Fatigue and Chronic Fatigue Syndrome Introduction Nearly everyone struggles with being overtired or overworked from time to time. Temporary fatigue usually has a specific cause. It is easily treated. Chronic fatigue lasts longer and is more intense. It is a nearly constant state of weariness. It develops over time, diminishing your energy and mental capacity. Fatigue at this level affects your emotions and your sense of well-being. This reference summary explains fatigue. It discusses the causes of fatigue and when you should see a health care provider for treatment. Fatigue Fatigue is a feeling of a lack of energy and motivation. It can be physical, mental or both. Fatigue is not the same thing as sleepiness, but it is often accompanied by a desire to sleep. Apathy is a feeling of indifference or lack of motivation. It may happen along with fatigue. In some cases, fatigue is a symptom of an underlying problem that requires medical treatment. But most of the time, fatigue can be traced to one or more of your habits or routines. Fatigue is common. About 20% of people have fatigue at some point in their lives that is intense enough to interfere with their daily activities. 1
Causes Taking time to discover the reasons you feel fatigued is the first step toward relief. In general, most cases of fatigue may be attributed to one of three areas: Lifestyle factors. Medical conditions. Psychological problems. Feelings of fatigue often have an obvious cause, such as: Alcohol use. Excessive physical activity. Inactivity. Lack of sleep. Unhealthy eating habits. Fatigue may also be caused by caffeine use. Caffeine provides temporary feelings of energy. But when the affects of caffeine wear off, you may feel even more tired than before. Constant exhaustion may be a sign of a medical condition or underlying illness. If you always feel fatigued, it may be caused by: Anemia. Cancer. Diabetes. Emphysema. Heart disease. Liver or kidney failure. Overactive or underactive thyroid. Obesity. Restless legs syndrome. Sleep apnea. 2
Anemia is a condition in which blood is not able to carry enough oxygen to the body. The most common cause is not having enough iron. Emphysema involves damages to the air sacs in the lungs. It makes it hard to catch your breath. The body does not get the oxygen it needs. Restless legs syndrome, or RLS, causes a powerful urge to move the legs when lying down or sitting. Sleep apnea causes a person s breathing to stop or get shallow when he or she sleeps. Breathing pauses can last from a few seconds to minutes. They may happen 30 times or more an hour. Fatigue could also be caused by certain medicines, such as: Antidepressants. Antihistamines, which are used to treat allergies. Blood pressure medicines. Cold remedies. Cough medicines. Heart medicines. Prescription pain medicines. Fatigue is also a common symptom of mental health problems, such as: Anxiety. Depression. Grief. Stress. Chronic Fatigue Syndrome Chronic fatigue syndrome, or CFS, is a disorder that causes extreme fatigue. This fatigue is not the kind of tired feeling that goes away after you rest. Instead, it lasts a long time and limits your ability to do daily activities. The main symptom of CFS is severe fatigue. The fatigue must last for 6 months or more for it to be CFS. 3
Other symptoms of CFS include: Depression. Exhaustion after doing normal activities that were not difficult in the past. Fatigue after sleep. Headaches. Mild fever. Muscle aches. Short-term memory problems. Sore throat. CFS is hard to diagnose. There are no tests for it and other illnesses can cause similar symptoms. Your health care provider has to rule out other diseases before making a diagnosis of CFS. No one knows what causes CFS. It is most common in women in their 40s and 50s, but anyone can have it. It can last for years. Because the cause of chronic fatigue syndrome is unknown, treatment programs are directed at relief of symptoms rather than cure. The goal is to regain some level of preexisting function and well-being. Self-Care at Home There are steps you can take to prevent and control fatigue. Healthy lifestyle choices may be able to cure temporary or chronic symptoms. To control your stress, take time for yourself to do activities you find relaxing. You can: Go for a bike ride. Meditate. Practice yoga. Read a book. Take a bath. Drinking less alcohol and caffeine may help. Eat a healthy and balanced diet. Stay hydrated by drinking plenty of water. Maintain a regular and manageable daily routine to avoid symptoms. 4
