How Fatigue Can Trigger Other Symptoms
I recently discussed how symptoms can be interconnected, and how decreasing one symptom can improve the others. With post-viral fatigue, chronic fatigue syndrome (CFS) or even ordinary fatigue, the more tired you get the more likely you are to experience other symptoms such as brain fog. This is supported by countless Occupational Health studies that have shown people who work too many hours develop:
- Mental and physical fatigue
- Stress, anxiety, depression and other mental health issues
- Hypertension and other cardiovascular issues
- Poor sleep
- Reduced performance and productivity
- Impaired planning, prioritization and decision-making
In other words, exhaustion triggers negative symptoms. Since I have chronic fatigue, I have less capacity so I must be careful about how and when I expend mental or physical effort to minimize exhaustion.
Pacing for Energy Management
My specialist recommended “pacing” as a tool to prevent overtaxing my nervous system. Pacing is strategy to limit daily activities to within my healthy capabilities in order to reduce symptoms. Pacing is a “less is more” strategy and involves reducing ordinary physical and mental tasks that most people take for granted to save energy to boost your performance in areas where you most need it. This is challenging as it requires support from others, such as a spouse or colleague to cover some of the things you stop doing.
Energy Budgets to Help Manage Symptoms
The goal of pacing is to manage your energy budget, much like how people manage spending to avoid running out of money. An energy budget is the amount of energy available to spend without aggravating symptoms.
Think of a marathon runner; if they try sprinting the entire race they probably will collapse before finishing. If they carefully manage their energy, they can win. However, if they push themselves hard enough to win, they probably will have a couple of rough weeks afterwards to recover before they can do well in another marathon. With long COVID and CFS energy budgets, the goal is to manage your energy well enough to finish the race without needing those weeks to recover. If that means taking more breaks and doing less than what healthy people can do, so be it. This is because with long COVID and Chronic Fatigue Syndrome, making it through every day is a marathon and no matter how well you place in today’s race, tomorrow will be another endurance event. You cannot afford to be 20% more productive today at the expense of being 0% productive for the next 10 days.
Examples of Pacing within an Energy Budget
Thought-intensive tasks like analysis, planning, multi-tasking, and group discussions fatigue me. I make more mistakes when I do these things late in the day or week or in back-to-back sessions. I do better with them at the start of my day or after a break or nap. It helps to schedule these activities at a time when I can do them well at a pace I can sustain.
Reducing mundane decisions is another example. When I buy clothing, I pick several identical pants and some shirts within a narrow range of colors so that I can just grab any combination and throw them on without considering if they match. When I make breakfast on a workday, it is nearly always one egg on whole grain toast and half a banana. No staring inside cupboards wondering what to make each morning. I just trigger my routine. On mornings when my wife volunteers to cook, I ask her not to ask me a lot of questions about what I want, how hungry I am, how it should be prepared, etc. as processing and answering each inquiry uses up the cognitive reserves I need for work.
When symptoms increase, I try to take a break. Ringing in the ears, nausea, intensifying headache, spacing out and losing time are all signs that I must rest or crash. I keep a small couch in my office so that if I start to fade, I can take a brief nap. My medical team strongly urges me to plan these breaks regularly without waiting for increased symptoms. It helps when I can comply, but this is extremely challenging when trying to keep a job.
Conclusion
When I manage my energy budget with pacing, both my symptoms and my work performance improve. When I fail to use pacing I am almost guaranteed to crash for days or even weeks. So for me, the choice is either use pacing or miss work for an IV migraine cocktail at the hospital and a week or more of horrible symptoms. Toughing it out not only does not work, but it actually makes things far worse.
For more information
- Washington Post: For long COVID fatigue, a strategy called ‘pacing’ helps
https://www.washingtonpost.com/wellness/2023/01/16/long-covid-fatigue-pacing/ - PHSA: Managing Fatigue in Post COVID-19 Recovery with Pacing
http://www.phsa.ca/health-info-site/Documents/post_covid-19_fatigue.pdf - University of Leeds: Impressive results with Long COVID pacing trial
https://www.leeds.ac.uk/news-health/news/article/5219/impressive-results-with-long-covid-pacing-trial
“The findings of this research are exciting because… a structured pacing programme has now been shown to reduce symptoms and improve quality of life.” - Long COVID Physio: Pacing
https://longcovid.physio/pacing
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I invite on-topic, helpful comments from readers with free Google accounts. I am especially interested in comments that share useful tips for fighting long-COVID, Chronic Fatigue, Chronic Pain and Migraines. Off-topic comments, comments that name other sites or products without including much relevant textual explanation, and comments disparaging any person or group will be deleted. As I am trying to keep this a positive place, I may also delete comments in a despairing tone that focus only on symptom misery rather than helpful ways to combat it. Thank you very much for sharing your thoughts and helpful tips!