Chronic fatigue

Fatigue, chronic fatigue syndrome, CFS, myalgic encephalomyelitis, ME, Systemic Exertion Intolerance Disease, SEID.

Chronic fatigue is a common symptom that can have various causes or be a consequence of mental as well as physical illnesses and their treatments.

In contrast, chronic fatigue syndrome is relatively rarely diagnosed. For example, sufferers feel deep exhaustion even after minor physical exertion, such as after a walk, and are often met with incomprehension by those around them.

So far, no single cause can be found for chronic fatigue syndrome, but it is most likely to be a multifactorial event. It is a diagnosis of exclusion. This means that the diagnosis can only be made once other diseases associated with chronic fatigue have been ruled out by a bio-psycho-social exploration of the medical history (anamnesis), clinical examinations and, if necessary, further diagnostic clarifications.

Chronic fatigue syndrome is also known as chronic fatigue syndrome, chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), among others. In 2015, the National Academy of Medicine (formerly the Institute of Medicine) proposed “Systemic Exertion Intolerance Disease (SEID)” as a new name to express that affected patients poorly tolerate multiple physical, cognitive, and emotional stresses.

Tired man

What is chronic fatigue/chronic exhaustion syndrome?

Chronic fatigue is elusive. Sufferers show different symptoms in varying degrees of severity. Above all, chronic fatigue syndrome is characterized by extreme fatigue that began at a definable time and has persisted for at least six months. Even sufficient sleep and rest do not bring recovery to sufferers. Even in the absence of external stressors and physical illness, they may feel severely exhausted all the time. Many struggle to manage their daily lives. They cancel leisure activities to save all their resources for work. In severe cases, those affected can no longer cope with work. Because of the wide range of symptoms and unclear causes, chronic fatigue is difficult to treat. It is similar to fibromyalgia, but this is a different disease.

At what age does chronic fatigue syndrome occur?

Since many sufferers experience an odyssey from one practice to another and presumably many diseases are not recognized, the number of sufferers is difficult to determine. In Switzerland, experts estimate that between 17,000 and 34,000 people are affected. Chronic fatigue syndrome affects women two to four times more often than men. Younger people are more likely to be affected: CFS usually appears for the first time between the ages of 20 and 50. Only in a few people the fatigue actually lasts longer than six months. Of all patients who see a doctor or physician because of fatigue, only about two percent meet the criteria for chronic fatigue syndrome.

Chronic fatigue syndrome: These are the causes

Why am I always tired? Many people ask themselves this question. But causes and triggers of chronic fatigue syndrome are still unclear. Several factors probably act together as triggers. So far, researchers have not been able to find specific causes that can be detected in all chronic fatigue sufferers. Those who have relatives who already suffer from CFS have a higher risk of developing it themselves. Many sufferers are very active before the onset of the disease.

Predisposing factors may be genetic, previous fatigue experience in the context of infections, tumor treatments, inflammation, or prolonged stress, establishing a “fatigue memory.” Possible triggering factors may include multiple physical, cognitive, and emotional or psychological stressors (CFS as Systemic Exertion Intolerance Disease, SEID). Secondary stressors (e.g., threat of incapacity, excessive exertion, comorbidities) and inappropriate physical exertion can perpetuate and exacerbate the condition. Patients often complain of non-restorative sleep, decreased sleep quality and longer sleep times.

Discussed as possible triggers of chronic fatigue syndrome are:

  • Infections: Viral diseases (especially glandular fever, rubella, or herpes) or bacterial infections (for example, chlamydia, legionella/legionnaire’s disease, coxial).
  • Physical diseases: Anemia, diabetes, thyroid dysfunction, COPD, a rare form of low blood pressure.
  • Immunological changes
  • Altered composition of the intestinal flora
  • Psychosocial factors

Mental illness as a cause of chronic fatigue syndrome

Chronic fatigue, on the other hand, can occur in the context of mental illness, such as depression or anxiety disorder. In chronic fatigue syndrome, psychological problems can be both predisposing and precipitating factors as well as a consequence of this condition. Those who can no longer pursue a familiar activity quickly become depressed. However, sufferers often recount drastic events before the onset of fatigue, such as the loss of a job or the death of a loved one.

