Long Covid: How to fight fatigue
Expert Rachael Rogers on overcoming long Covid’s most common symptom
Fatigue goes beyond usual tiredness and is not only physical but mental too
While millions of people have had Covid-19 and recovered with no lingering effects, there is a sizeable minority who haven’t been so lucky. An estimated 1.3 million people reported having long Covid symptoms in December 2021, according to the Office of National Statistics.
Post-Covid-19 syndrome, to give it its official name, is defined as: “Ongoing symptoms after 12 weeks not explained by an alternative diagnosis. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and can affect any system in the body.”
The most common symptom is fatigue, with up to 80 per cent of sufferers experiencing a crushing sense of exhaustion that makes conducting normal life impossible.
Here specialist occupational therapist Rachael Rogers, from the Post-Covid Assessment Clinic, Oxford, and co-author of the Long Covid Self-Help Guide, shares her tips for people living with fatigue – and reveals how to get your energy back for good.
What is fatigue?
Everyone experiences tiredness but it’s usually resolved by a good night’s sleep or half an hour with your feet up.
Fatigue, however, goes beyond normal tiredness and not only is it a physical sensation but a mental one too. It doesn’t go away, no matter how much rest or sleep you have, and interferes with day-to-day activities.
Fatigue is a symptom of many other conditions including multiple sclerosis, Parkinson’s disease, hypothyroidism, ME and chronic fatigue syndrome, and it’s commonly seen in patients recovering from infection, surgery or major medical events, such as a heart attack or stroke.
There are no specific medications to cure or treat the fatigue but there are many things you can do to help manage energy levels.
The three Ps
Imagine a mobile phone battery that is a lot smaller than it used to be and in worse condition.
Before long Covid, you had a larger, better-quality battery that allowed you to get through every day without a second thought. It recharged itself regularly and, with relaxation or a good night’s sleep, would top itself up easily.
However, now you will have to think about this reduced battery and consider: How are you going to use the energy that you do have wisely? How can you keep charging it up? And, ultimately, how can you gradually improve the quality and size of the battery?
This is where the three Ps – prioritising, planning and pacing – can help.
■ Prioritising: Are there any areas in your life where you might be able to conserve some energy?
Consider these changes: doing an online shop rather than going to the supermarket; taking the bus instead of walking to work; and accepting help with chores around the house when they are offered.
■TIP: Ask yourself what must get done, what can wait, what can be crossed off the list entirely? In addition, what can be done by someone else?
■ Pllanning: Knowing how you are going to spend your day – from large events to the smaller tasks – can help you manage the energy you have left in your battery.
Build in recovery time after medical appointments. Arrange important calls for a time when you usually feel better. Set aside time to rest. Do a relaxation exercise earlier in the day so you have more energy in the afternoon.
■TIP: Use a planner to help you prioritise and pace your activities, especially if you have brain fog. Written plans give you less to think about, rather than trying to hold it all in your head.
Pacing: This means that throughout the day you perform an
activity, then rest, then more activity followed by another rest, and so on.
It may be that you will need to break an activity down into small chunks, so rather than vacuuming the whole house in one go and then sitting down for a cup of tea, you might need to do just one room and then rest.
Pacing applies to mental tasks too – these use just as much energy from the battery. So rather than working at the computer for two hours, you may need to stop after 30 minutes and rest.
■ TIP: Set an alarm as a reminder to pause for five minutes on the hour, every hour.
Know when to stop
The lack of energy can feel very frustrating and overwhelming at times, especially when there are things you want or need to be doing.
You may notice that you have a fairly immediate response to overdoing an activity, in that you feel tired or lose energy part way through, or you may have a delayed reaction.
Establishing time or task limits can make sure you get some rest early enough.
For example, if after 10 minutes of reading you lose focus, you know you will need to stop at this point and not push through.
Or if a day of gardening wipes you out for the next two days, set yourself the task of tidying up just one small section and then stop for the day. ■■TIP: Break activities down into smaller chunks and be clear on the stopping point.
Get the right rest
Many of us think we are resting when we are reading a book or a magazine, watching TV or scrolling through our phone. But while they do not require a huge amount of energy, they are still using up a little.
Proper, restorative rest helps to charge up your battery. Rests are “pauses” of activity.
These might be in the form of relaxation or breathing exercises, meditation techniques, mindfulness, restorative yoga practice or soothing sensory techniques such as sound apps, a heated blanket, or aromatherapy. It’s best if you can rest away from your bedroom so you can keep it just for sleeping. Many people describe a “tired but wired” feeling at night, often making it difficult to get to sleep or to have a restful sleep.
Having regular rests throughout the day can help to avoid this feeling.
■TIP: Avoid napping during the day as this can affect your sleep at night. If you need to nap, or think you might fall asleep while resting, set an alarm so you don’t nap for long.
How to pace up
Finding your energy baseline is a key part of the recovery journey. This means working out the amount of activity you can comfortably achieve each day, and the tasks that can drain or increase your energy.
Once you’ve done that, you might feel ready to ‘pace up’.
Pacing up means carefully increasing physical and mental activity. Start with adding in just one new activity or lengthening an existing one. This might mean listening to the radio for a bit longer or having longer conversations with people.
But you must get used to the new level before pushing yourself further. For example, rather than increasing a daily walk each time you go out, maintain your new level for a week or two and then consider the next increase. As you pace up, you may notice a slight increase in fatigue, stiffness or brain fog.
This is normal and will hopefully settle after a day or even a few hours.
However, if the sensations persist for a week or more, it may mean that the increase was too much or too quick. Adjust it accordingly.
■■TIP: Keep the increase very small, so it will have minimal impact on your body. We often suggest around 10 per cent more initially to avoid crashing.
Flare-ups and setbacks
People sometimes report getting a bit stuck at a particular level with their energy management.
Sometimes there are clear reasons as to why a flare-up or setback has occurred – it might be that you’ve had an exceptionally busy time, you’ve had another bug or things have got a bit stressful, as they do at times in life.
We know that long Covid has a fluctuating nature.
Recovery is not a smooth line and it can feel like you are taking two steps forward and one step back. This can seem incredibly frustrating.
But it might be that this is the level where things need to be right now and that’s OK for this phase of your recovery.
■TIP: You may need to shift things down a notch or two for a short time, allow your body to recover and then pace up again slowly.
■The Long Covid Self Help Guide: Practical Ways to Manage Symptoms from the Specialists at the Post-Covid Clinic, Oxford is available to buy now (Green Tree, £13.49)
Break your activities into small chunks and know when to stop and recharge