What is chronic fatigue syndrome? Plus, 6 tips to manage it
Clinically reviewed by Dr. Chris Mosunic, PhD, RD, MBA
Some people experience exhaustion on another level. Here’s what to know about chronic fatigue syndrome (CFS/ME) – from symptoms to prevention and treatment options.
Everyone goes through periods of time when they’re just exhausted. Maybe your kids keep waking you up, or a huge project has you working into the wee hours of the morning. Or maybe you’re just going out all the time, and those late nights have finally caught up with you.
In these situations, a few nights of solid sleep is usually all you need to feel like yourself again. But for some people, no amount of rest seems to be enough.
When you’re living with chronic fatigue syndrome, extreme exhaustion lingers day after day and simple tasks like getting out of bed, showering, or prepping meals can feel impossible. This condition can also cause problems with memory and focus, so it can feel like you’re living with a constant mental fog.
Because symptoms can be hard to explain and sometimes come and go, you might feel misunderstood by others and unsure about what’s happening with your own body. After all, it’s frustrating when doing something as simple as taking a short walk—an activity that may reenergize some—leaves you feeling worse, not better.
Put simply, CFS can really get you down—but we’ve got you. Here’s what you need to know about CFS and how you can manage its impact on your life.
What is chronic fatigue syndrome (myalgic encephalomyelitis)?
Chronic fatigue syndrome (CFS), which is also referred to as myalgic encephalomyelitis (ME), is a long-term condition that causes extreme, persistent tiredness and other physical and mental symptoms that affect daily life.
This level of exhaustion is different from ordinary tiredness, because it doesn’t improve with rest or sleep, and it can have an enormous impact on how you live, work, and connect with others.
The levels of exhaustion experienced can vary, though. If you live with CFS, you likely feel tired while doing basic tasks, and you might find that physical or mental effort can leave you feeling worse instead of refreshed. Some people experience mild symptoms and manage to keep up with day-to-day life, but many find that CFS forces them to reduce work hours, miss out on social events, or need extra help with household tasks. For others, symptoms can be severe enough to keep them mostly homebound and sometimes even bedbound.
Chronic fatigue syndrome can affect people of all ages, including children. Though it’s most common in adults in their 40s and 50s, CFS tends to impact women more often than men, though researchers don’t yet fully understand why.
Living with CFS may often feel lonely and frustrating, especially when people around you don’t fully understand the limitations or pain it causes. But you’re not alone, and there are resources, support networks, and treatments to help manage CFS and make life a little easier. If you suspect you or someone you know may have CFS, keep reading for more insights into symptoms, causes, and helpful ways to cope.
5 symptoms of chronic fatigue syndrome
Chronic fatigue syndrome affects people differently, because everyone who lives with it has their own individual experience. Symptoms can change over time, too — sometimes coming on suddenly or easing up. This unpredictability can be a major part of the struggle, as you’re never sure how you’ll feel from one day to the next while trying to balance daily life. Here are a few common symptoms that many people share:
Persistent fatigue: The main symptom of CFS is a deep, lasting exhaustion that doesn’t improve with rest or sleep. This can make even minor tasks feel like climbing a mountain.
Post-exertional malaise (PEM): A key symptom of CFS, PEM is where even small amounts of physical or mental effort can lead to a severe increase in symptoms afterward. This crash can last for days, weeks, or longer, making it hard to plan activities or predict how you'll feel each day.
Unrefreshing sleep: Many people with CFS report waking up feeling just as tired as before they went to bed. This can make fatigue and other symptoms even worse.
Cognitive impairment: Brain fog can make it difficult for people with CFS to concentrate, remember information, or process thoughts quickly. Tasks requiring focus can feel draining, and decision-making can be especially challenging, which can be frustrating when you were once able to do these things easily.
Aches and pain: Physical pains in the muscles and joints, headaches, sore throats, and tender lymph nodes can make it difficult for people with CFS to be physically active and manage daily life.
What are some potential triggers of chronic fatigue syndrome?
While more research is needed to fully understand CFS, there are some potential triggers that experts believe can affect CFS flare ups. Here are a few of the most common.
Viral infections: Some people develop CFS after a viral infection, such as Epstein-Barr virus or human herpesvirus 6. These infections may weaken the immune system or trigger lasting changes that lead to CFS symptoms. However, not everyone with CFS has a history of viral infections.
