Autoregressive language models frequently degrade during long-horizon generation, producing repetitive text, losing instruction adherence, and exhibiting unstable entropy. Despite the prevalence of these failures, practitioners lack online diagnostics to detect them in real-time as they occur. We formalize this degradation as cognitive fatigue, a measurable generation-time state characterized by decay in attention to the original prompt, representational drift, and entropy miscalibration. We introduce the Fatigue Index (FI), a lightweight, model-agnostic diagnostic that aggregates these three signals under explicit axioms (monotonicity, boundedness, interpretability) enabling reliable runtime monitoring. Across nine models (1B-13B parameters), FI trajectories exhibit structured temporal dynamics, predict task degradation (AUROC = 0.95) and repetition (Spearman rho = 0.94), and reveal non-monotonic scaling behavior: instruction-tuned models below 3B exhibit faster collapse than base models, with this trend reversing at 7B. Stress analyses further show that FI onset accelerates under longer contexts, middle-positioned evidence, and reduced numerical precision. These results establish cognitive fatigue as a coherent and measurable phenomenon, and position FI as a principled tool for runtime reliability monitoring in production LLM systems.