Maybe you find it difficult to fall and stay asleep despite being absolutely exhausted. Maybe you have trouble focusing, too, and feel like you just can't remember things the way you used to — like your brain is always in a fog.
If you've had these symptoms for more than three months without an obvious cause, a condition known as chronic fatigue syndrome (CFS) may be to blame. And while there's unfortunately no cure, there are ways to cope with this CFS to make life a little easier.
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What Is Chronic Fatigue Syndrome, Exactly?
Also known as myalgic encephalomyelitis (ME) or systemic exertion intolerance disease (SEID), CFS is a disorder characterized by extreme fatigue or tiredness lasting at least six months that doesn't go away with rest and can't be explained by an underlying medical condition, explains Kishor Gangani, MD, MPH, internist at Texas Health Arlington Memorial Hospital.
Other symptoms, per the National Health Service, include:
- Difficulty sleeping
- Muscle or joint pain
- Sore throat
- Difficulty concentrating
- Memory issues
- Flu-like symptoms
- Fast or irregular heartbeats
According to the Centers for Disease Control and Prevention (CDC), between 836,000 and 2.5 million people have CFS in the U.S., with the reason for the wide discrepancy being that the condition often goes undiagnosed. It is less common in children and most often seen in adults assigned female at birth who are between the ages of 40 and 60.
What Causes Chronic Fatigue Syndrome?
Despite a significant amount of research over decades, the cause of CFS still remains unknown.
"Amongst many possible causes, the ones that have been most thoroughly studied are viruses, immune dysfunction, endocrine and metabolic dysfunction and neuropsychiatric factors," notes Dr. Gangani.
It seems that about half of CFS cases — as well as its painful cousin fibromyalgia — are triggered by infections, especially viruses, says Jacob Teitelbaum, MD, a board-certified internist and CFS expert.
Most recently, there's been a connection made between CFS and COVID-19, especially after the number of cases of CFS skyrocketed during the pandemic. It's no surprise, seeing as there's already been well-documented evidence of a wave of CFS cases following the first SARS epidemic in 2003, including one September 2006 study in the BMJ.
According to current estimates by the COVID Symptom Study, 10 to 15 percent of people who get COVID-19 will develop post-viral chronic fatigue syndrome, or "long COVID."
"With over 25 million Americans having had the virus, it is likely that 3 to 5 million will develop chronic fatigue syndrome and/or fibromyalgia from having had COVID-19," Dr. Teitelbaum says. "Even Dr. Fauci has noted that persistent COVID-19 likely represents post-viral chronic fatigue syndrome, and Congress just allocated $1.15 billion to research this, which is almost 100 times as much as last year."
How to Manage Chronic Fatigue
While this is good news, CFS still can be quite difficult to diagnose because many of its symptoms look similar to other conditions.
"There are no definitive, approved medications available to cure CFS, and no curative therapies that have been established," Dr. Gangani says. "Management is supportive and focused on treating symptoms and associated comorbid conditions, including sleep disorders, depression and anxiety."
If you have CFS, there are many things you can do to ease your symptoms. Here, experts reveal their tried-and-true coping methods.
1. Seek the Correct Diagnosis
An astounding 84 to 91 percent of people with CFS have yet to receive a correct diagnosis, according to a February 2015 paper by the Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.
"Most often, if doctors do not know what is wrong with a patient, they consider it to be depression or anxiety, which implies to family members that this is not a real illness," notes Dr. Teitelbaum. "As a result, the insurance companies use that as an excuse not to pay your disability benefits or cover your health insurance costs."
In addition, it's helpful for your treatment to get a diagnosis from a physician. If you suspect you have CFS but haven't gotten a diagnosis, look for a doctor who specializes in the condition.
2. Address Sleep Problems
One of the most common sleep complaints in people with CFS is frequent nighttime awakenings, says Lisa Medalie, PsyD, behavioral sleep medicine doctor, insomnia specialist and creator of DrLullaby. But she notes that some people also struggle with falling asleep.
"The gold standard method for addressing difficulties falling asleep and returning to sleep continues to be cognitive behavioral treatment for insomnia," she says. This technique helps you identify the thoughts and behaviors that are holding you back from falling asleep and replace them with habits that foster healthy sleep habits, she explains.