Immune system issues: Some studies suggest that people with CFS may have an overactive or irregular immune response, which leads to inflammation and other immune-related symptoms that may contribute to the fatigue and other symptoms seen in CFS. Research into immune system dysfunction and its possible link with the development and persistence of CFS is ongoing.
Hormonal imbalance: Hormonal imbalances, including irregular levels of cortisol and other stress-related hormones, have been observed in people with CFS. It’s unclear whether these imbalances are a cause or a result of the condition.
Genetic factors: Genetics may play a role in CFS, as it can run in families. While no single gene has yet been linked to CFS, there may be a genetic tendency for some people to develop it. Having a family history of CFS or similar conditions may increase the likelihood of developing the illness, but it doesn’t guarantee it. Researchers are still studying how genetics may interact with other factors to contribute to CFS.
Physical or emotional trauma: Some people may develop CFS after experiencing a major physical injury, surgery, or emotional trauma (including childhood trauma). The body's response to extreme stress, whether physical or emotional, might trigger CFS symptoms, because of the complex relationship between physical, mental, and emotional health.
How to treat chronic fatigue syndrome
Treating chronic fatigue syndrome can be challenging, because there isn’t a defined cure for it. The fact that no one knows exactly what causes CFS can leave people feeling lost or wondering if their symptoms are even real.
But it’s important to remember that CFS is a genuine, recognized condition that affects thousands of people worldwide, and it’s backed by extensive research. While we don’t yet fully understand it, CFS is not your fault, and know that it’s more than just being tired.
Treatment usually focuses on managing your symptoms to improve your quality of life, along with medical care and lifestyle adjustments. Here’s an overview of common treatment options and supportive therapies to help people with CFS live more comfortably.
Medical support
Most people start by seeing a primary care doctor who can help diagnose CFS and rule out other conditions with similar symptoms. Because CFS affects many different aspects of health, it’s common for patients to work with several specialists, like neurologists, rheumatologists, or sleep specialists, to manage specific symptoms. Finding doctors who understand CFS or are willing to learn about it can make a big difference in treatment quality and overall support.
Medications
While there’s no specific medication for CFS, several types of medications may help manage certain symptoms. Medications don’t work the same way for everyone, and finding the right combination may take time. Work closely with a doctor to find the safest and most effective options for your symptoms. Here are some common options:
Pain relievers: Over-the-counter medications like acetaminophen or ibuprofen can help manage mild muscle and joint pain. For more severe pain, doctors may prescribe other pain medications, but these should be used carefully to help you avoid developing a dependency.
Sleep aids: Since unrefreshing sleep is a common symptom of CFS, doctors may recommend short-term use of sleep aids to help you fall asleep or stay asleep. But since long-term reliance on these can sometimes make sleep issues worse, non-medication sleep strategies, like improving sleep hygiene, are also used.
Antidepressants: Some people with CFS find antidepressants helpful, especially if they’re experiencing depression, which is common with chronic illnesses. Low doses of certain antidepressants can also help relieve pain or improve sleep, even in people who aren’t clinically depressed.
Therapies
Professional therapy may help you improve your quality of life and cope with the effects of CFS. Here are some you might want to try:
Cognitive behavioral therapy (CBT): Cognitive behavioral therapy is a type of talk therapy that can help you manage the emotional effects of living with CFS, such as stress, anxiety, and feelings of frustration. It focuses on changing thought patterns and building coping strategies to make it easier to live with the challenges of CFS, even though it doesn’t treat the physical symptoms directly.
Graded exercise therapy (GET): Graded exercise therapy takes a structured, gradual approach to physical activity. A physical therapist will guide you in slowly increasing your activity levels without triggering post-exertional malaise. However, GET can be controversial since many people with CFS experience worsened symptoms after even minor physical activity, so it’s important to work with a medical professional who understands CFS and to listen closely to your body’s limits.
6 tips for living with chronic fatigue syndrome
Living with CFS can feel like a daily balancing act, but relying on small, practical strategies can help to manage symptoms and make life a bit easier.
What works for you might not work for another person, so use these tips as a starting point for finding what helps you to manage CFS.
1. Pace yourself with any activity
Balance activity with rest, and understand your energy limits so you don’t push yourself too far. If you find yourself exhausted after certain activities, try breaking them into smaller parts, and take rest periods in between. Instead of cleaning the entire kitchen at once, you might wash the dishes one day and wipe down surfaces the next.
