09 which indicated small effect size.
 36

Table 11
Mean, Standard Deviation and t-Values for 18-20and 21-25 Students area on Chalder
fatigue quality of sleep and Mental wellbeing
18-20 21-25
Variables M SD M SD t(298) p LL UL Cohen’s d
CF 19.40 1.997 19.59 2.041 .481 .031 .582 0.35 0.09
QS 26.23 5.74 26.73 6.09 .629 .583 -2.0 1.00 0.08
MW 47.97 10.85 47.76 10.32 .200 .842 -.25 2.75 0.02
Note.CF=Chalder Fatigue,QS=quality of sleep MW=Mental wellbeing

Table 11 showed mean differences across 18-20 and 21-25. Findings

indicated significant mean differences on fatigue with t (298) = .481 p < .05. The
value of Cohen’s d was 0.09 which indicated small effect size. Results revealed that
21-25 students exhibited higher scores on fatigue(M=77.21, SD=11.84) as compared
to 21-25 students (M=76.48, SD=14.07). Results revealed that 21-25 students
exhibited higher scores on quality of sleep (M=26.73, SD=6.09) as compared to 18-
20 students (M=26.23, SD=5.74). The value of Cohen’s d was 0.08 which indicated
small effect size. Results revealed that 18-20 students exhibited higher scores on
quality of sleep (M=47.97, SD=10.85) as compared to 21-25 students (M=47.76,
SD=10.32). The value of Cohen’s d was 0.02 which indicated small effect size.
 37

Table 12
Mean, Standard Deviation and t-Values for Joint and Nuclear families’ Students on
fatigue sleep and mental wellbeing.
Joint Nuclear
Variables M SD M SD t(298) p LL UL Cohen’s d
CF 19.56 2.14 19.53 1.92 .11 000 -.43 .49 0.01
QS 26.16 6.15 26.81 6.44 -.86 -.98 -2.1 .83 0.10
MW 47.42 10.54 48.12 11.16 -.55 -.69 -3.1 1.78 0.06
Note.CF=chalder fatigue ,QS=Quality of sleep, MW=Mental well Being

Table 12 shows mean differences across joint or nuclear family system.

Findings indicate significant mean differences on fatigue with t (298)=.11, p<0.001.
The value of Cohen’s d was 0.01which indicate small effect size. Joint family system
scores high on fatigue (M= 49.86, SD= 13.25) as compared to nuclea family system
(M= 47.25, SD= 11.34). Nuclear family system scores high on quality of
seep(M=26.16, SD= 6.15) as compared to joint family system (M= 47.42, SD= 6.15).
Nuclear family system scores high on mental well being(M=28.12, SD= 11.16) as
compared to joint family system (M= 47.42, SD= 10.14).
 38

Table 13

Summary of Findings N = (300)

No Hypothesis Result
1 There will be the negative relationship Accepted
between the fatigue and sleep.

2 There will be the negative relationship Accepted

between the fatigue and mental well-being.
3 There will be negative correlation between Accepted
fatigue and mental well-being.
4 There will be positive correlation between Accepted
high sleep and mental well-being.
 39

Research Findings

Predictors Outcome

r=-0.75** Sleep
β= -.75

Fatigue

r=-.016** Mental
β= -.014 Well being

Figure II: Research findings of present study

This model showed that fatigue has significance negative correlation with
sleep(r= -.75). Fatigue is significant predictor of sleep (β= -.75). It also shows that
fatigue has significance negative correlation with mental wellbeing(r = -0.1).
Fatigue is significant predictor of mental well being (β= -.014).
 40

Chapter IV

Discussion

The study is used to find the impact of fatigue on quality of sleep and mental
wellbeing. The study was conducted on a sample of (N=300) out of which 150 were
female students and 150 were male students. They was also examined by different
demographic variables which are age, gender, marital status, no. of children,
qualification, family system, and residence. Descriptive statistics, range, skewness,
kurtosis, correlation, regression, and ANOVA were computed. The study is
significant in that it emphasizes the impact of fatigue in one's life. It is critical to take
rest in obtaining a healthy lifestyle. A person's cognitive capacities may be harmed if
he doesn’t take sufficient rest.

The first variable is Fatigue which is defined as the self recognized state in which an
individual experiences an enormous sustained sense of exhaustion and decreased
capacity for physical and mental work that is not relieved by rest.The second variable
is quality of sleep can be characterized as sleep satisfaction, integration of aspects of
initiation, maintenance, quantity of sleep, and regeneration when we are awakened
(Kline Christopher, 2013) n & Deci, 2010).The third variable is Mental well being
which is defined as a condition of well-being in which the individual recognizes his
or her own potential, can cope with the usual demands of life, can work successfully
and fruitfully, and is able to contribute to his or her community.

