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Fatigue is the central symptom in CFS and a significant problem for most people with fibromyalgia. Manifesting as listlessness and a reduced tolerance for exercise, fatigue can be brought on by low levels of activity or for no apparent reason. Fatigue is often much greater than and lasts far longer than it would in a healthy person ("post-exertional malaise").

Fatigue has many causes besides CFS and FM, including:

Being too active, living “outside energy envelope”
Produces muscle tension, which is tiring
Poor Sleep  
Feel tired if sleep not restorative
Deconditioning from lowered activity level
Stress creates worry and muscle tension
Low spirits produce sense of listlessness
Poor Nutrition           
Lack energy if don’t eat well
Side effects include fatigue

Strategies for Fatigue

You can address fatigue by matching the strategies below to the causes you experience. For our suggestions on how to get started, click on the link in the box to the right. 

Perhaps the single most important key to controlling fatigue, and the other main symptoms of CFS and FM, is to adjust your activity level to fit your limits (pacing). 

Pacing includes priority setting, rest breaks, short activity periods, switching between high and low intensity tasks and living by a schedule. Pacing also includes mental adaptation: accepting that life has changed and learning to live a different kind of life. For ideas on how to incorporate pacing into your life, see the section titled Pacing.
Treat Pain and Poor Sleep
Treating these other symptoms using the strategies described in the sections on pain and sleep produces the bonus of reducing fatigue at the same time.
Exercise counteracts the fatigue caused by a lower activity level. For ideas on what you can do, see the page titled Exercise.
Managing Stress
Using relaxation and other stress management strategies addresses fatigue by reducing worry and muscle tension. Managing stress also helps reduce pain and fog, and may improve sleep. For more, see the section on stress management.
Treat Depression
One symptom of depression is fatigue, so treating depression can reduce fatigue. As with pacing and stress management, addressing emotions can improve several symptoms. For more, see the discussion of depression in the section on emotions.
Improve Nutrition
People with CFS and fibromyalgia often have problems getting good nutrition. Severity of symptoms may make it difficult to eat well. Getting help, freezing meals on days with good energy and using prepared foods can help. 

Also, many people with CFS/FM experience food sensitivities and food allergies. The most effective strategy for food sensitivities is an elimination diet, in which foods are taken out of the diet and then reintroduced one by one. For more, see the article Nutrition and Chemical Sensitivity on the self-help program website.
Check for Medication Side Effects
Many medications, including some anti-depressants and drugs prescribed for pain, create fatigue as a side effect. To combat this source of tiredness, ask your doctor about fatigue when reviewing medications. A change of medication or a change in dosage may reduce fatigue.
Consider Using Stimulant Medications
Stimulant medications such as Nuvigil, Provigil, Adderall and Ritalin can help those who are sleepy during the day, as opposed to just tired. (Sleepy means falling asleep watching TV, reading, riding in the car, etc.)

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