How to overcome chronic fatigue?

Just Fatigue — or Chronic Fatigue Syndrome?

Everyone feels fatigue at some point. We’ve all been weary and tired — possibly too tired to get motivated for important tasks or chores. But does a lack of energy mean you are on your way to developing chronic fatigue syndrome (CFS)? Not at all, experts say. Fatigue is very different from chronic fatigue syndrome.

“At any one time, about 25 percent of the population will say they’re feeling fatigued. Six or more months of fatigue? Maybe one out of 20 people would feel that,” says Leonard A. Jason, PhD, professor of psychiatry at DePaul University in Chicago and director of the DePaul University Center for Community Research. “The person with chronic fatigue syndrome has something that lasts versus someone who’s just stressed out or overextended.”

Still, fatigue is something that should always be taken seriously. Ongoing fatigue could be a sign of a number of health problems and should be treated.

Chronic Fatigue Syndrome vs. Common Fatigue

Fatigue differs from chronic fatigue symptoms in many ways. Remarkably, duration isn’t always among them. Even though someone must feel fatigue for six months or longer to be diagnosed with CFS, that’s not the only basis for diagnosis. “There are some people who have six or more months of fatigue because of overextended lifestyles — working all-night shifts and then having responsibilities during the day,” Jason says.

Other factors that differentiate the two include:

  • Responsiveness to rest. “With general fatigue, most people recover quickly with rest,” Jason says. “A person who is overextended is going to recover after a week in the Bahamas. A person with CFS is still going to be sick after a week’s vacation. Rest doesn’t take care of all of their symptoms. It will make them feel better, but they still have the illness.”
  • Responsiveness to exercise. Exercise can help cure general fatigue by promoting better sleep and by serving as an energy booster. Exercise also is a natural antidepressant. But if people with CFS work out too hard, they often find that their chronic fatigue symptoms grow worse.
  • Other symptoms. People with general fatigue feel a lack of energy and motivation. People with CFS, however, experience some other chronic fatigue symptoms, such as problems with memory or concentration, sore throat, muscle or joint pain, headaches, tender lymph nodes, and difficulty sleeping.
  • Differences in how fatigue feels. CFS patients report feeling odd types of fatigue. They might feel a “wired fatigue,” Jason says, in which they are energized and absolutely exhausted at the same time.
  • The cause of your fatigue. People with general or chronic fatigue can find a cause for their lack of energy and address it. If it’s overexertion, they can rest. If it’s an illness, they can treat it. In most cases, these steps are enough to make the fatigue go away. Chronic fatigue syndrome does not have a root cause that has been identified.

What Causes Common Fatigue?

While the causes of chronic fatigue syndrome are still unknown, there are plenty of reasons people may experience ordinary fatigue. “General fatigue could be due to being out all night partying, working too hard, taking care of the kids and having no time to rest, doing a marathon, or exertion at the gym,” Jason says.

Common fatigue also can be chronic, lasting for months. It can be caused by health problems such as:

  • Anemia
  • Allergies
  • Depression
  • Sleep disorders
  • Chronic pain
  • Thyroid problems
  • Cancer
  • Alcohol or drug abuse
  • Diabetes
  • Lupus or other autoimmune diseases
  • Infection
  • Malnutrition

8 Fatigue-Fighting Energy Boosters

Try these energy boosters to fight your fatigue:

  • Treat any underlying physical illness that’s causing the fatigue
  • Get needed rest
  • Cut back on your responsibilities
  • Exercise regularly and eat well
  • Drink enough water
  • Use relaxation techniques like yoga or meditation
  • Take multivitamins
  • Be sure to get enough sleep each night

What not to do? Don’t take stimulants as an energy booster. Caffeine and energy drinks often just make the problem worse by causing you to crash after a short-lived surge. You’re better off fighting fatigue and boosting your energy through lifestyle changes, healthy living, and plenty of rest.


Chronic fatigue syndrome (CFS/ME)

Diet and supplements

It’s important you eat regularly and have a healthy, balanced diet. You should be offered practical advice about how to achieve this if, for example, your CFS/ME symptoms are making it difficult for you to shop or prepare food.

If you feel sick (nauseous), eating starchy foods, eating little and often, and sipping drinks slowly may help. If this doesn’t work, medication can be prescribed.

Diets that exclude certain food types aren’t recommended for people with CFS/ME. There’s also insufficient evidence to recommend supplements, such as vitamin B12, vitamin C, magnesium, or co-enzyme Q10.