The analysis revealed that the psychometric properties of the scales used to
measure the study variables were satisfactory. Before applying analysis on the data.
The outliers were eliminated by checking the Z score values of the data, after
eliminating the outliers the value of skewness and kurtosis were found to be in the
range +1 to -1 respectively, which indicates the normal distribution of scores. As all
the values were below 2 so it confirmed the normality of the data (see Table 2).
 41

Alpha coefficients for the" Calder Fatigue Scale, Pittsburgh Sleep Quality Index
(Buysse, et al., 1989 ), and The Warwick-Edinburgh Mental Well-being Scale
(WEMWBS) ".were satisfactory with relative values of .81,.78,.80 and respectively.

To evaluate and verify the validity of scales, the item-total correlation was
computed, which proved that every item in the scale, correlates with the central
theme which it was supposed to measure this analysis indicated that there were no
problematic items present in the scales, and thus original items were retained for
further analysis. The study is based on four hypotheses which will be discussed one
by one.

The first hypothesis was there will be the positive relationship between the
fatigue and sleep. The study did not support this because a significant negative
correlation was found between fatigue and quality of sleep. Previous researches show
fatigue due to illness damage neuronal pathway which impairs quality of sleep in
patient. Several factors may play a role in the link between MS fatigue and poor
sleep (Kaminska, M., R. J. Kimoff, K. Schwartzman, and D. A. Trojan) (2011).
13th).

The second hypothesis was that there will be a negative correlation between
the fatigue and quality of sleep. Results of the study were in support of the
hypothesis as a significant negative correlation was observed between the quality of
sleep and cognitive flexibility. Hinds et al17 verified the link between fragmented
tiredness sleep and greater daily weariness, implying a cycle in which sleep
disruptions contribute to increasing daily weariness, leading to longer but less
effective sleep periods. Excessive fatigue can seriously affect the sleep. Excessive
work involving too much energy expenditure lead to fatigue. Because sleep help to
restore energy, so sleep is disturbed on the day when too much energy is expand.
Fatigue causes muscle soreness that causes people to poor quality sleep. Nervous
fatigue causes people to have nightmares that impair sleep quality.
 42

The third hypothesis was there will be negative correlation between fatigue
and mental well-being result of the study was in support of the hypothesis because a
significant negative correlation was observed between fatigue mental well being. In
university students, mental weariness associated with a worse sense of well-being
and poor academic achievement .Fatigue has been defined as a health symptom that
can affect cognitive skills including focus, memory, and decision-making (Hockey,
et al., 2000; van der Linden, et al., 2003).A person with impaired cognitive and
decision making skills will feel low about himself. Fatigue also impairs ones posture
and social adjustment or dealing which lead to low self confidence and low self
worth.

The fourth hypothesis was there will be positive correlation between high
quality of sleep and mental well-being. Study support this hypothesis because a
significant positive correlation was found between sleep and mental wellbeing .Ferrie
et al. found that changes in sleep length (from moderate sleep Quality to both short
and long sleep quality) were linked with lower Cognitive performance (J.E. Ferrie, et
el. , 2011). (J.E.Ferrie, at el., 2011). Sleep–wake cycles in individuals with
schizophrenia ranged from well entrained to highly disturbed rhythms with
fragmented sleep epochs, together with delayed melatonin onsets and higher levels of
daytime sleepiness.

Conclusion

The present study explores the effect of fatigue on sleep and mental well
being. The study concluded that there is a negative relationship between fatigue and
quality of sleep, fatigue and mental wellbeing. Likewise, there is also a positive
relationship exist between quality of sleep and mental wellbeing.

Individual who are physically active and healthy enjoy good quality of sleep
and mentally wellbeingness as compared to the individual who are fatigued and ill.
Significant gender differences also find on the scale of fatigue, quality of sleep and
mental wellbeing, results show that women more likely to report having fatigues than
men. Moreover, married people have good quality of sleep and have high mental
wellbeing as compared to married.
 43

Limitations

1. The first limitation of the research is about to the generalizability of the data, because
information was collected only from Sargodha.
2. This research is quantitative in nature, it doesn't provide deep information like
qualitative researches provide. That's why the data assembled was not enhancedand
broad.
3. Purposive sampling technique was used and these techniques have some
disadvantages which we also face in the research. It causes vulnerability to errors in
judgement by the researcher. It reduces the level of consistency and also increases
the chance of biasing. This sampling technique enables us to generalize ourdata
findings.
4. Social desirability can be a potential thereat for the internal validity of the research
because all the scale are self-reported measures.
5. It was a survey research, so it doesn't guarantee the causality of the dependent
variable, because in survey research we are unable to control external factors which
can affect our findings. So, we can't depend on correlation findings.

Suggestions

1. It is purposed that use random sampling technique rather than purposive technique.
2. Data must be collected on a larger scale and collect from more than one city to
increase the generalizability of the research.
3. It is suggested that for further researchers to gathered qualitative data rather than
quantitative.
4. It is suggested that researchers won't depend upon just survey research design they
can utilize their findings by using the multiple-technique approach.

