When Tim died it hurt. And I don't just mean that my heart broke. I mean that I hurt physically. I felt so tired that my bones ached. My stomach hurt. I felt sick. My head ached. I didn't experience this, but I know that other widows had chest pains so bad they ended up in A&E. And there's widow brain too. It's all completely normal with the shock and sadness that comes along with bereavement.
 
Please remember, though – if any of these symptoms become distressing, last a long time or get worse, please talk to your doctor, call 111, or in an emergency, call 999.
 
Being exhausted
Grief messes with our sleep, gives our brains a lot to do, stops us eating properly – it's hardly surprising it leaves us exhausted. Try to eat as well as you can, sleep when you can and manage your energy.
 
Feeling pain in muscles and joints
The tension of grief can leave us with aches and pains, and grief can actually make pain worse. Try to exercise if you can – even just a walk round the block – as exercise can improve mood. Try having a massage, which can also help skin hunger. Colleges that run health and beauty courses often have low-cost massages to provide experience for students.
 
Chest pain and shortness of breath
Chest pain and shortness of breath are associated with anxiety. However, if these come on suddenly or are painful, talk to your doctor of call 999 – paramedics and doctors would rather be called in for something that isn't serious that miss something that really is.
 
Headaches
Headaches often accompany anxiety and stress. Trying to relax can help, but it's easier said that done. Warm baths and music helped me.
 
Widow brain
The confusion, forgetfulness and lack of concentration that comes alongside bereavement is often known as widow brain.
 
Stomach upsets and appetite changes
Grief can make us eat more, eat less, eat junk food, comfort eat feel sick, feel hungry, think we are never going to feel hungry again. This is all normal and will settle. Try and eat some fruit and veg, but eat what makes you feel comforted.
 
Picking up bugs
Grief can affect our immune systems, leaving us more vulnerable to infection. Wash your hands regularly, make sure kitchen surfaces are clean, cook food thoroughly, get the vaccines you are offered, and wear a mask in crowded palaces during cold and flu season can help to keep infection levels down.
 
Health anxiety
One of the issues with the physical symptoms around grief is that they can become part of health anxiety, where we become convinced that every symptom, from a headache to a painful toe, is something life-changing. I have gastritis, and sometimes when its bad I vomit. I threw up blood one day. My wonderful GP, who was an incredible support to me after Tim died, fast-tracked me for an endoscopy while reassuring me that she was sure everything was okay, and fortunately she was right. On the flip side, bereavement can also leave us caring less about our health and ignoring symptoms. If you are on regular medications, keep taking them (pill boxes and reminders on phones are really helpful) and build in a bit of self care.

After Tim died, I became so tired. The kind of tired that squashes you flat. The kind of tired that it felt like even my bones hurt. Feeling this exhausted can be scary. But it is a normal part of grief.

​Why does grief make you tired?
You're in shock
A psychological shock triggers the fight, flight or freeze response. Our bodies fill with the stress hormone cortisol, desensitising us and putting us on alert. After a bereavement, particularly a sudden and unexpected one, our cortisol levels remain high for a prolonged period of time, leaving us exhausted.

Your brain has so much to process
Our brains get tired when they are being asked to process information all the time – every decision requires energy. So grief exhaustion is both physical and mental.

You can't sleep
Grieving often means your head just won't stop – it's full of spinning thoughts and tough memories. You may also be having nightmares, flashbacks or intrusive memories. All of these will affect your sleep.

There's so much to do
Bereavement leaves us with a lot of admin, from bank accounts to businesses, and from phone contracts to funeral arrangements. There is so much that needs to be completed, and some things must be done in specific timelines.

Losing someone also means losing their help at home. This can include routine jobs around the house and caring responsibilities. For some people, bereavement means having to find somewhere else to live, sometimes at short notice.

