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As the name implies, chronic fatigue is an exhausting illness: people with chronic fatigue experience unexplained and extreme tiredness that can last for months, if not years. Their ability to perform functional activities—day-to-day activities—is severely impacted.

Until recently, it was widely assumed, even among doctors, that the disorder was psychological, or worse, imagined. However, in 2015, a government panel of experts defined chronic fatigue as a “serious, debilitating condition” with distinct physical symptoms.

The Institute of Medicine (IOM) committee estimated that up to 2.5 million Americans have the illness, with at least 84% of them undiagnosed. Patients frequently suffer from their illness for years before receiving a diagnosis.

While there is no cure for chronic fatigue, its symptoms can be managed with a variety of medications and therapies ranging from sleep aids and pain relievers to gentle exercise and counseling. Continue reading to learn more about the syndrome and signs that it’s time to see a doctor about chronic fatigue.

1. You’re constantly tired  

This is not exhaustion from a long week. This is severe fatigue that causes a significant reduction in your ability to function on a daily basis and can last for six months or more.

The tiredness is caused by activities that you could once do easily, rather than by excessive activity. Even sitting in an uncomfortable position for an extended period of time can cause symptoms. The fatigue is constant and does not go away with rest.

2. You feel even worse when you push your limits 

The medical term for this is post-exertional malaise. It means that putting more stress on your body than it can handle causes your symptoms to worsen. A patient’s lymph nodes may swell, and they may experience joint pain or pain in other areas. It could take a full day or more to recover.

3. You often wake up tired 

People suffering from chronic fatigue can sleep for 12 hours but wake up feeling as if they haven’t slept at all. Most people who suffer from chronic fatigue develop a sleep problem that they did not previously have. The most common complaints, such as insomnia and frequent awakenings, can leave people feeling depleted rather than restored in the morning. That is why, for people suffering from chronic fatigue, conserving the energy they do have is critical.

4. Your brain feels sluggish 

Some people who suffer from chronic fatigue experience cognitive impairment. Generally, they experience a delay in their ability to process information. It takes longer to process information.  They may also experience lapses in their short-term memory.

These difficulties with mental processes, which may also include difficulty paying attention, problem-solving, and planning, can make it difficult to maintain a job or interact in social situations. The problems worsen when you’re stressed or have over-exerted yourself. They can, predictably, lead to feelings of isolation and hopelessness.

5. You get lightheaded just from standing 

For many chronic fatigue patients, simply standing upright—for example, in the shower or while doing dishes—can cause dizziness, lightheadedness, and possibly fainting. The symptoms improve but do not necessarily disappear when the person lies down or elevates her feet.

This is referred to by doctors as orthostatic intolerance. It is related to the effect of chronic fatigue on the autonomic nervous system, which is the part of the nervous system that controls everything automatically in our bodies, including circulation. Chronic fatigue has been linked to blood pressure and blood flow issues.

6. You get headaches, or joint or muscle pain 

Pain is a common symptom of chronic fatigue, but it can manifest itself in a variety of ways, ranging from chronic headaches to joint and muscle pain. It also varies in intensity from person to person.

7. You also experience other symptoms 

There are several other complaints that chronic fatigue patients report, though they are less common. A sore throat, tender lymph nodes in the neck and armpits, genitourinary system problems (including gynecological issues), and sensitivity to certain drugs, foods, chemicals, or other stimuli are also on the list.

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