Implications

This discovery is used by clinical, social, and educational psychologists.

These findings may also be useful to academics looking at the relationship between
fatigue sleep quality, and mental wellbeing. The current study opens up new avenues
for researchers to better grasp the true nature of fatigue, which can have a significant
impact on our mental well being. Physical health, mental wellbeing both are very
important for university student to achieve academic goal.In the present pandemic
 44

era, everyone must cope with a new situation that may come to their family and
friends; therefore Mental wellbeing is also a vital trait for students and others. As a
result, this study is beneficial in this aspect.
 45

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Appendix A

Informed consent

I am research student of BS at Department of Psychology, Govt. Post Graduate

college for women Chandni Chowk, Sargodha. I am conducting the present research
in order to understand the Impact of fatigue on mental well being and sleep. For this
purpose you are requested to complete the following questionnaires. I assure that the
information you provide will be kept anonymous and confidential. The information
collected from you will only be used for research purpose.

You have the right to refuse or withdraw your participation at any stage of the
research. However, there is no physical, psychological, or social risk in participating
in the study. Your corporation is highly valuable and will assist to advance scientific
knowledge.

Thank you.

Consent

I am willing to participate in the present study and I have no objection to

above mentioned process of publication of information provided by me.

Signature

Demographic information

Age: Education:

Gender: Men/Women No of children:

Residence: Rural / Urban Family system: joint / nuclear

 53

Appendix B

Chalder Fatigue Scale

Please answer all questions.

SR. Less than No more More Much

No usual than usual than more than
usual usual

1 Do you have problems with tiredness?

2 Do you need to rest more?

3 Do you feel sleepy or drowsy?

4 Do you have problems starting things?

5 Do you lack energy?

6 Do you have less strength in your

muscles?
7 Do you feel weak?

8 Do you have difficulties

concentrating?
9 Do you make slips of the tongue when
speaking?
10 Do you find it more difficult to find
the right word?
11 Better No worse Worse Much
than than usual than worse than
usual usual usual
12 How is your memory
 54

Appendix C

PITTSBURGH SLEEP QUALITY INDEX(PSQI)

INSTRUCTIONS:

The following questions relate to your usual sleep habits during the past month only.
Your answers should indicate the most accurate reply for the majority of days and
nights in the past month. Please answer all questions during the past month,

1. When have you usually gone to bed? ____________________________________

2. How long (in minutes) has it taken you to fall asleep each night?
____________________________________
3. What time have you usually gotten up in the morning?
____________________________________
4. A. How many hours of actual sleep did you get at night?
____________________________________

B. How many hours were you in bed? ____________________________________

5 During the past month, how often have Not Less than Once or Three or
you had trouble sleeping because you during once a twice a more times
Not during past month. past week week a week
month

A Cannot get to sleep within 30 minutes

B Wake up in the middle of the night or

early morning

C Have to get up to use the bathroom.

D Cannot breathe comfortably

E Cough or snore loudly

F Feel too cold

 55

G Feel too hot

H Have bad dream

I Have pain

J Other reason (s), please describe,

including how often you have had
trouble sleeping because of this reason
(s):

6 During the past month, how often have

you taken medicine (prescribed or
“over the counter”) to help you
sleep?

7 During the past month, how often have

you had trouble staying awake while
driving, eating meals, or engaging in
Social activity?

8 During the past month, how much of a

problem has it been for you to keep up
enthusiasm to get things done?

9 During the past month, how would you Very Fairly Fairly Very bad
rate your sleep quality overall? good good bad
(3)
(0) (1) (2)
Do you have a bed partner or room Not Less than Once or
10 mate? during twice Three or
the past once a more times
a week
week
month a week

:
 56

If you have a room mate or bed partner,

ask
him/her how often in the past month
you have

had:
Loud snoring
.

Long pauses between breaths while

asleep

Legs twitching or jerking while you

sleep

Episodes of disorientation or confusion

during sleep

Other restlessness please describe

 57

Appendix D

The Warwick-Edinburgh Mental Well-being Scale (WEMWBS)

Please answer all questions.

SR. STATEMENTS None of Rarely None of Often All of

NO the time the time the
time
1 I’ve been feeling optimistic
about the future

2 I’ve been feeling useful

3 I’ve been feeling relaxed

4 I’ve been feeling interested in

other people
5 I’ve had energy to spare

6 I’ve been dealing with problems

well
7 I’ve been thinking clearly

8 I’ve been feeling good about

myself
9 I’ve been feeling close to other
people

10 I’ve been feeling confident

11 I’ve been able to make up my

own mind about things
12 I’ve been feeling loved

13 I’ve been interested in new

things
14 I’ve been feeling cheerful