Rashmi Singh is always complaining of sluggishness, sleepiness and exhaustion at work. No, it’s not the heavy lunch that is to blame. She is suffering from chronic fatigue syndrome, or chronic fatigue, which, as per Johns Hopkins Medicine, is characterised by profound tiredness. Such symptoms may vary and worsen with the lack of physical or mental activity and, sometimes, even become severe with light sensitivity, headache, muscle and joint pain, difficulty concentrating, mood swings, and depression.
The 27-year-old Bengaluru-based telesales caller, who works in an e-commerce portal, isn’t the only one. As per the World Health Organization (WHO), occupational stress, burnout and fatigue are becoming occupational hazards as intrinsic demands of the job, individual susceptibility, and poor work organisation contribute to increased stress in health workers. In fact, WHO stresses on the fact that prolonged job stress may cause burnout, chronic fatigue, absenteeism, high staff turnover, reduced patient satisfaction, and increased diagnosis and treatment errors.
“Chronic fatigue is a complex issue that often stems from a multitude of factors. While it’s true that post-acute sequelae of SARS-CoV-2 infection, also known as long Covid, can contribute to a few symptoms, it’s important not to simplify the matter. In metro cities like Delhi, Mumbai, lifestyle choices such as hectic schedules, poor nutrition, stress, and inadequate sleep can contribute to the problem. Modern lifestyles can be gruelling. Prolonged periods of work with little physical activity, coupled with irregular eating habits that often lean towards fast food, can lead to deficiencies in essential nutrients. These can cause fatigue and can also exacerbate the toll taken by physical and mental stress,” says Dr Rahul Tambe, senior consultant, internal medicine, Nanavati Max Super Speciality Hospital, Mumbai.
Fatigue is a nonspecific symptom with a broad range of causes including acute and chronic medical disorders, psychological conditions, medication overuse, and substance use, says Dr Ajay Aggarwal, director and head, internal medicine, Fortis Hospital, Noida.
“The term ‘fatigue’ can be used to describe difficulty or inability to initiate activity (subjective sense of weakness); reduced capacity to maintain activity (easy fatigability); or difficulty with concentration, memory, and emotional stability (mental fatigue),” he adds.
However, fatigue can be of different types: “Acute fatigue is most often attributable to an acute medical condition, which can often be diagnosed on the basis of its other clinical manifestations. It may also be the result of a recent life stressor. For example, a patient who starts drinking alcohol to address a stressful situation at work may also complain of fatigue. Chronic fatigue is associated with an underlying chronic medical or psychological condition, medication toxicity, or substance use,” says Aggarwal.
But various factors including medical conditions like fibromyalgia and autoimmune diseases, psychological factors such as depression and chronic stress, poor lifestyle choices, hormonal imbalances, certain medications and treatments, infections, and nutritional deficiencies, can cause chronic fatigue. “It is often a complex condition with multiple contributing factors, and identifying the underlying cause(s) requires a thorough medical evaluation,” says Jitendra Chouksey, Co-founder & CEO of Fittr, health and wellness platform.
Is Covid-19 adding to it?
Covid-19 cannot be the sole reason for chronic fatigue, says Dr Babina Nandakumar, chief medical officer, Jindal Naturecure Institute, Bengaluru. “Some individuals who had recovered from Covid-19 experience persistent symptoms such as fatigue, brain fog, muscle weakness, and malaise. These symptoms may last for weeks or months after the acute infection has resolved. While the exact mechanisms behind long Covid are still being investigated, it is thought to involve a combination of viral persistence, immune dysregulation, and tissue damage,” she adds.
Post-Covid fatigue refers to a persistent feeling of exhaustion and weakness that can last for weeks or months after recovering from Covid-19. “A diagnosis of post-Covid fatigue usually requires recent history of Covid-19 infection, persistence of fatigue for at least several weeks or months after the acute phase of Covid-19 has resolved and absence of alternative explanations,” says Aggarwal.
