Can you relate to this: you sleep enough hours at night, avoid physical work, and rest enough during the day, but you still feel terribly fatigued?
When you feel chronically fatigued, it could actually be a condition called myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). It is an invisible struggle in which your body feels permanently drained, even after rest.
In this article, we'll unpack the main symptoms of ME/CFS to help you validate and communicate your experience. We'll also explore steps you can take to ease your symptoms and improve your quality of life, and tell you how Everlab can help investigate potential underlying factors contributing to your chronic fatigue.
Chronic fatigue symptoms tend to cluster rather than appear in isolation. While each person’s experience is unique, here are some tell-tale signs you may have CFS:
PEM presents as fatigue that worsens after the slightest physical or mental activity. In most cases, the fatigue is a disproportionate response to the level of activity, and has a delayed onset.
Unlike normal post-exercise fatigue that peaks during or immediately after activity and improves with rest, PEM typically develops 12 to 48 hours after exertion.
You might feel relatively fine during a short walk, only to "crash" the next day. This delayed response can be confusing when you don't recognise the pattern.
Other symptoms of PEM include:
Patients with myalgic encephalomyelitis/chronic fatigue syndrome often report having extreme, continuous tiredness that lasts at least six months.
This type of fatigue is different from everyday tiredness because:
For many, this fatigue affects work capacity, social engagement, and basic self-care.
Brain fog is a non-medical term for a cluster of cognitive symptoms affecting memory, concentration, information processing, and executive function.
If you have brain fog, MRI and PET scans show reduced blood flow to certain brain regions and impaired connectivity between brain networks in patients with chronic fatigue.
You may struggle to follow conversations, reread the same paragraph multiple times, or feel mentally exhausted after short periods of concentration.
Common brain fog symptoms include:
Unrefreshing sleep (non-restorative sleep) is a core diagnostic criterion for ME/CFS. Patients with chronic fatigue often fail to achieve adequate deep sleep despite spending enough time in bed.
Here's how you'd normally struggle getting restorative sleep:
Orthostatic intolerance (OI) occurs when the autonomic nervous system struggles to regulate heart rate and blood pressure when you are upright.
Many people with ME/CFS experience symptoms when standing or sitting upright for prolonged periods.
A commonly associated condition is Postural Orthostatic Tachycardia Syndrome (POTS), which involves a significant increase in heart rate shortly after standing.
The common symptoms of postural orthostatic tachycardia syndrome include:
ME/CFS can involve widespread, shifting pain that varies in intensity and location. Many people also experience flu-like symptoms such as:
Some people can also experience recurrent migraines or tension headaches.
ME/CFS doesn't affect everyone equally. Understanding risk factors helps identify who may be more vulnerable and potentially enables earlier intervention.
Since there’s no single diagnostic test for ME/CFS, diagnosis is typically based on symptoms and exclusion of other conditions.
In most cases, if you exhibit at least 3 of the 5 main symptoms, you might get a ME/CFS diagnosis. The mandatory symptoms for a diagnosis include:
Additional symptoms include memory problems, trouble standing upright, muscle pain, allergies, and sensitivities to food, light, odours, or chemicals.
Diagnosis often takes time, and many people experience periods of uncertainty before receiving clarity.
Unfortunately, there is no specific cure for chronic fatigue syndrome. Treatment focuses on managing symptoms and supporting overall function.
You can get medications to ease symptoms and co-occurring issues such as muscle pain, sleep disturbances, or nausea. If you have POTS, you can also get medications to regulate your blood pressure and heart rate.
Similarly, antidepressants or anti-anxiety medications may be used to manage co-morbid depression or anxiety. That said, a mental health professional can help to distinguish actual mental health problems from ME/CFS symptoms.
Living with ME/CFS can take a psychological toll on a person, with many suffering anxiety and depression. People constantly battle the loss of their abilities, careers, social relationships, independence, and purpose.
If you have the symptoms, here are a few things you can do at home to ease your symptoms:
Pacing is widely regarded as the most effective self-management approach for chronic fatigue symptoms. It involves staying within your personal “energy envelope” to reduce the risk of crashes.
Tracking physical, cognitive, and emotional exertion helps identify limits. Aim to stay below about 70 per cent of your capacity, and only increase activity when your baseline is stable.
However, pacing is not graded exercise. It prioritises listening to bodily feedback rather than pushing through symptoms.
Schedule rest periods throughout your day to conserve energy. Lie down, close your eyes, and avoid any mental effort during rest periods.
Adopting an anti-inflammatory diet and working with a professional to optimise your thyroid function may help reduce brain fog and pain symptoms.
For orthostatic symptoms, increasing fluid intake to 2-3 litres per day and adjusting salt intake under medical guidance may support blood volume.
You can wear support stockings, elevate the head of the bed, and use aids such as shower chairs to reduce strain on the autonomic nervous system.
Good sleep hygiene, a dark sleeping environment, and consistent routines may improve sleep quality. Some people report benefits from magnesium supplementation, though it's best to discuss this with a sleep specialist.
Understanding your symptoms is critical in managing the complexities of ME/CFS. For better support and investigation, consider these steps:
Living with chronic fatigue symptoms can feel isolating, especially when rest does not bring relief. By understanding these symptoms, you are better equipped to advocate for yourself and make choices that support your quality of life.
For more personalised insights into your health, Everlab offers comprehensive assessments. We offer advanced testing to track biological patterns and out-of-range markers that may be contributing to your fatigue. With our data-driven approach, you will better understand your individual health profile and improve your symptom management plan over time.
Steven is a specialist general practitioner, preventative health consultant, medical educator, healthcare entrepreneur and co-founder of Everlab. With 15+ years of clinical experience, and driven by his passion for preventive care outcomes, Steven is dedicated to personalised and innovative approaches to enhance well-being, extend human lifespan, and improve healthspan.
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