Do You Have Chronic Fatigue? Warning Signs & When to See a Provider

We all feel exhausted sometimes, whether it’s after a long week, a sleepless night, or a tough workout. But if you’re feeling tired all the time—even after a good night’s sleep—and it’s starting to interfere with your daily life, it could be a sign of something else: chronic fatigue.

Recognizing the warning signs of chronic fatigue can help you know when it’s time to see a provider about your symptoms. And the sooner that happens, the sooner you can get relief, avoid long-term complications, and improve your quality of life. 

Think you might have chronic fatigue? Read on to learn about the common symptoms of chronic fatigue and how to know if what you’re feeling is regular tiredness or a sign of something more chronic.

What Is Chronic Fatigue?

Chronic fatigue goes far beyond the normal tiredness that comes with a jam-packed schedule. It’s a persistent, overwhelming exhaustion that doesn’t get better with sleep or rest—and it can last for months or even years. Experts estimate that up to 3.3 million Americans have chronic fatigue syndrome (CFS), and up to 90% may be undiagnosed.

In everyday language, we often conflate feeling fatigued with feeling tired, but they’re two different things, says Jessica Meisner, NP, a nurse practitioner based in North Carolina and board certified in Family Medicine. “The major difference is that regular tiredness is due to specific factors, such as sleep, stress, or physical exertion. It improves and resolves with rest, whereas chronic fatigue is debilitating fatigue that lasts longer than six months and is not relieved with adequate rest, sleep, or decreased stressors.”

Meisner says that chronic fatigue, also known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), may come with other symptoms, including:

• Impaired memory or concentration
• Muscle pain
• Unrefreshing sleep
• Headaches
• Post-exertional malaise (a hallmark symptom that describes a worsening of symptoms after physical or mental activity)

ME/CFS is a complex and often misunderstood condition that can negatively impact everyday life. People with chronic fatigue may find it exhausting to go to work or school, enjoy leisure activities, or complete everyday tasks like grocery shopping.

Causes and Risk Factors of Chronic Fatigue Syndrome

The exact cause of ME/CFS is unknown, but several factors may play a role, including:

• Viral or bacterial infections
• Changes in your immune system or metabolism
• Physical or emotional stress
• Genetics

The symptoms of chronic fatigue can overlap with other chronic health conditions—such as fibromyalgia, depression, or thyroid issues—which can make it difficult to diagnose. 

Anyone can develop chronic fatigue at any age. But, some people are more at risk than others, including Black and Latino people and anyone assigned female at birth. Women are three times more likely to have ME/CFS than men. If other people in your family have chronic fatigue, that can also raise your risk, as there is some evidence that it may run in families.

Signs and Symptoms of Chronic Fatigue

So how do you know if what you’re experiencing is chronic fatigue, instead of regular tiredness? Meisner says, “With normal tiredness, you’ve worn yourself out, but if you get adequate rest and hydration, it usually resolves on its own—where chronic fatigue sticks with you, regardless of what you do.” 

There are five primary symptoms of ME/CFS. To be diagnosed with ME/CFS, you must have three main symptoms, and at least one of two additional symptoms. Let’s take a look. 

1. Fatigue That Lasts 6 Months or Longer

This is one of the core symptoms of ME/CFS. We’re not talking about the kind of tired that goes away after a good night’s sleep or a strong cup of coffee. This is a persistent, deep exhaustion that lasts for months and significantly limits your ability to function at home, work, school, and social events.

2. Unrefreshing Sleep

This is another core symptom of chronic fatigue. It describes a state of regularly waking up unrefreshed—even if you slept for 7–9 hours straight. You may also have trouble falling or staying asleep.

3. Post-Exertional Malaise (PEM)

Post-exertional malaise, or PEM for short, is a unique and defining symptom of ME/CFS and the last of the three core symptoms. PEM describes a sudden worsening of symptoms after even minor physical, mental, or emotional exertion—like grocery shopping or having a conversation. Bouncing back from these crashes can take days or even weeks, depending on the severity of your fatigue.

In addition to these three core symptoms, you must experience either problems with your thinking or memory (symptom #4 below) or a worsening of symptoms when you sit or stand for a prolonged period of time (symptom #5 below).

4. Impaired Thinking or Memory

Cognitive impairment is one of the two additional symptoms of ME/CFS, of which you need at least one to be diagnosed with ME/CFS. 

Trouble focusing, forgetfulness, and slowed thinking are common signs of chronic fatigue. You may notice that you’re reacting more slowly or you’re having trouble paying attention or remembering things. This “brain fog” may be more pronounced when you’re under a tight deadline or multitasking. 

5. Symptoms Worsen When Sitting or Standing Upright

Up to 95% of people with chronic fatigue experience issues when sitting or standing upright for long periods. The official name for this symptom is “orthostatic intolerance.” It’s the second of the two additional symptoms of ME/CFS, of which one is required to be diagnosed. 

