What is fatigue?
We are all familiar with the feeling of fatigue after exercise or a long period of concentration. Sometimes, however, fatigue can be felt in a way that does not seem normal. Despite resting, and a good night’s sleep, fatigue occurs after minimal effort, is prolonged and limits your usual activity. It can leave people feeling dull and finding it difficult to concentrate and recall memories.
Fatigue is very common after viral infections, such as COVID and normally it settles after 2 or 3 weeks. However, in some people it can linger for weeks or months.
What causes post-COVID fatigue?
There are many reasons why people feel fatigued after a COVID infection. These are:
- A continuing response to the COVID virus even though the infection has got better.
- The effect of a serious illness. Fatigue caused by pneumonia can take up to 6 months to resolve.
What makes post COVID fatigue last a long time?
In some people, different things contribute to the fatigue and make it last a long time. Low 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.
What can I do about fatigue?
Recognise that the fatigue is real and be kind to yourself. Explain to your family, friends, and colleagues at work the impact the fatigue is having. Because fatigue is invisible, sometimes it is not properly understood. Until it is experienced it can be hard to understand the impact of fatigue and how debilitating it can be.
Get a good night’s sleep. Fatigue feels much worse if your sleep pattern is also disturbed. Try to improve your sleep pattern 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.
Plan, prioritise and delegate.
- Plan. Plan each day in advance so that you can do what you need, 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. An activity diary can help with this.
- Prioritise. You can also decide which activities that you are doing are most important to you. If this is a task which is very important do it when you have the most energy. If they are not important, but ‘have to be done’ can you delegate them?
- Delegate. 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. Finally, make sure you are doing some things which are enjoyable, such activities can be energising.
Keeping an activity diary. For one or two weeks, keep a record of what you have done during the day and how you feel after each activity. Also 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.
Keep active. Energy levels are also helped by staying active. Being unfit makes you more tired. Once the amount of activity you are doing is stable, try to increase the amount you do slowly and gently. 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.
When should I talk to my doctor?
Talk to your GP so they can rule out any other condition that could be causing your tiredness if;
- Your fatigue is getting worse rather than better.
- After 4 weeks your fatigue is unchanged.
- You are worried or have other new symptoms.
Post exertional symptom exacerbation
A worsening of your fatigue after exertion
It is common to experience tiredness and fatigue during and even after an episode of illness. Fatigue 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, it can take time to fully recover. With Long COVID you may feel fatigued after activities which were not previously difficult to cope with and this can affect your quality of life and ability to function as you did previously. This is more likely to occur at the end of the day or at the end of a busy week.
Sometimes people experience a number of other symptoms worsening after physical stress. This could include brain fog, muscle aches or headaches alongside increased fatigue. Clinicians may call these “post exertional symptoms”. They are not in themselves dangerous but can affect your quality of life.
What is the cause of these post exertional symptom?
The exact cause is not yet fully understood.
The triggers and symptoms can vary from person to person but are usually associated with physical exertion. Any exertion can leave you feeling exhausted, mentally, emotionally and physically.
What can I do to help my recovery?
- Aim to gradually build up your activity according to the symptoms you are experiencing: https://www.yourcovidrecovery.nhs.uk/your-wellbeing/getting-moving-again
- Try to find the right balance between activity and rest by planning, prioritising and pacing: https://www.yourcovidrecovery.nhs.uk/your-road-to-recovery/managing-daily-activities/
- Changing between different types of activity (e.g. mental and physical) can help rather than doing the same type of activity until you are exhausted.
- Getting good quality rest can be difficult but it is a very important aspect of managing your recovery. But, avoiding all activity and spending long periods of time lying down can cause additional problems due to loss of muscle strength and fitness and make you more likely to experience an increase in fatigue when you try to do something.
- If you begin to notice a sustained improvement in your symptoms and you are having more good days than bad days, gradually increase your activity levels.
- Prioritise essential tasks rather than feeling you have to accomplish everything.
- Identify people who can help you if needed.
- Try breaking up complex tasks into stages. https://www.yourcovidrecovery.nhs.uk/your-road-to-recovery/managing-daily-activities/
- Spend some energy on things you enjoy to help improve your quality of life.
When should I talk to my healthcare professional?
- If your symptoms of fatigue and exhaustion are getting worse rather than better, talk to your healthcare professional 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.