What is fatigue?
We are all familiar with feeling tired after a busy week caused by work, being a carer, intense exercise, or from long periods of concentration. Sometimes however, the feeling of reduced energy levels can be felt in a way that does not seem normal and we still feel tired even after minimal effort.
This feeling of extreme exhaustion is called fatigue, and it can interrupt or stop us from doing everyday activities. The usual things that refresh us such as sleep, doing a favourite activity or a pastime, no longer help. Fatigue can leave you unable to do important or meaningful activities, and you can find it difficult to concentrate and/or recall memories.
Fatigue is very common after viral infections, such as COVID, but it often settles over two or three weeks, with most people feeling better within 12 weeks. However, in some people it can last for weeks, months, or longer.
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What causes post-COVID fatigue?
- There are many reasons why people feel fatigued after a COVID infection, including:
A continuing response to COVID even though the infection has cleared
- The effect of a serious illness – for example, fatigue caused by pneumonia can take up to six months to resolve
- Longer-lasting effects of COVID on the body, which can be present even if the initial infection was mild
What makes post-COVID fatigue last a long time?
We do not yet fully understand all the causes of fatigue post-COVID. In some people, different things contribute to fatigue and make it last a long time. Pre-existing long-term conditions and disability, lower levels of physical activity, a disturbed daily routine, poor sleep patterns, demanding work, caring responsibilities, low mood, anxiety and stress can all make fatigue worse. In some people, post-COVID fatigue is linked to long COVID. You can find out more by reading the long COVID section.
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What can I do about fatigue?
- Recognise that fatigue is real and can affect your everyday well-being. Coming to terms with your fatigue and recognising that there are things you cannot do at the moment will help you manage your recovery. Because fatigue is invisible, it can be hard for others to understand its impact and how disabling it can be, unless they have experienced it themselves. It might help to explain to your family, friends, and colleagues at work the impact the fatigue is having on you and your life.
- Establish routines that promote sleep. Fatigue feels much worse if your sleep pattern is disturbed. Try to improve your sleep pattern by putting in place routines and behaviours that will help. For example, avoiding screens (phone, computer, TV), caffeinated drinks or alcohol the hour before bedtime. You can find out more by reading the sleeping well section.
- Try relaxation techniques. These can help with fatigue as they promote a good sleep pattern and can help reduce stress. Consider trying techniques such as mindful meditation, aromatherapy, yoga, tai chi, and other activities you find relaxing, such as reading or having a long shower or bath.
- Remember the 3 Ps: Plan, Prioritise and Pace.
- Plan – Plan each day in advance so you can do what you need to do and consider what can be delegated to other people. Build a regular routine and try to avoid ‘boom and bust’ behaviour, where you are very active on ‘good’ days and then feel exhausted the following day (bust). An activity diary can help with this. Make sure you plan enough time to rest as well.
- Prioritise – You can also decide which activities are most important to you. If a task is very important to you, do it when you have the most energy. For less important tasks but ones that ‘have to be done’, think about delegating them. Be kind to yourself and give yourself permission to ask for help where possible. It is not a sign of weakness and can help your recovery.
- Pace – Think about areas where you can save energy, for example, online shopping rather than a trip to the supermarket, or cooking at the weekend for the week ahead when you are busy. It is important to realise that sometimes pacing your activities may mean just resting. Finally, make sure you are doing some things which are enjoyable as such activities can be energising.
- Find your baseline. Some people find it helpful to identify the level of an activity or the cumulative effect of several activities they can achieve without substantially increasing fatigue. This is called a ‘baseline’ and can be used to help prioritise activities and pace yourself to avoid a pattern of ’boom and bust’. Take time to work out your baseline for any given activity or several activities, recognising that this might take several attempts and you might have to revisit it and adjust. This is completely normal. An activity diary is a good way to help find your baseline.
- Keeping an activity diary. For one or two weeks, keep a short record of what you have done during the day, how you feel after each activity, and if you notice anything that makes your symptoms or fatigue worse. Importantly, note if you had a good day. Activities can be physical, social, cognitive (thinking), or emotional, and some can be more tiring than others. Diaries can help you spot unhelpful activity patterns, such as irregular sleep patterns and ‘boom and bust’ behaviours. Activity trackers can also be a great way to do this if you have access to one.
- Try some physical activity. When you begin to feel like you are managing your fatigue and you no longer have any symptoms from COVID, you may be able to extend what you do. Any increase in your activity should be very gradual, taking time to assess how an activity is impacting your fatigue. Do not try to push through your fatigue; pay close attention to any signs your symptoms are getting worse. Make sure you rest before, and after any new amounts of activity, and remember that the effect may take a couple of days to show. Once the new amount of activity you are doing is stable, increase any additional amount slowly and gently. Again, keeping a close eye on your symptoms. Look at the section on getting moving again to help with this.
- Eat well. A healthy diet can help. See the section on eating well.
A worsening of my symptoms after exertion
It is common to experience fatigue during and even after an episode of illness. Feeling tired for weeks or months after a serious illness can be quite normal. People who are recovering from an illness often report feeling a little better each day, but it can take time to fully recover.
About 5% of people who have had COVID, report symptoms of long COVID, which is characterised by long periods (longer than 12 weeks) of extreme fatigue and other symptoms, especially after exertion such as exercise.
There is a concern that some individuals can struggle with fatigue. Post-exertional symptom exacerbation (PESE), or post-exertional malaise (PEM) is a term used to describe feeling unwell after minimal cognitive (thinking), physical, emotional or social activity, or activity that could previously be tolerated. Symptoms can worsen 12-72 hours after activity and last for days or even weeks, sometimes leading to a relapse. Symptoms made worse by activity can include difficulty thinking or “brain fog”, muscle aches or headaches alongside increased fatigue. Clinicians may call these post exertional symptoms and they can affect your ability to function as you did previously and your quality of life.
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Why do my symptoms get worse after exertion?
The exact cause is not yet fully understood. The things that make your symptoms worse can vary from person to person but are usually associated with physical or cognitive (thinking) exertion but can also include sensory overload from noises or light. Identifying possible things that provoke symptoms, temporarily reducing activity levels, monitoring symptoms and not returning to usual activity levels until the flare-up has improved, can help respond promptly to worsening symptoms. Activity and energy management, or pacing, alongside quality rest balanced with activities, can help reduce the severity of feeling unwell after exertion.
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When should I talk to my healthcare professional?
- If your symptoms of fatigue and exhaustion are getting worse, talk to your healthcare professional, such as a pharmacist or local doctor so they can rule out any other condition that could be causing your problems
- If your fatigue has become so severe that you are often spending all day in bed, ask your healthcare professional for specialist support