Physical activity done at a comfortable pace is important to maintain good health. People with CFS need to learn how much activity is helpful and when to stop so they do not increase their level of fatigue. In general, people with CFS should pace themselves carefully and avoid excessive physical or emotional stress. Exercise should be supervised by a health care provider or physical therapist. Avoid social isolation. Do things you enjoy with family members and friends. When to Seek Help People seek medical care when the fatigue and mental difficulties of chronic fatigue syndrome affect their quality of life. Seek help from a health care provider if you have felt fatigued for two or more weeks, despite: Eating a healthy diet. Drinking plenty of fluids. Making an effort to rest. Reducing stress. Seek help from a health care provider right away if you feel fatigued and you experience: Abnormal bleeding, including bleeding from your rectum or vomiting blood. Severe abdominal, pelvic or back pain. Severe headache. Get emergency medical care right away if you experience fatigue along with: Chest pain. Feeling that you may pass out. Irregular or fast heart beat. Shortness of breath. Contact a health care provider if your fatigue is related to a mental health problem and your symptoms also include: Thoughts of harming yourself or others. Thoughts of suicide. 5
Treatment Treating chronic fatigue syndrome focuses on relieving specific symptoms. People with CFS are often sensitive to many medicines, especially those that affect the central nervous system. Your health care provider will begin with low doses of medicine. Your dose may be gradually increased. This depends on side effects and your response. Medicines should only be used in CFS if all other causes of fatigue have been ruled out. Your health care provider may prescribe: NSAIDS for pain relief. These include ibuprofen and naproxen. Low dose antidepressants. Anti-anxiety medicines. Stimulants to treat lethargy or sleepiness. Antimicrobials may be prescribed if a specific infection is a cause of your CFS. Antibiotics and antiviral or antifungal drugs should not be prescribed for treatment of CFS. Some people with CFS may feel better after treatments that are considered complementary and alternative to standard care. Standard care is what medical doctors and health professionals practice. Examples of these other health professionals are registered nurses and physical therapists. Complementary and alternative medicine is also known as CAM. CAM is the term used for medical products and practices that are not part of standard care. Alternative medicine means treatments that you use instead of standard ones. Complementary medicine is the use of nonstandard treatments along with standard ones. The two types of treatments complement each other, or work together. The claims that CAM treatment providers make about their benefits sound promising. But more research is needed to better understand CAM practices. CAM therapies sometimes tried by people with CFS include: Acupuncture. Massage therapy. People with CFS may feel better with such techniques. 6
Acupuncture is the practice of inserting thin needles into specific body points to improve health and well-being. It originated in China more than 2,000 years ago. Research has shown that acupuncture reduces nausea and vomiting after surgery and chemotherapy. It can also relieve pain. Many people can relieve CFS symptoms with experimental therapies, herbal supplements and nutritional supplements. Dietary and herbal products may improve symptoms of CFS. Herbal medicines are dietary supplements that people take to improve their health. They are made from herbs. An herb is a plant or plant part used for its scent, flavor or therapeutic properties. Dietary supplements and herbal preparations can have serious side effects. Some can interfere or interact with prescription medicines. Do not begin any treatments without first consulting your health care provider. Regular follow-up care is needed for your health care provider to observe your treatment. Because your treatment program should be based on your medical condition and symptoms, it should change over time. Visit your health care provider regularly. Summary Fatigue is a feeling of a lack of energy and motivation. It can be physical, mental or both. Fatigue is not the same thing as sleepiness, but it is often accompanied by a desire to sleep. Apathy is a feeling of indifference or lack of motivation. It may happen along with fatigue. Nearly everyone struggles with being overtired or overworked from time to time. Temporary fatigue usually has a specific cause. It is easily treated. Chronic fatigue syndrome, or CFS, is a disorder that causes extreme fatigue. This fatigue is not the kind of tired feeling that goes away after you rest. Instead, it lasts a long time and limits your ability to do daily activities. In some cases, fatigue is a symptom of an underlying problem that requires medical treatment. But most of the time, fatigue can be traced to one or more of your habits or routines. 7
Taking time to discover the reasons you feel fatigued is the first step toward relief. In general, most cases of fatigue may be attributed to one of three areas: Lifestyle factors. Medical conditions. Psychological problems. There are steps you can take to prevent and control fatigue. Healthy lifestyle choices may be able to cure temporary or chronic symptoms. People seek medical care when the fatigue and mental difficulties of CFS affect their quality of life. 8