Sleep, rest and relaxation

You may have sleep problems that make your CFS/ME symptoms worse. For example, you may:

  • have problems getting to sleep
  • have unrefreshing or restless sleep
  • need an excessive amount of sleep
  • sleep during the day and be awake at night

You should be given advice about how to establish a normal sleeping pattern. Having too much sleep doesn’t usually improve the symptoms of CFS/ME, and sleeping during the day can stop you sleeping at night.

You should change your sleep pattern gradually, and your doctor should review how it’s going regularly. If your sleep doesn’t improve after making changes, you may have an underlying sleep problem that will need to be addressed.

It’s likely you’ll need to rest during the day, and your doctor should advise you about the best way to do this. For example, they may suggest limiting each rest period to 30 minutes and teach you relaxation techniques, such as breathing exercises.

If you have severe CFS/ME and need to spend much of your time in bed, it can cause problems, including pressure sores and blood clots. These problems, and how to avoid them, should be explained to you and your carers.

Other lifestyle changes to manage CFS/ME

Other ways to manage CFS/ME include:

  • equipment – some people may need a blue badge for parking, a wheelchair, a stairlift, or other adaptations for their home
  • changes in your place of work or study – when you’re ready and well enough to return to work or studies, your doctor should be able to advise you on changes that could ease your return

There’s limited or no evidence to recommend:

  • pacing – this is a technique that many people with CFS/ME find helpful for managing their symptoms; the general aim is to balance rest and activity to avoid making your fatigue and other symptoms worse, but there hasn’t been enough research into pacing to confirm whether it improves CFS/ME or has any risks
  • resting completely – there’s no evidence this helps
  • complementary medicine – there isn’t enough evidence that it’s helpful for CFS/ME

You shouldn’t take up vigorous unsupervised exercise such as going to the gym or for a run as this may make your symptoms worse.

NICE has more information on managing CFS/ME

What to know about chronic fatigue syndrome

CFS is complex and can impact a wide range of systems and functions.

There is a long list of potential symptoms. Many of these symptoms may appear similar to other conditions, making a thorough diagnosis difficult but important.

Core symptoms

Share on PinterestChronic fatigue causes relentless exhaustion among other symptoms.

Doctors first focus on identifying the primary (core) symptoms of the CFS. These may change slightly from person to person, but for a doctor to reach a diagnosis of CFS, they need to note these three of the following core symptoms.


Fatigue is an extreme lack of energy. Doctors officially recognize extreme fatigue as a significantly reduced ability to perform activities that were once routine before the onset of CFS. The fatigue in CFS often lasts 6 months or longer.

In the context of CFS, it is important to note that a doctor does not use “fatigue” to refer to a person feeling tired or unmotivated at a certain point in the day. People with CFS may not be able to shake this fatigue. Sleep or rest does not replenish energy and may even make symptoms worse in some individuals.

The fatigue in CFS may be so severe that it interferes with daily function.

Post-exertional malaise

Post-exertional malaise (PEM) is another core symptom of CFS. PEM is a deterioration of symptoms after physical or mental exertion.

When a person with PEM engages in too much physical or mental activity, they will experience worsening symptoms over the next few hours or days, and will often feel intense exhaustion as they recover.

A person experiencing PEM may describe it as having their internal battery completely and immediately drained. When they push themselves too far, it can harm the body. Therefore, people with CFS must pace themselves throughout the day to avoid overexertion.

Sleep disorders

People with CFS also experience a range of sleep disorders, including unrefreshing sleep. Even after a long night of rest, they wake up tired.

There are a number of sleep disorders that can potentially lead to sleep that does not replenish energy, including:

  • insomnia, which is trouble falling and staying asleep
  • hypersomnia, which is excessive sleep
  • sleep apnea, in which a person stops breathing as they sleep
  • light sleep, a disorder that means an individual never enters the deeper stages of sleep
  • fragmented sleep, consisting of frequently waking up and falling back asleep
  • phase shifting, in which a person may not be able to fall asleep until sunrise
  • involuntary spasms in the legs or arms
  • restless legs
  • nightmares with vivid dreams that disrupt sleep
  • night sweats

Along with the three above core symptoms that are present, one or both of the following must also be present for the diagnosis of CFS:

Cognitive impairment

Difficulties with thought processes can occur in many forms for people with CFS.

People with cognitive impairment may have memory problems. They may not be able to remember recent conversations or might always be losing belongings. Movies and books can become extremely difficult to follow all the way through.

Thinking or simple problem solving may severely reduce energy levels in a person with CFS.