There are many potential risk factors for post-Covid-19 fatigue like old age, female sex, and severe clinical status in the acute phase of infection, high number of comorbidities, and pre-diagnosis of depression/ anxiety.
How to combat fatigue?
Combatting fatigue involves addressing these issues. Regular physical activity, a balanced diet rich in essential nutrients, sufficient hydration, and consistent quality sleep are key. Managing stress through techniques such as yoga and mindfulness can also be beneficial. Tambe says, “Chronic fatigue is often a symptom of underlying health issues that could impact longevity, such as heart disease or diabetes. Further, prolonged stress and poor lifestyle habits, which can cause chronic fatigue, may indeed affect lifespan. If you are feeling excessively fatigued, it’s advisable to meet a clinical expert to detect and manage the causes of the condition.”
Daily routine like prioritising quality sleep by maintaining a consistent sleep routine and creating a conducive sleep environment can help. Chouksey suggests, “Follow a balanced diet, stay hydrated, and exercise regularly to boost energy levels. Manage stress through relaxation techniques and ensure a healthy work-life balance. Seek support from friends and family, and consult a healthcare professional to address any underlying health issues.”
It is advisable to consult a doctor to screen for any physiological or psychological cause of fatigue. “In patients with residual or idiopathic fatigue (undetermined cause), certain medications such as antidepressants and graded exercise therapy may be helpful. People suffering from fatigue due to sedentary lifestyle, overwork can benefit from aerobic exercise and adequate sleep,” adds Aggarwal.
Also, there can be variation seen in the amount of fatigue depending on one’s professional capabilities. The working force in offices spends close to 8-9 hours on their office chair, eating junk and not giving priority to their lifestyle. They should build-in a few changes like doing some physical exercise daily, even a 15-minute walk for the initial phase or yoga, eating healthy and at proper intervals between 2-3 hours, getting proper sleep, reducing caffeine, drinking less alcohol and more water for better energy, etc. “By adopting these strategies and making positive lifestyle choices, one can prevent fatigue,” adds Nandakumar.
Is fatigue linked to lifespan?
Chronic fatigue is not directly linked to lifespan. But underlying causes of fatigue (if left unaddressed) can affect overall health and well-being, potentially impacting longevity. “Identifying and addressing the root causes of fatigue, such as medical conditions or lifestyle factors, is crucial to support long-term health and improve quality of life. At Fittr, we advise masses to manage underlying health issues, by adopting a healthy lifestyle while following quantified nutrition, and prioritising self-care,” says Chouksey. Proper diagnosis, treatment, management of the underlying causes of fatigue is crucial for maintaining overall health. “There can be a symptom of underlying medical conditions, such as autoimmune disorders or cardiovascular diseases, which, if left untreated or unmanaged, can have long-term effects on health and lifespan. So it is important to address chronic fatigue and its underlying causes to optimise health, potentially mitigating any negative impact on lifespan,” says Nandakumar.
Common causes
- Cardiac and respiratory conditions: Congestive heart failure, chronic obstructive pulmonary disease, sleep apnea, etc.
- Endocrinologic/ metabolic conditions: Hypothyroidism, hyperthyroidism, chronic renal disease, chronic hepatic disease, adrenal insufficiency, electrolyte abnormalities, etc.
- Infectious diseases: Viral hepatitis, human immunodeficiency virus (HIV) infection, subacute bacterial endocarditis, tuberculosis
- Psychological conditions: Depression, anxiety disorder, somatization disorder (nausea, vomiting, headache due to stress, physical weakness)
- In some cases, the complaint of chronic fatigue may simply be explained by overwork
— Dr Ajay Aggarwal, director and head, internal medicine, Fortis Hospital, Noida
Overcoming fatigue
- Seven-eight hours of good quality sleep is a must
- Boost your energy with banana, pumpkin seeds, mushrooms, egg yolk, and sunlight to improve energy and Vitamin D levels
- Take chana, amaranth and peanuts regularly to improve haemoglobin
- Add one physical activity to your routine — exercise or workout
- Dance and meditation help in relieving stress and anxiety, and let’s one stay calm