Treatment for Chronic Tiredness
Managing chronic fatigue syndrome can be as complex as the illness itself. There is no cure, no prescription drugs have been developed specifically for CFS, and symptoms vary considerably over time. These factors complicate the treatment process and require patients and health care professionals to constantly monitor and frequently revise treatment strategies.
One key to managing CFS is working with health care professionals to create an individualized treatment program. This program should be based on a combination of therapies, for example traditional and alternative, which address symptoms, activity management and coping techniques.
Identification of a CFS patient’s greatest problem is most important since the illness affects people differently. Relief of symptoms is the primary treatment goal. Expecting a CFS patient to feel "normal" (for example, a return to usual activities) should not be the immediate goal because trying to reach that goal may aggravate the illness. CFS is a complicated illness and therefore may require input from a variety of medical professionals. Primary care providers can develop effective treatment plans based on their experience in treating other illnesses.
Coping with Chronic Tiredness
Living with chronic fatigue syndrome can be difficult. Like other debilitating chronic illnesses, CFS can have a devastating impact on daily life, requiring patients to make significant lifestyle changes and adapt to a series of new limitations.
Common difficulties for CFS patients include problems coping with:
- the changing and unpredictable symptoms
- a decrease in stamina that interferes with daily living activities
- memory and concentration problems that seriously impact work or school performance
- loss of independence, livelihood and economic security
- alterations in relationships with family and friends
- worries about raising children
- concerns about the potential impact of decreased sexual activity on intimate relationships
Feelings of anger, guilt, anxiety, isolation and abandonment are common in CFS patients. While it's normal to have such feelings, unresolved emotions and stress can make symptoms worse, interfere with pharmacological therapies and make recovery harder.
Treatment Options for Chronic Tiredness
There are many different types of treatment and management tools available for Chronic Fatigue Syndrome. These include:
- Professional Counseling
- Cognitive Behavioral Therapy (CBT)
- Graded Exercise Therapy (GET)
- Symptomatic Treatment
- Alternative Therapies
- Support Groups
- Pharmacologic Therapy
- Sleep Hygiene
- Pain Therapy
- Orthostatic Instability Treatment
Managing Activity and Exercise
For patients with CFS, learning to manage activity levels is key to managing the illness itself. This requires a new way of defining exercise. While vigorous aerobic exercise is beneficial for many chronic illnesses, CFS patients can't tolerate traditional exercise routines. Exercise programs aimed at increasing aerobic capacity are not recommended.
The majority of people with CFS are affected by post-exertional malaise, which is defined as intensifying of symptoms following physical or mental exertion, with symptoms typically worsening 12-48 hours after activity and lasting for days or even weeks. It's important, however, not to avoid activity and exercise altogether. Such avoidance leads to serious deconditioning and can actually worsen other symptoms. It is also important not to engage in an endless "push-crash" cycle in which patients do too much when they feel better, crash, rest, start to feel a little better, do too much again, and so on.
Instead, CFS patients must learn to pace activities and work with their health care professionals to create an individualized exercise program that focuses on interval activity or graded exercise. The goal is to balance rest and activity to avoid both deconditioning from lack of activity and flare-ups of illness due to overexertion. Effective activity management may help improve mood, sleep, pain and other symptoms so patients can function better and engage in activities of daily living.
Developing an Exercise Program
It is very important that any activity plan be started slowly and increased gradually. When beginning an activity program, some CFS patients may only be able to exercise for as little as a few minutes. Patients who are severely deconditioned or who are caught in the "push-crash" cycle should limit themselves to the basic activities of daily living - getting up, personal hygiene, dressing, and necessary tasks - until they have stabilized.
Several daily sessions of brief, low-impact (light) activity can then be added. Simple stretching and strengthening exercise using only body weight for resistance is a good starting place for most people with CFS. All exercise needs to be followed by a rest period at a 1:3 ratio, exercising for one minute then resting for three minutes. These sessions can be slowly increased by one to five minutes a week as tolerance develops.
Daily exercise can be divided into two or more sessions to avoid symptom flare-ups. Activity should be alternating and brief, spread throughout the day and followed by rest. If patients experience a worsening of symptoms, they should return to the most recent manageable level of activity.
Strength and conditioning exercises are an important component of the overall activity program. Standard rehabilitative methods, such as resistance training and flexibility exercises, may help improve stamina and function, increase strength and flexibility, reduce pain and increase range of motion.
Activity should begin slowly with simple stretching and strengthening exercises. Examples of functional exercises include repeated hand stretches, sitting and standing, wall push-ups or picking up and grasping objects. Patients can begin with a set of two to four repetitions, building to a maximum of eight repetitions. Once this stage is mastered, resistance band exercises (using bands for strength training) can be added to build strength and flexibility. Patients should be careful to adhere to the principle of brief intervals of exercise, followed by adequate rest, to avoid post-exertional malaise.
Severely Sick Patients
A subset of people with CFS are so severely ill that they're largely housebound or bed bound. They require special attention, including a modified approach to exercise. Hand stretches and picking up and grasping objects may be all that can be managed at first. Gradually increasing activity to the point patients can handle essential activities of daily living - getting up, personal hygiene and dressing - is the next step.
A realistic goal with severely ill patients is focusing on improving flexibility and minimizing the impact of deconditioning so they can increase function enough to manage basic activities.