Diseases associated with chronic fatigue, such as anemia (anemia of the blood), have also been observed to trigger CFS, as have diabetes, thyroid dysfunction, sleep apnea syndrome, or COPD.

How does chronic fatigue manifest itself?

Everybody feels exhausted and tired once in a while. But in chronic fatigue syndrome, the feeling of fatigue clearly exceeds a normal fatigue in extent and especially in duration. It cannot be compared to the exhaustion after a mountain tour, a stressful day at work or a sleepless night.

These symptoms are indicative of chronic fatigue syndrome

  • Sudden onset: You can pinpoint the time when symptoms started – often after a stressful event.
  • Intense fatigue: you feel so physically and mentally exhausted that you avoid many usual activities. After physical activity, the discomfort gets worse.
  • Long duration: you have had the symptoms for more than six months.
  • No rest: Even extensive sleep and plenty of rest will not improve your condition.
  • Cognitive difficulties: You have trouble thinking.
  • Lying down only: As soon as you stand up, you feel dizzy and lightheaded.

Typical of the course of the disease is that the debilitating fatigue often does not appear until twelve to 48 hours after an activity. Even simple everyday activities, such as a trip to the bakery, cause sufferers to feel as if they have pulled an all-nighter a day or two later. Often, physical pain or neurological complaints (e.g., headaches, visual disturbances, and other failure symptoms) also accompany fatigue. In addition, higher sensitivities to sensory stimuli (sounds, smells, light, etc.) and intolerances to medications and foods can be observed.

Chronic fatigue: diagnosis with us

Basically, fatigue can have a wide variety of causes. Therefore, we clarify through anamnesis and further diagnostic examinations whether physical and/or mental illnesses can be responsible. Further, a blood test can provide several insights:

  • Are the inflammation levels elevated?
  • Are viruses from a current or past infection visible?
  • Is the cellular immune system functioning normally?
  • Are sufficient immunoglobulins (antibodies) present?

In particular, the living conditions are inquired about. Both family and work situation and sleep quality may play a role in the development of chronic fatigue.

In particular, we try to find out whether the basic criteria of a chronic fatigue syndrome are given: The complaints started at a certain moment and have existed for at least six months. They are not a result of excessive exertion and do not improve with sleep and rest. The feeling of perpetual fatigue leads to significant limitation in both work and leisure. For this purpose, it also plays a role whether other symptoms occur in addition to the leaden fatigue. To get a detailed picture of the disease, we may ask you to keep a diary of the onset of fatigue and other symptoms.

Prevention, early detection, prognosis

How severely the symptoms of chronic fatigue affect sufferers varies widely. Some manage to go to work every day and spend the rest of the day and the weekend in bed. Others are barely able to manage their households even in a makeshift way. In many cases, chronic fatigue syndrome occurs in waves. The symptoms get better after some time, then they return with full force. Sometimes patients do not feel any symptoms at all for a period of time. However, it can be easy to relapse when they resume their previous life.

The sooner you get professional help, the better your chances of recovery. With timely and consistent interdisciplinary support from us, the prognosis is encouraging: while not everyone will fully regain their pre-disease performance, many sufferers recover and are able to lead full lives again. However, they need patience for this: treatment of chronic fatigue syndrome often takes years.

Self-help groups

The exchange with people who are affected by the same disease can be a great support in coping with the disease. Advice on finding a suitable self-help group is available from Selbsthilfe Zürich. Self-Help Zurich and the University Hospital Zurich are cooperation partners in the national project “Health literacy thanks to self-help-friendly hospitals”.

Treatment of chronic fatigue syndrome

There is no causal treatment for the disease itself in chronic fatigue syndrome yet, as the causes are still unclear. Treatments can only ever relieve the symptoms. However, we have effective methods at hand for this and can often significantly improve the living situation of affected persons. For pain and sleep disorders, we prescribe painkillers, sleeping pills, or antidepressants as needed. Psychotherapy often helps. In the process, patients learn to replace negative thoughts with positive ones, to reshape entrenched thought patterns, and to use their remaining energies sparingly.

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