You are hypervigilant
Hypervigilance is a state of extreme alertness where you are constantly assessing the environment for threats, both real and perceived. You may feel that since you have been through a traumatic event, what's to stop another? Hypervigilance can be a symptom of post-traumatic stress disorder (PTSD). It is exhausting in itself, as well as making it hard to relax or sleep.

You aren't eating properly
It can be hard to eat well when you are grieving – it may not seem worth it to cook for one, or your appetite may not be what it was. Not having enough of the right kind of nutrients leaves you without energy. Both your diet and your alcohol intake can also affect the depth of your sleep.
​
What to do?

• Be kind to yourself. I really mean this. You've been through a lot
• Rest when you need to. Naps can be wonderful things
• Try to get the sleep you need
• Learn to manage the energy that you have
• Eat as well as you can

 

​The spoon theory was created by Christine Miserandino to explain to a friend about what it felt like to have the chronic illness lupus. She used it to describe how every task in a day requires a block of energy, be it physical or mental, and that she had to budget out those blocks across the day. She wrote it up as an essay for her blog.
 
"I quickly grabbed every spoon on the table; hell I grabbed spoons off of the other tables. I looked at her in the eyes and said 'Here you go, you have Lupus'… I asked her to count her spoons. She asked why, and I explained that when you are healthy you expect to have a never-ending supply of spoons. But when you have to now plan your day, you need to know exactly how many spoons you are starting with. It doesn’t guarantee that you might not lose some along the way, but at least it helps to know where you are starting. She counted out 12 spoons…. I asked her to list off the tasks of her day, including the most simple. As she rattled off daily chores, or just fun things to do; I explained how each one would cost her a spoon… I think she was starting to understand when she theoretically didn’t even get to work, and she was left with 6 spoons. I then explained to her that she needed to choose the rest of her day wisely, since when your spoons are gone, they are gone."
 
Spoons and grief
The spoon theory was created for chronic illness, but it can also be used for the impact that grief has on your physical and mental spoon numbers. Early on in grief I was so tired that my bones hurt, which took away some of my physical spoons. I also had widow brain, which took away some of my mental spoons too. Creating a spoons graphic based on your own needs can be a useful exercise to help you understand what you need, and what you can do to look after yourself.

What you can do

• Be kind to yourself
• Some days you might wake up with very few spoons – those are the days that you need to rest, both physically and mentally
• Get to know your limitations
• Prioritise the things that have to be done, the things that it would be useful to do, and the things that can be put off to another day
• Schedule your day to meet the spoons you have – you may have more energy at different times of day

• Accept that you may need to ask for help, and accept help when it's offered (I know it's hard)
• Understand that, when you are low on mental spoons, physical spoons, or both, it's hard to make plans. And that you might need to change your plans at the last minute, too.
• Pace yourself – if you have a busy day ahead, have a quiet day the day before if you can, and be prepared that you might need to rest the day after
• Take breaks when you need them
• Explain to people what you are going through – the spoon theory can help
• Try to eat and sleep as well as you can, and consider adding in a basic multivitamin and multimineral if you're not eating well
• Exercise when you can

 
Notes about spoons

• Your numbers of spoons can change from day to day
• Physical and mental spoon numbers can differ – gardening may be a high physical spoons activity but if you enjoy it, it might be low on mental spoons, or even help you to replenish your spoons
• The number of spoons any activity takes will vary from person to person
• Replenishing mental spoons differs for different people – for extroverts, spending time with people helps, and for introverts, spending time alone might be the right thing to do. I'm an ambivert with introvert leanings, and so I love being with people right up to the point that I suddenly need to be alone
• The spoons lost in grief do come back, but your spoon numbers might drop on milestone dates or days when grief hits hard 

Lack of sleep can have an effect on our health – it's been linked to obesity, heart disease, memory loss, high blood pressure, diabetes and a less effective immune system. Not having enough sleep can leave you craving sugary, salty or carbohydrate-heavy food.

Lack of sleep has connections between depression and anxiety. It can even affect your balance.

