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Fatigue syndrome: when tiredness persists

Dr. med. André Sommer

Dr. med. André Sommer

The word fatigue comes from French and means exhaustion or tiredness. We all know about how overexertion or lack of sleep can lead to physical and mental exhaustion. This condition is reversible in healthy people. This means that we are quickly fit and energetic again with sufficient rest and sleep. However, the feeling of exhaustion doesn't disappear in those affected by fatigue syndrome—no matter how much rest and sleep they get. As a result, everyday life can be severely affected. Fatigue syndrome often occurs as a side effect of chronic diseases such as multiple sclerosis or cancer. It can also be due to a lack of red blood cells (anemia) or thyroid dysfunction; in these cases, fatigue syndrome is easier to treat.

What are the symptoms of fatigue syndrome?

In medicine, a syndrome is a collection of various symptoms (complex of symptoms). Those affected by fatigue syndrome suffer extreme fatigue even though they get enough sleep. Everyday activities lead to disproportionate exhaustion. Energy reserves are quickly used up and cannot be replenished despite the increased need for rest. The following symptoms can occur as part of fatigue syndrome:

  • Rapid exhaustion
  • Feeling of weakness
  • Motivation disorder, lack of motivation
  • Fatigue, lack of energy, increased need for rest
  • Reduced physical resilience
  • Disturbed sleep behavior
  • Difficulty concentrating

These symptoms can be very stressful and can limit daily activity (depending on the severity). Due to the constant weariness and the feeling of lack of energy, it is difficult for those affected to live their everyday lives.

What causes fatigue?

The symptoms of fatigue can have various causes.

Fatigue as an accompanying disease:

Fatigue syndrome occurs as an accompanying (concomitant) disease for various other diseases. People who have cancer are often affected. Fatigue syndrome occurs in up to 90 percent of those affected. With neurological diseases such as Parkinson's disease and multiple sclerosis (MS), it is estimated that 50 percent suffer from fatigue. Other chronic diseases with fatigue include:

  • Rheumatoid arthritis (rheumatism)
  • Lupus erythematosus

However, if no neurological disease or cancer is known, the following possible causes of fatigue syndrome should be clarified:

Fatigue as a symptom of the following diseases:

  • Anemia, for example due to iron deficiency
  • Thyroid disease
  • Sleep disorders
  • Nocturnal breathing interruptions (sleep apnea syndrome)
  • Malnutrition
  • Chronic pain syndrome

Keep in mind!

Fatigue syndrome is not to be confused with chronic fatigue syndrome (CFS). This is an independent neurological disease.

Fatigue as a side effect of medication

With therapy involving interferons, for example, with multiple sclerosis or hepatitis C and chemotherapy drugs (cancer treatment), fatigue syndrome can occur as an undesirable side effect.

Chronic fatigue syndrome (CFS, myalgic encephalomyelitis)

CFS (synonym: myalgic encephalomyelitis) is an independent clinical diagnosis to be differentiated from fatigue syndrome.

With depression and burnout

Listlessness, exhaustion, and an increased need for sleep can occur with depression or burnout. This should not be confused with fatigue syndrome.

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What helps with fatigue?

Unfortunately, fatigue syndrome is rarely treated, although it is very stressful for those affected. The first thing to do is to find out the cause of the fatigue or to rule out depression. Because if you treat the underlying disease, such as anemia, thyroid disease or sleep apnea syndrome, fatigue also improves. In the case of tumor patients, the focus is on education. Fatigue often begins 3–4 days after the start of chemotherapy. Since this involves a multifactorial event, the fatigue is not so easy to treat.

If you suffer from fatigue syndrome, even simple activities such as cooking or brushing your teeth can lead to excessive fatigue. Nonetheless, the following tips may help:

  • Take more breaks during the day. This will help you deal with fatigue.
  • Physical training is important: Light endurance sports such as Nordic walking or cycling are suitable for increasing your resilience and relieving your fatigue.
  • Dehydration can increase fatigue. Always drink enough.
  • There are specific rehabilitation measures where you learn to use your available energies effectively.
  • Is a cool environment good for you? Some people suffering from fatigue are sensitive to heat. Cold scarves or cooling vests help with heat.

Can fatigue syndrome occur with irritable bowel?

Yes. In addition to the typical gastrointestinal symptoms, a large number of irritable bowel patients suffer from so-called extraintestinal symptoms (not related to the digestive tract). In addition to depression and anxiety, fatigue can occur with irritable bowel syndrome (IBS). It’s estimated that between 40 and 80 percent of irritable bowel patients are affected by fatigue syndrome. Mental fatigue and physical exhaustion can occur briefly (acute) or permanently (chronically). It is still unclear whether fatigue syndrome as part of IBS can be improved by appropriate nutritional therapy. The exact mechanisms of origin are still largely unclear.

How does fatigue syndrome develop?

The underlying causes of fatigue syndrome are diverse. For most underlying diseases, it has not yet been finally clarified why fatigue syndrome occurs. Various factors probably work together. For some causes, however, the development of fatigue is clear. For example, if the fatigue syndrome is due to anemia, we have too few red blood cells that transport oxygen to the tissue. As a result, the brain and muscle cells are not supplied with sufficient oxygen. We feel tired and quickly exhausted. If fatigue syndrome occurs without a known previous illness, a blood test should always be carried out. With sleep apnea syndrome, there is a lack of oxygen supply to the body during sleep. The nocturnal breathing interruptions cause unconscious reactions that lead you to wake up. As a result, your sleep is not restful. This leads to daytime sleepiness.

What is chronic fatigue syndrome?

Chronic fatigue syndrome (CFS) is also called myalgic encephalomyelitis (ME). Unlike fatigue syndrome, CFS is not just a symptom complex: It is an independent neurological disease of the brain. The main symptoms of chronic fatigue syndrome also include mental and physical fatigue and rapid exhaustion. Muscle pain (myalgia) and headaches are also added to this. In severe cases, CFS leads to disability or even being bedridden. It can be described as a long-lasting, flu-like effect. Therefore, immunodeficiency is also suspected as the cause of CFS / ME.

Symptoms of CFS / ME at a glance:

  • Chronic fatigue
  • Body aches
  • Swollen lymph nodes
  • Difficulty concentrating
  • Feeling of overload after physical or emotional exertion
  • Nausea and gastrointestinal complaints
  • Food intolerances
  • Headaches

CFS / ME is difficult to diagnose. The question of whether chronic fatigue syndrome actually exists as a separate disease is also controversial. The diagnosis CFS / ME may only be made if all other possible causes of fatigue syndrome have been excluded. However, there is increasing evidence that it is an immunological disease. Virus infections are suspected as possible triggers. New studies show that Epstein-Barr virus (EBV) infection and decreased immune system memory cells play a role in CFS / ME.

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Loebel, M., Strohschein, K., Giannini, C., Koelsch, U., Bauer, S., Doebis, C., ... & Knops, M. (2014). Deficient EBV-specific B-and T-cell response in patients with chronic fatigue syndrome. PloS one, 9(1), e85387. Downloaded on 01/08/2018 from:

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Dr. med. André Sommer

Dr. med. André Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara Care.

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