You may notice that your symptoms worsen when you’ve been upright for a while, or you might feel faint, dizzy, nauseous, or lightheaded. You may experience heart palpitations or a drop in blood pressure. Once you lie down, you may feel better again. 

Other Possible Symptoms of ME/CFS

Above, we reviewed the main symptoms of ME/CFS. But people with chronic fatigue may regularly experience other troublesome symptoms, such as:

• Muscle aches and pains
• Headache
• Sore throat
• Tender lymph nodes
• Chills or night sweats
• Gastrointestinal issues
• Changes in vision
• Increased sensitivity to certain foods, odors, light, sounds, or chemicals

Why Chronic Fatigue Shouldn’t Be Ignored

It’s important to get chronic fatigue checked out—not only so you can get some answers, but to rule out something more serious. “Chronic fatigue can be a sign of an underlying autoimmune condition and can worsen chronic diseases, especially diseases which are caused by inflammation,” says Meisner. 

Some conditions that may be masked by chronic fatigue include:

• Sleep disorders
• Mental health conditions like depression and anxiety
• Autoimmune diseases, including lupus or rheumatoid arthritis
• Multiple sclerosis or other neurologic conditions 
• Anemia (iron deficiency)
• Thyroid issues, including hyperthyroidism and hypothyroidism

Getting the right diagnosis early can help you manage symptoms, whether they’re caused by ME/CFS or something else.

When to See a Provider About Chronic Fatigue

It can be easy to write off fatigue as normal tiredness, but if you recognize yourself in some of the symptoms above, it’s worth talking to your healthcare provider. Left untreated, chronic fatigue can interfere with your ability to work and maintain relationships. It can also take a toll on your mental health, leading to or worsening depression or anxiety. 

It’s time to talk to a healthcare provider about your fatigue if:

• Your fatigue has lasted more than six months.
• Rest and sleep don’t help you feel better.
• You’re unable to carry out normal daily activities without feeling wiped out.
• You feel like you spend a lot of time recovering after work, social events, or errands.
• You’re experiencing additional symptoms like dizziness, nausea, or brain fog.

What to Expect at Your Appointment

There is no single test for ME/CFS. Your provider will first rule out other conditions through bloodwork, urine tests, and possibly sleep studies. They’ll also ask detailed questions about your symptoms, medications, mental health, and lifestyle.

To be diagnosed with ME/CFS, you’ll typically need to meet these criteria:

• Significant fatigue for at least 6 months
• Post-exertional malaise
• Unrefreshing sleep
• Either cognitive impairment or orthostatic intolerance (symptoms worsen when standing or sitting upright)

How Chronic Fatigue Is Treated

There is currently no cure for ME/CFS, but there are ways to manage your symptoms and improve your quality of life.

• Sleep hygiene: Adopting better sleep habits may make your sleep more restful. Tips include following a regular sleep schedule, adopting a consistent bedtime, limiting daytime naps, and keeping your bedroom dark, cool, and quiet. 
• Pacing: Pacing is a protocol specifically designed for people with chronic fatigue that helps them better understand and manage their energy levels. It helps you ease into physical activity so you can avoid a crash from post-exertional malaise, says Meisner. 

• Diet and hydration: Eating a healthy diet and staying well-hydrated can help balance your energy levels. Meisner recommends adopting a low-inflammatory diet such as the AIP (Autoimmune Protocol) diet or a diet that is free of gluten, dairy, and corn. 
• Talk therapy: Mental health counseling, particularly cognitive behavioral therapy (CBT), can help people better cope with their fatigue, especially if they’re also dealing with depression or sleep issues. “CBT helps by reworking your brain, so you can look for the more positive things in life and focus your brain off of how tired you feel,” says Meisner.
• Medications: Depending on your symptoms, your provider might prescribe pain relievers, sleep aids, antidepressants, or medications that treat dizziness or low blood pressure.

Could You Have Chronic Fatigue?

Chronic fatigue is more than just being tired. It’s a persistent, deep exhaustion that doesn’t go away with rest and disrupts your ability to work, socialize, and enjoy your life. If the symptoms we reviewed above sound familiar, consider making an appointment with your healthcare provider.

ME/CFS affects millions of people—but many go undiagnosed. The sooner you talk to your provider, the sooner you can rule out other conditions, get a clearer picture of what’s going on, and begin a treatment plan that helps you reclaim your energy and quality of life.

How K Health Can Help

Worried about how your energy levels are affecting your quality of life? You can visit a primary care provider online.

With the K Health app, you can check your symptoms, explore conditions and treatments, and if needed, text with a healthcare provider in minutes. 

K Health’s AI-powered app is based on 20 years of clinical data.