Pacing helps reduce the risk of post-exertional malaise (PEM), and allows you to get more done over time without crashing. Listen to your body, and don’t be afraid to stop when you need to rest.
2. Improve your sleep hygiene
Not feeling refreshed after a full night’s sleep is a common challenge with CFS, but there are ways you can improve sleep quality. Focus on creating habits and an environment that helps you get better rest.
Aim to go to bed and wake up at the same time each day, as a regular schedule can help regulate your body’s sleep patterns. Avoid caffeine and screens before bed, since these can interfere with your sleep quality.
You might also try calming activities before bed, like reading, gentle stretches, or deep breathing exercises. A peaceful bedroom—one that’s dark, quiet, and cool—can also make a difference. Take a look at our six tips to create the best sleep environment.
💙 Explore ways to improve your sleep from a psychologist and sleep specialist during Dr. Orma’s Sleep Science.
3. Track your CFS symptoms and triggers
If you know what’s causing crashes in your energy, you can make the adjustments you need to help you feel balanced. Keep a journal of your symptoms, activities, and other factors like diet or stress, and look for patterns. You may start to notice that certain activities make symptoms worse or that specific foods or types of stressors trigger a flare-up.
If you notice that certain physical activities increase your fatigue, you might plan rest days around these activities or avoid them altogether. Tell your doctor the insights that you gain, too, as it provides them with a clearer picture of what’s affecting your symptoms.
4. Practice relaxation techniques
Living with CFS is challenging, both physically and mentally, so managing your stress levels is important. Use relaxation techniques, like deep breathing, meditation, or gentle yoga, as these are low-impact ways to help reduce stress. This can make managing symptoms a bit easier, and they may even ease some physical symptoms.
Simple breathing exercises, such as inhaling deeply through your nose, holding for a few seconds, and exhaling slowly, can be calming and help you feel more centered. If you don’t know where to start, explore the guided meditations on the Calm app.
💙 Learn how to Breathe into Relaxation with this short and simple meditation from Jay Shetty.
5. Pay attention to the food you eat
A balanced diet won’t cure CFS, but it can support your overall health and help you feel more energized.
Focus on whole foods, like fruits, vegetables, lean proteins, and whole grains, that provide essential nutrients without spiking your blood sugar. Some people with CFS find that smaller, more frequent meals, as opposed to a few larger meals, keeps energy levels steadier throughout the day.
Staying hydrated is also important, so drink plenty of water and limit sugary or caffeinated drinks, which can lead to energy crashes. If certain foods seem to make you feel worse, talk to a doctor or dietitian who can help identify any dietary triggers and suggest the best foods for your specific needs.
6. Build an understanding support network
Living with CFS can feel isolating, especially when people around you don’t fully understand the condition. But there are others out there who totally get what you’re going through.
Try to join a support group, either in person or online, as these encouraging communities often share tips, experiences, and support for handling the day-to-day challenges of CFS, so you can feel less alone. You might also explore these 10 mindful tips for when you feel lonely, to help you feel a little better.
Chronic fatigue syndrome FAQs
What is the difference between chronic fatigue syndrome and fibromyalgia?
Chronic fatigue syndrome (CFS) and fibromyalgia are both chronic illnesses that can cause extreme fatigue, pain, and other similar symptoms. This can make them easy to confuse, especially as people are sometimes diagnosed with both, but they’re actually separate conditions with key differences.
CFS: The primary symptom of CFS is a long-lasting, intense fatigue that doesn’t improve with rest and often worsens after physical or mental activity, known as post-exertional malaise (PEM). Other symptoms of CFS may include unrefreshing sleep, cognitive issues (brain fog), and muscle or joint pain, but the main focus is usually the extreme exhaustion and energy limitation.
Fibromyalgia: This is mainly characterized by continuous, widespread pain and tenderness throughout the body, with sensitivity even to a light touch. People with fibromyalgia often experience fatigue, sleep disturbances, and cognitive issues too, but the focus tends to be on pain rather than fatigue. Fibromyalgia is often thought to involve how the brain processes pain signals, making the person hypersensitive to pain.
Can you prevent chronic fatigue syndrome?
Currently, there is no known way to prevent chronic fatigue syndrome, as its exact cause is still unclear. CFS is thought to be triggered by a combination of factors, such as viral infections, immune system issues, hormonal imbalances, and possibly genetic predisposition. Because these factors aren’t fully understood, and because the triggers can vary widely from person to person, there’s no surefire way to avoid developing CFS.
