Chronic fatigue is a condition that causes someone to be extremely tired—to the point that they can’t function in their daily life. It is also often misunderstood.
I’ve cared for many patients with chronic fatigue, and I’ve seen the effects this condition has on both the patients and their families. I want to help patients and their loved ones understand what chronic fatigue is, and how it can be managed and treated.
What is Chronic Fatigue?
Chronic fatigue’s main symptom is physical tiredness that causes a person to not be able to function in their daily life. It can be related to chronic fatigue syndrome (more on that in bit), it can be a symptom of another medical condition, or chronic fatigue may be a side effect from a medication or treatment.
The word “chronic” in this case means that the fatigue has been present for 6 months or more. It doesn’t necessarily mean that it will never improve—it simply means that the fatigue has been present for 6 months, and doesn’t seem to be getting better.
Someone with chronic fatigue may find that even getting out of bed is a struggle. Others find that they can get up and do a few things during the day, but can’t handle having a job any longer. Or they may need help with their children, housework and other daily living needs.
In the primary care setting—internal medicine, family medicine—about 1/4 to 1/3 of my patients complain of some type of fatigue; of these, most have a reason that can be explained (medical, stress, other issues). About 10% may have chronic fatigue syndrome or idiopathic (no known specific cause) fatigue.
Common Causes of Chronic Fatigue
Some of the most common causes of chronic fatigue include:
Chronic Fatigue Syndrome
- Chronic diseases such as heart disease, kidney disease, or lung diseases like COPD
- Hormonal causes such as thyroid problems, or imbalances of sex hormones such as testosterone
- Psychiatric issues such as mood disorders or other chemical imbalances
- Infections, such as mono, hepatitis, various viruses
- Autoimmune disorders, such as rheumatoid problems
- Medication side effects, such as those for high blood pressure, antidepressants and some pain medications
- Cancers and blood disorders
- Sleep disorders, such as obstructive sleep apnea
- Effects of long-term chronic stress
Chronic fatigue syndrome (CFS), which accounts for less than 10% of cases of chronic fatigue, is marked by the following symptoms:
- loss of memory or concentration
- feeling unrefreshed after sleeping
- chronic insomnia (and other sleep disorders)
- frequent headaches
- the fatigue itself—it’s a serious and unrelenting fatigue that makes daily functioning impossible
- even more significant fatigue after activity
Those most at risk for CFS include young-and-middle-aged women, and those with depression or other underlying psychological disorders. Allergies, environmental factors and genetics are also implicated in some cases.
A diagnosis of CFS usually involves ruling out the various medical issues I mentioned earlier. As I stated, the vast majority of cases of chronic fatigue are caused by a medical condition, and only 10% or less are CFS or other unknown causes.
Once chronic fatigue has been identified, the main focus is on addressing the underlying causes and managing symptoms to help the patient feel better and start functioning in their life again.
How to Improve Symptoms
Because of the many medical conditions that can causes chronic fatigue, I can’t go into details of managing each of them specifically. What I can say is that if you are experiencing fatigue that affects your daily functioning, work with your doctor on ways to manage the illness or disease related to the fatigue, so that the fatigue will hopefully improve along with other symptoms.
Here are recommendations I regularly give my patients to help improve chronic fatigue symptoms:
- Avoid alcohol and other types of sedatives, as they seem to have a significant effect on those who already struggle with fatigue.
- Focus on getting adequate rest, and make your bedroom a place that is conducive to rest. My colleagues at the Deaconess Sleep Center have tips on How To Get A Good Night’s Sleep.
- Even though it may seem like the opposite of what you would do when you’re tired, it’s proven that moderate exercise a few times a week will gradually increase your energy levels. I recommend starting out with even just a few minutes of walking, working up to 30 minutes at least 5 days a week. Yoga and tai chi can also help for improving body awareness and mental state, but getting your heart rate up is the key to improving energy.
- Nutrition really matters. Eating whole, unprocessed foods, with lots of fruits and vegetables, lean protein and whole grains can drastically improve energy levels. Avoiding sodas and drinking more water can also help.
- One’s mental attitude can affect outcomes when it comes to fatigue. Accepting that it’s a problem, and that some time and focus will need to go into improving it, is an important step. Many try to ignore it, or worse, seem to fall into a “pit of despair,” and mindset really matters when it comes to overcoming fatigue.
- Sometimes medication and/or therapy can be helpful in overcoming the stress and depressive symptoms that can be associated with chronic fatigue.
I want to note that all of the things above may not “cure” chronic fatigue or resolve it completely, but these things will help, and you can feel better than before.
The key for managing chronic fatigue (and most other chronic health conditions) is to work with your doctor as partners in your care, to address the issues and manage symptoms.