A sleep-focused physician can help you with this type of therapy and discuss medications that might help. But you can also try natural remedies for insomnia on your own, including adding certain foods and beverages to your diet, practicing relaxation techniques, creating a sleep-friendly environment in your bedroom and getting daily exercise (more on that last one in a minute).
3. Eat a Wholesome, Balanced Diet
A healthy diet full of fruits, vegetables, lean proteins and whole grains has been shown to help with myriad diseases, including CFS. In fact, one January 2019 review in Biomedicine & Pharmacotherapy showed that people with ME/CFS were more likely to have deficiencies of vitamins, minerals and essential fatty acids.
Donna Casey, MD, internist at Texas Health Presbyterian Hospital Dallas, recommends filling your plate with the following to make sure you're getting your fair share of the right nutrients in your diet:
- Fruits and vegetables of all different colors
- Healthy fats, such as avocados, nuts and nut butter, olives and olive oil
- Wholesome carbohydrates, like legumes, oats, brown rice, quinoa and barley
- Lean proteins, including fish, poultry and low-fat dairy
4. Drink Water Throughout the Day
Our bodies are made up of 60 percent water, according to the USGS, so it's no surprise that we need a decent amount of H2O throughout the day in order to function optimally — and this is especially true if you have CFS.
One August 2011 study in Nutrition Reviews found that people with mild dehydration experienced higher levels of fatigue, as well as confusion and anger.
Just how much water you need to stay hydrated depends on factors like your body size, how much you exercise and the weather, but a good general guideline is to drink half your body weight in ounces daily.
5. Ease into Exercise
"People who exercise regularly sleep better and feel more energized overall, especially when that exercise is performed outdoors," Dr. Medalie says. "Light tells the brain to stop producing melatonin, our body's sleep hormone. Therefore, without sufficient light exposure, we can see increased fatigue."
Research, including one July 2011 study in Current Pain and Headache Reports, has shown that regular exercise can help ease symptoms related to FMS, a condition very similar to CFS. Because pain is a common symptom of both conditions, some exercises may be better tolerated than others, including lower-impact activities like yoga, pilates, water aerobics and bicycling.
"Light exercise five times per week with a goal of 30 minutes each time may be a good start," Dr. Gangani says.
"Light" exercise means different things for different people, so aim to find a movement pattern that feels doable for you, whether that's walking, biking or even just some light stretching or yoga poses.
The important thing is to stay within your limits, because activity that's too strenuous can often make symptoms worse, according to the CDC. If you're new to exercising with CFS, talk to your doctor before starting, and keep a journal of your activity so you can closely monitor your symptoms for 12 to 48 hours afterward. It may also be helpful to work with a physical therapist or rehabilitation specialist.
6. Cut Down on Stress
Minimizing negative energy and stressors whenever possible can assist in the healing process, notes Dr. Casey. She recommends making small changes in an effort to remove anything in your life that does not bring you joy and instead brings you stress, such as avoiding toxic or negative people or cutting back on your social media use.
Dr. Medalie agrees, adding that thinking excessively about problems and putting your system constantly into "fight-or-flight mode" from elevated stress can take enough out of you to feel significant fatigue.
Especially if you often feel overwhelmed by stress, seeing a therapist can help. And it's worth trying some stress-relieving or relaxation techniques on a regular basis, such as deep breathing, mediation or yoga.
- Centers for Disease Control and Prevention: "Epidemiology: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome"
- BMJ: "Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study"
- COVID Symptom Study: "How long does COVID-19 last?"
- "Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness"
- Biomedicine & Pharmacotherapy: "Chronic fatigue syndrome (CFS): Suggestions for a nutritional treatment in the therapeutic approach"
- USGS: "The Water in You: Water and the Human Body"
- Nutrition Reviews: "Water, Hydration and Health"
- The National Academies of Sciences, Engineering, and Medicine: "SHARE Report Sets Dietary Intake Levels for Water, Salt, and Potassium To Maintain Health and Reduce Chronic Disease Risk"
- Current Pain and Headache Reports: "Exercise Therapy for Fibromyalgia"
- Centers for Disease Control and Prevention: "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Treating the Most Disruptive Symptoms First and Preventing Worsening of Symptoms"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.