Tired all the time is a condition that includes chronic fatigue syndrome. It can also be technically known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This is a debilitating disease that can cause a wide range of symptoms.

The main feature of ME/CFS is a type of exhaustion known as post-exertional malaise, crash’ or payback’. This involves flu-like symptoms after exercise and not having enough energy for daily activities.

Feelings of extreme fatigue can develop over six months or more.  Sleep does not reduce the feeling of exhaustion. Accompanying symptoms include consistent problems with short-term memory and concentration, as well as chronic body discomfort.

Physical activity

Research shows that people with ME/CFS have a different physiological response  from others to activity or exercise. As well as abnormal exhaustion after any form of exertion, exercise causes a worsening of other symptoms. The response may be delayed, perhaps after 24 hours and may result in post-exertional malaise for a few days, or serious relapses lasting weeks, months or even years.

Brain fog

A range of neuro-cognitive problems typically occur with ME/CFS. Difficulties in thinking, concentrating are common, as well as memory loss, vision, clumsiness, muscle twitching or tingling.
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Causes and diagnosis

Women are two to four times more likely than men to be diagnosed.

25 per cent of people with ME/CFS will have a mild form and be able to get function on either part-time or full time, basis. But they will have to reduce many activities. 

About 50 per cent will have a more intense form of ME/CFS and not be able to function effectively. Finally around 25 per cent will experience severe ME/CFS and have to stay at home or in bed. 

The way that some conditions interact in the body and mind might leave some people at risk for ME/CFS, e.g. stress.

Immune dysfunction, may be the cause of the complex mix of symptoms common to ME/CFS. Many scientists think that the problem is not a single virus but rather the immune system that’s supposed to keep those pathogens in check. While most people host countless dormant viruses from childhood without getting ill, CFS patients may react to them since two types of their immune cells known as natural killer cells and T-cells seem not to function properly. 

Hormonal differences and their influence on the immune system are consistent with immune dysfunction, and would also indicate why women who suffer more autoimmune diseases, are so much more likely to suffer ME/CFS than men.


Treatment for CFS/ME aims to relieve the symptoms. Your treatment will depend on how CFS/ME is affecting you.

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Tests and supplements

There’s no single test to tell if someone has chronic fatigue syndrome. A thorough review of the health of family members, medicines, allergies, smoking and drinking habits, often accompanies a thorough physical exam. 

Blood and urine tests help to assess conditions that cause similar symptoms. Typically other diagnoses need to be eliminated before diagnosing chronic fatigue syndrome. These include:

  • Sleep disorders. Chronic fatigue can be caused by sleep disorders. A sleep study can determine if your rest is being disturbed by disorders such as obstructive sleep apnoea, restless legs syndrome or insomnia.
  • Medical problems. Fatigue is a common symptom in several medical conditions, such as anemia, diabetes and underactive thyroid (hypothyroidism). Blood tests provide evidence here.
  • Heart and lung impairments. Problems with your heart or lungs can make you feel more fatigued. An exercise stress test can assess your heart and lung function.
  • Mental health issues. Fatigue is also a symptom of a variety of mental health problems, such as depression, anxiety, bipolar disorder and schizophrenia. 
Tests often show hormonal imbalances such as adrenal fatigue and sub-optimal thyroid function. Heavy metal toxicity is also common, and people with CF/CFIDS often experience gut issues including some IBS symptoms and consequently we find a high percentage of our patients with CF/CFIDS have some form of imbalanced gut flora, Candida and/or parasites. It is also very common for people with CF/CFIDS to have food sensitivities or intolerances.