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Fatigue is the central symptom in CFS and a significant problem for most people with fibromyalgia. The term ‘fatigue' may be a misleading way to refer to refer to the physical and mental exhaustion experienced by people with the two conditions.

Manifesting as listlessness, sleepiness and a reduced tolerance for exercise, fatigue can be brought on by low levels of activity or for no apparent reason. Fatigue is often much greater than and lasts far longer than it would in a healthy person ("post-exertional malaise").

For people with CFS and/or FM, fatigue can have many causes. One is the conditions themselves, which leave people with less energy for daily activities.

Other causes include:

Here are seven ways to combat fatigue, matched to causes above. If you are bothered by fatigue, you can use the ideas below as a basis for your fatigue management plan.

Pacing

Perhaps the single most important key to controlling fatigue, and the other main symptoms of CFS and FM, is to adjust your activity level to fit your limits. This is often called "living within the energy envelope" or pacing.

Rather than fighting the body and experiencing repeated cycles of push and crash, you seek to understand your body's requirements and to live within them. Pacing includes priority setting, rest breaks, short activity periods, switching between high and low intensity tasks and living by a schedule.

Each person's limits will be different, depending mainly on the severity of their illness. Dr. Paul Cheney summarizes this approach well when he says, "Proper limit-setting, which is always individualized, is the key to improvement." You can read much more on this topic in Part 3.

Another part of the challenge of adjustment is psychological: accepting that life has changed and learning to see your life in a new way. This acceptance is not resignation, but rather an acknowledgment of the need to live a different kind of life, one which honors the limits imposed by illness.

In the words of one person in our program, "Getting well requires a shift from trying to override your body's signals to paying attention when your body tells you to stop or slow down." This process of accepting limits and learning to live a different kind of life usually takes several years and requires coming to terms with loss, the topic of Chapter 26.

Treat Pain and Poor Sleep

Fatigue is intensified by pain and poor sleep. Pain is inherently tiring and also tends to produce muscle tension, which in turn intensifies fatigue. Non-restorative sleep leaves you as tired in the morning as you were before going to bed. Treating pain and sleep using the strategies described in the two previous chapters produces the bonus of reducing fatigue at the same time.

The relationship between fatigue on the one hand, and pain and sleep on the other, works in the other direction as well. Treating fatigue can have a positive impact on sleep and pain. Since feeling tired increases the experience of pain, reducing fatigue lessens pain.

In sum, fatigue, pain and sleep interact with one another. An improvement in one symptom can have a positive effect on the other two. Probably the most common symptom to attack first is sleep.

Exercise

If being ill reduces your activity level and leads to deconditioning, you may be able to start a spiral in the other direction with exercise. Exercise produces a higher level of fitness, thus reducing the fatigue caused by inactivity. It also helps combat pain, lessens stress and improves mood. For more, see Chapter 16.

Reduce Stress

You can combat the fatigue coming from stress by using relaxation and other stress management strategies, as outlined in Chapter 18. Because stress is so pervasive in chronic illness and because it intensifies symptoms such as pain and poor sleep as well as fatigue, many patients use a variety of strategies to combat it. Like other self-management strategies, stress management techniques improve multiple symptoms.

Address Depression and Other Emotions

Powerful emotions are part of chronic illness, a response to the disruption, losses and uncertainty it brings. Emotions can be treated using a combination of self-management strategies, professional help and medications. For more, see Chapter 19.

Improve Nutrition

CFS and fibromyalgia patients often experience several kinds of problems getting good nutrition. First, because of energy limitations, lack of appetite or severity of symptoms, some people may not spend enough time to prepare and eat balanced meals. Getting help, freezing meals ahead of time and using prepared foods can help.

Second, most people with CFS and FM experience an intolerance of alcohol and many are sensitive to caffeine and/or sweeteners. Cutting down or eliminating these substances may reduce symptoms and mood swings and also improve sleep.

Lastly, about one third of CFS patients, and a comparable portion of fibromyalgia patients, experience sensitivities to various foods or have difficulty absorbing nutrients. The most effective strategy for controlling food allergies is an elimination diet, in which foods are taken out of the diet and then reintroduced one by one. For more ideas on nutrition, see Chapter 17.

Consider Medication Changes

Many medications, including some anti-depressants and drugs prescribed for pain, create fatigue as a side effect. A change of medication or a change in dosage may help.