Other people with this syndrome may become lost in familiar settings, such as their own neighborhood. They may require intense effort to remember simple directions, names, or even written instructions.

CFS can cause different cognitive impairments in different people.

Orthostatic intolerance

These are symptoms that occur when moving from lying on your back to sitting or standing, including dizziness, lightheadedness, or feeling faint. This also might cause a person to feel as if they are seeing spots or experience blurred vision.

Other symptoms

Other symptoms known to occur in CFS include the following:


Almost all people with CFS experience some form of pain or discomfort, ranging from headaches and cramps to severe, widespread pain.

People with CFS most commonly describe the pain sensation as a general ache or soreness in the muscles and joints. This pain may occur in one area then move to another. Headaches are also common.

Other pain descriptors are common as well, including pain that people describe as:

  • shooting
  • stabbing
  • burning or tingling
  • throbbing

Someone with CFS may also be highly sensitive to light, touch, heat, or cold. Experiencing these sensations to an extreme extent may cause pain.

Other potential symptoms

There are many other possible symptoms of CFS, ranging in severity, and may change from person to person.

Possible symptoms include:

  • sore throat
  • enlarged lymph nodes
  • muscle twitching
  • rashes
  • canker sores
  • anxiety or panic attacks
  • depression
  • high stress levels
  • dizziness
  • flu-like symptoms
  • saying words wrong
  • low or high body temperature
  • numbness
  • tinnitus
  • extreme symptoms of premenstrual syndrome (PMS)
  • altered senses, such as visual problems
  • lack of sex drive, sexual impotence
  • hair loss
  • weight changes
  • heart palpitations
  • chest pain
  • seizures
  • paralysis

Chronic Fatigue Syndrome

What Is It?

Published: October, 2018

Chronic fatigue syndrome, also known as myalgic encephalomyelitis, is a complicated illness characterized by at least six months of extreme fatigue that is not relieved by rest, and a group of additional symptoms that also are constant for at least six months. In many people with chronic fatigue syndrome, the disorder begins suddenly, often following a flulike infection or an episode of physical or psychological trauma, such as surgery, a traumatic accident or the death of a loved one. In other cases, chronic fatigue syndrome develops gradually. The illness lasts for many months or years, and only a small percentage of people recover full health.

Many people feel tired a lot of the time, and many seek help from their doctors. Most people who experience chronic (long-lasting) fatigue are not suffering from chronic fatigue syndrome. Depression and overwork are much more common causes of chronic fatigue.

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Chronic Fatigue Syndrome sufferers ‘can overcome symptoms of ME with positive thinking and exercise’

Sufferers of chronic fatigue syndrome report extreme fatigue, joint pain, headaches and memory problems, but doctors still do not know the cause or cure Photo: Alamy

The finding is important because many CFS sufferers believe that exercise will make their condition worse.

The study found that there was no deterioration over two and a half years and most people reported feeling less tired and were able to complete daily tasks more easily.

Yesterday Prof Michael Sharpe, the study author, of Oxford University, said that it was difficult to find an umbrella cure for CFS or ME because it was likely to encompass several illnesses with different causes.

“It’s probably not all the same thing,” he said. “It’s quite likely that within that there is a range of different causes. Nobody has really been able to pin down a way of dividing it up.”

The illness was first diagnosed in the 19th century as neurasthenia, but has been given many other names since including CFS, myalgic encephalomyelitis (ME), system exertion intolerance disease and Epstein-Barr virus. Suggestions about the cause have ranged from infections, gut bacteria, stress, depression, immune problems, trauma, environmental toxins or allergies.

“It’s wrong to say people don’t want to get better, but they get locked into a pattern and their life constricts around what they can do,” Professor Sharpe

In the new study, 481 people were followed for around two years to see how they benefited from four different treatments. It was found that neither standard medical treatment, including medication to control pain, nausea and sleeping problems, nor “adaptive pacing therapy”, which helps patients adapt to their disabilities, had little long-term impact.

But gradually increasing exercise and therapy to remove patients’ negative thoughts that they would never get better seemed to work. Prof Sharpe said the study was likely to prove controversial because a “minority” believe that CFS is either caused by a virus or is chronic and cannot be alleviated.

“They seem to think this research casts some doubt on the nature of the illness and implies that it is a mental illness and not a real illness,” he said. “The science is not giving us any strong new answers.”

Prof Sharpe added: “It’s wrong to say people don’t want to get better, but they get locked into a pattern and their life constricts around what they can do. If you live within your limits that becomes a self-fulfilling prophesy.”