Sleep can be so hard when you are grieving - your head is full of spinning thoughts and tough memories, and you may have nightmares. ​​Here are some hints and tips for improving sleep.
 
During the day

• Get sunlight, or use bright daylight bulbs during the day to reinforce your circadian rhythm
• Use the bed to sleep, not to work
• Exercise during the day can help you sleep at night, by increasing sleep duration, deep sleep duration and fewer times waking up. Avoid strenuous exercise or competitive sport in the few hours before bed
• People who eat a Mediterranean-style diet have a lower risk of insomnia, and are more likely to have a good night's sleep.
• Avoid napping if possible
• Try stopping smoking, as nicotine affects sleep
• If you drink alcohol, try cutting it down, especially late at night – while it makes you feel sleepy, it disrupts later sleep
• Try cutting down caffeine, especially later in the day

 
In the evening

• Don't eat a heavy meal too close to bedtime
• Avoid devices for half an hour to an hour before bedtime, and don't have TVs, computers or smartphones in the bedroom
• Don't drink too many fluids before bedtime
• Have a warm bath or shower, with lavender-based bubble baths, soaps, body washes and body lotion – there is some evidence that the scent of lavender does have an effect on sleep

 
Bedtime

• Think about your sleep hygiene – have a target bedtime, and a fixed wake up time, even at the weekends
  • But if you really aren't sleepy, don't force yourself to go to bed
• Dim the lights
• Take half an hour to wind down – music, reading, stretches, yoga
• Have a consistent pre-bed routine, such as cleaning teeth, putting on pyjamas
• Make sure your mattress, pillow, duvet and bedding are comfortable
  • Mattress toppers add extra snuggliness
  • Wool mattresses, mattress toppers and duvets can help you regulate your temperature 
• Weighted blankets may help with stress and anxiety
• Keep your bedroom cooler than other rooms
• Have blackout curtains or blinds
• Block sounds with ear plugs, or drown them with white noise
• Listen to low volume audio or music on a player that switches off automatically – Radio 4, radio 4 Extra, podcasts and Audible are all good options for audio, but make sure it's not too interesting or it will keep you awake!
  • The Calm app has meditation, music and stories designed to lull you to sleep
• Use lavender oil or lavender-based pillow sprays,
• Have a glass of warm milk – tryptophan can improve sleep and mood, and warm milk reminds me of being a little kid tucked up in bed

 
If you can't sleep

• Try counting sequences
  • Count sheep
  • Count backwards from a hundred, starting again every time you make a mistake
  • Count the Fibonacci sequence
• Try the cognitive shuffle
• Try the 'military method' – relaxing each part of your body, and then making your mind blank
• Try progressive muscle relaxation, where you tense each part of your body and then release the tension
• Try slow breathing – it can help in sleeping as well as grounding
  • 7/11 breathing – breathe in for a count of seven, and breath out more slowly, to a count of eleven
  • Box or four-square breathing – breathe in for a count of four, hold for a count of four, breathe out for a count of four and hold for a count of four
  • Alternate nostril breathing – block your left nostril, and inhale and exhale through your right nostril, then block your right nostril, and inhale and exhale through your left nostril
  • 4-7-8 breathing – breathe in through your nose for a count of four, hold your breath for a count of seven, and then breathe out through your mouth for a count of eight
• Try mindfulness or meditation
• Distract yourself with imagery – visualise the route of a favourite walk, a childhood room, a wonderful beach or an amazing view. Bring in as many details as you can, including sounds, sights, views, textures, colours
• Try sleep hypnosis – there are lots of sleep hypnosis audio tracks on YouTube
• Tell yourself to stay awake…
• If you can't sleep after 20 minutes, get up and do something calming in dim light, and then try again

 
If insomnia is making you so tired during the day that you can't work, care for yourself or others, or means that driving feels dangerous, talk to your doctor. There may be medications or therapy techniques that could help.