But, paying attention to general wellness habits can sometimes help reduce the risk of illnesses that may lead to conditions like CFS. This includes prioritizing good sleep (these 10 tips can help), managing stress, and supporting your immune system as best you can. You can try to do this by eating a balanced diet, staying active, and washing your hands to avoid infections. Although these habits can’t guarantee prevention, they can help support your overall health.
If you’re already experiencing symptoms that might indicate CFS, get early support from a healthcare provider to help manage symptoms and provide guidance.
Are there specific tests to diagnose chronic fatigue syndrome?
No single test can definitively diagnose chronic fatigue syndrome, which can make getting a diagnosis feel like a very long process. Instead, CFS is often diagnosed through a process of elimination, meaning doctors rule out other conditions that might cause similar symptoms, like sleep disorders, autoimmune diseases, or thyroid issues first. The diagnostic process often includes a physical exam, blood tests, and a detailed review of your medical history and symptoms.
Because CFS doesn’t have clear physical markers that show up on tests, doctors who are familiar with the condition generally diagnose it based on specific criteria, such as experiencing severe fatigue lasting at least six months, post-exertional malaise , and other symptoms like unrefreshing sleep, cognitive issues, or muscle and joint pain.
While diagnosis can be a lengthy and sometimes frustrating process, it’s an important step in finding the right support and treatments for managing your symptoms.
Can diet changes help alleviate symptoms of chronic fatigue syndrome?
Diet changes won’t cure CFS, but some people find that eating a balanced, nutrient-rich diet can make a positive difference in their energy levels and overall wellbeing. If you’re interested in adjusting your diet to support your health with CFS, consider talking with a nutritionist or dietitian who can help create a balanced plan tailored to your needs and sensitivities.
Eat whole foods: Eating whole foods like fruits, vegetables, whole grains, and lean proteins provides essential vitamins and minerals that support overall health.
Eat more often: For some people with CFS, smaller, frequent meals help maintain steadier energy levels throughout the day, rather than experiencing spikes and crashes that can come with larger meals or sugary foods.
Stay hydrated: Hydration is also important, as dehydration can contribute to fatigue and worsen symptoms. Drinking enough water and limiting sugary or highly caffeinated drinks may help keep energy more consistent.
Avoid triggers: Some people with CFS find that certain foods trigger worsened symptoms, such as processed foods or those high in refined sugars.
Is exercise recommended for people with chronic fatigue syndrome?
Exercise recommendations for people with CFS are complex, because physical activity can sometimes worsen symptoms instead of improving them. Many people with CFS experience what’s known as post-exertional malaise, which is when even small amounts of movement can lead to a significant crash in energy levels and an increase in symptoms, lasting days or even weeks. Because of this, traditional exercise routines can be too much for many people with CFS and may end up doing more harm than good.
That said, gentle, carefully managed physical activity can sometimes be helpful if you approach it gradually and with close attention to your body’s limits. This might mean short stretches, gentle yoga (here are five relaxing poses to try), or light activities, such as short walks, with the guidance of a medical professional, but only if these don’t trigger PEM.
Some people find pacing and graded exercise therapy (GET) helpful, where activity is introduced in small, manageable steps over time. However, GET can be controversial and isn’t suitable for everyone with CFS, so always work with a knowledgeable healthcare provider to figure out what’s right for you.
The most important thing is to listen to your body, rest when you need to, and avoid overdoing it.
How does chronic fatigue syndrome affect mental health?
Living with chronic fatigue syndrome can take a serious toll on your mental health, as it can lead to feelings of isolation, frustration, and even depression. CFS can be limiting, meaning you can struggle to keep up with work, social activities, or hobbies, which can make you feel disconnected from others and your previous life.
Many people with CFS experience brain fog, where they have difficulty with memory, focus, and processing information. This can add to feelings of frustration or anxiety, especially if these issues affect your daily tasks or relationships.
It’s also common for people with CFS to feel misunderstood or invalidated, as the illness isn’t always visible to others, and symptoms can be unpredictable. This lack of understanding can lead to feelings of loneliness, as well as stress from having to constantly explain or justify your experience. Emotional support, whether through counseling, support groups, or online communities, can make a big difference, including in helping with coping strategies, stress management, and ways to work through feelings of isolation.
Try to build a supportive network, find hobbies or activities that work within your energy levels, and be kind to yourself, so you can care for your mental health.
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