Researchers, which also included teams from King’s College London and Queen Mary University of London said the study showed that sufferers could try therapies without worrying that they would exacerbate their condition.

Prof Peter White, of Queen Mary University, added: “But it is also a reminder that these treatments do not help everybody and more research is needed.” The study was published in The Lancet Psychiatry journal.

CLARIFICATION: This article originally stated that Chronic Fatigue Syndrome (ME) is not actually a chronic illness. In fact, the University of Oxford study reported that Graded Exercise Therapy (GET) and Cognitive Behavioural Therapy (CBT) can alleviate symptoms of the condition but did not say that it was not chronic. We are happy to make this clear, and the article has been amended. The ME Association opposes GET on the basis that it can exacerbate symptoms, and says that the use of CBT as a primary treatment strategy is based on the flawed belief that ME/CFS is a psychological problem.

Symptoms of ME

The main symptom of CFS is persistent physical and mental fatigue (exhaustion). This does not go away with sleep or rest and limits your usual activities.

Most people with CFS describe this fatigue as overwhelming, and a different type of tiredness from what they have experienced before.

Other symptoms include:

  • Muscular pain, joint pain and severe headaches
  • Poor short-term memory and concentration, and difficulty organising thoughts and finding the right words (‘brain fog’)
  • Painful lymph nodes (small glands of the immune system)
  • Stomach pain and other problems similar to irritable bowel syndrome, such as bloating, constipation, diarrhoea and nausea
  • Sore throat
  • Sleeping problems, such as insomnia and feeling that sleep is not refreshing
  • Sensitivity or intolerance to light, loud noise, alcohol and certain foods
  • Psychological difficulties, such as depression, irritability and panic attacks

A doctor may suggest meeting with a psychologist or a therapist who can see whether mental health disorders might contribute to or mask CFS.

How Is Chronic Fatigue Syndrome Treated?

There’s no known cure for chronic fatigue syndrome. But experts say that these lifestyle changes can help:

  • Include regular, carefully planned exercise in your daily routine. Exercise can increase energy and make a person feel better. People with CFS should pace themselves while doing any physical activity that requires exertion. Talk with a doctor what’s right for you — you don’t want to overdo it and get discouraged. Studies show that “graded exercise” (which means starting with small activities and slowly working up to a higher level of exercise) is very helpful in CFS recovery.
  • Follow stress-management and stress-reduction techniques. A doctor or therapist can teach these — they’re great ways to take control of some aspects of the illness.
  • Ensure good sleep habits to overcome CFS-related sleep problems.
  • Work on ways to keep track of important things, such as keeping lists and making notes, you have problems with concentration or memory.

Meeting regularly with a therapist or counselor can help in CFS treatment. (So can getting involved in a support group for people with CFS.) The main goals of therapy are to help people cope with the illness and to change negative or unrealistic thoughts or feelings into positive, realistic ones.

Having a positive feeling that you can get better is very helpful. Therapy and support groups can also help teens with CFS and their parents deal with the academic or social challenges brought on by the illness, such as missed school, falling grades, or withdrawal from friends and social situations.

Doctors may suggest over-the-counter or prescription medicines for some of these symptoms.

What Else Should I Know?

  • Strong emotions can be a part of the illness, so it’s important to recognize and express your feelings. Feelings like sadness, anger, and frustration are completely normal — and it’s important to acknowledge how you feel and recognize that it’s not your fault. Recognizing emotions (rather than suppressing them or pretending you’re OK) can help you figure out what’s behind your feelings and help you manage problems.
  • It can help to keep a daily diary of feelings and energy highs and lows. This also can let you share information that might help your doctor. You can also track trends — for example, if your energy is high at one time of day and low at another — that will help you figure out when to exercise or do other activities.
  • Give yourself more time to do things, especially activities that take concentration or physical exertion.
  • Get support from family, teachers, and friends.
  • Get information about CFS from reliable sources. There’s a lot of misinformation and confusion about this disease. So it’s important to know and trust your sources.

Most important, don’t give up. Having chronic fatigue syndrome can be hard. But for most people, the symptoms are most severe in the beginning. Later, they may come and go. Teens with CFS generally get better faster and recover more completely than adults do. Most teens get partial or full recovery within 5 years after symptoms began.

It’s important to keep a positive approach to getting well and to not look for the reason why you have CFS. People who take action and stay positive can have a good outcome.

Reviewed by: Elana Pearl Ben-Joseph, MD Date reviewed: July 2018

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