tag:theconversation.com,2011:/us/topics/fatigue-34043/articlesFatigue – The Conversation2024-03-01T13:33:37Ztag:theconversation.com,2011:article/2220572024-03-01T13:33:37Z2024-03-01T13:33:37ZAltitude sickness is typically mild but can sometimes turn very serious − a high-altitude medicine physician explains how to safely prepare<figure><img src="https://images.theconversation.com/files/577770/original/file-20240225-28-vk2tcl.jpg?ixlib=rb-1.1.0&rect=77%2C33%2C7271%2C4869&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Altitude sickness is rare at elevations of less than 8,200 feet but becomes much more common at higher altitudes.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/girls-having-fun-royalty-free-image/854544188?phrase=mountain+adventure+travel&adppopup=true">Maya Karkalicheva/Moment via Getty Images</a></span></figcaption></figure><p>Equipped with the latest gear and a thirst for adventure, mountaineers embrace the perils that come with conquering the world’s highest peaks. Yet, even those who tread more cautiously at high altitude are not immune from the health hazards waiting in the thin air above.</p>
<p>Altitude sickness, which most commonly refers to <a href="https://medlineplus.gov/ency/article/000133.htm">acute mountain sickness</a>, <a href="https://doi.org/10.1016/j.pcad.2010.02.003">presents a significant challenge</a> to those traveling to and adventuring in high-altitude destinations. Its symptoms can range from <a href="https://doi.org/10.1089/ham.2017.0164">mildly annoying to incapacitating</a> and, in some cases, may progress to more <a href="https://doi.org/10.1183/16000617.0096-2016">life-threatening illnesses</a>. </p>
<p>While <a href="https://doi.org/10.18111/9789284424023">interest in high-altitude tourism is rapidly growing</a>, general awareness and understanding about the hazards of visiting these locations <a href="https://doi.org/10.1089/ham.2022.0083">remains low</a>. The more travelers know, the better they can prepare for and enjoy their journey.</p>
<p>As an <a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/36740">emergency physician specializing in high-altitude illnesses</a>, I work to improve health care in remote and mountainous locations around the world. I’m invested in finding ways to allow people from all backgrounds to experience the magic of the mountains in an enjoyable and meaningful way.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Researcher wearing cold-weather gear stands in front of a health clinic in the Himalayas." src="https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/578372/original/file-20240227-24-3c22h9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The author in front of the Himalayan Rescue Association clinic in Nepal.</span>
<span class="attribution"><span class="source">Brian Strickland</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
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<h2>The science behind altitude sickness</h2>
<p>Altitude sickness is rare in locations lower than 8,200 feet (2,500 meters); however, <a href="https://www.ncbi.nlm.nih.gov/books/NBK430716/">it becomes very common</a> when ascending above this elevation. In fact, it affects about <a href="https://wwwnc.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness">25% of visitors to the mountains of Colorado</a>, where I conduct most of my research. </p>
<p>The risk rapidly increases with higher ascents. Above 9,800 feet (3,000 meters), up to <a href="https://www.ncbi.nlm.nih.gov/books/NBK430716/">75% of travelers</a> may develop symptoms. Symptoms of altitude sickness are usually mild and consist of <a href="https://doi.org/10.1089/ham.2017.0164">headache, dizziness, nausea, fatigue and insomnia</a>. They usually <a href="https://doi.org/10.1016/j.rceng.2019.12.009">resolve after one to two days</a>, as long as travelers stop their ascent, and the symptoms quickly resolve with descent. </p>
<p>When travelers do not properly acclimatize, they can be susceptible to life-threatening altitude illnesses, such as <a href="https://doi.org/10.1016/j.resp.2007.05.002">high-altitude pulmonary edema</a> or <a href="https://doi.org/10.1089/1527029041352054">high-altitude cerebral edema</a>. These conditions are characterized by fluid accumulation within the tissues of the lungs and brain, respectively, and are the <a href="https://wwwnc.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness#">most severe forms of altitude sickness</a>.</p>
<p>Altitude sickness symptoms are thought to be caused by <a href="https://doi.org/10.1093%2Fbjaceaccp%2Fmks047">increased pressure surrounding the brain</a>, which results from the failure of the body to acclimatize to higher elevations. </p>
<p>As people enter into an environment with lower air pressure and, therefore, <a href="https://doi.org/10.1001/jamanetworkopen.2023.18036">lower oxygen content</a>, their <a href="https://doi.org/10.1093%2Fbjaceaccp%2Fmks047">breathing rate increases</a> in order to compensate. This causes an increase in the amount of <a href="https://doi.org/10.1016/s1357-2725(03)00050-5">oxygen in the blood as well as decreased CO₂ levels</a>, which then increases blood pH. As a result, the <a href="https://doi.org/10.1093%2Fbjaceaccp%2Fmks047">kidneys compensate</a> by removing a chemical called bicarbonate from the blood into the urine. This process makes people urinate more and helps correct the acid and alkaline content of the blood to a more normal level.</p>
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<figcaption><span class="caption">Tips for preventing or reducing the risk of altitude sickness.</span></figcaption>
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<h2>The importance of gradual ascent</h2>
<p>High-altitude medicine experts and other physicians <a href="https://doi.org/10.1016/s0140-6736(76)91677-9">have known for decades</a> that <a href="https://doi.org/10.1089/ham.2010.1006">taking time to slowly ascend is the best way</a> to prevent the development of altitude sickness. </p>
<p>This strategy gives the body time to complete its natural physiologic responses to the changes in air pressure and oxygen content. In fact, spending just <a href="https://doi.org/10.1089/ham.2010.1006">one night at a moderate elevation</a>, such as Denver, Colorado, which is at 5,280 feet (1,600 meters), has been shown to <a href="https://doi.org/10.7326/0003-4819-118-8-199304150-00003">significantly reduce the likelihood of developing symptoms</a>. </p>
<p>People who skip this step and travel directly to high elevations are <a href="https://doi.org/10.1093/jtm/taad011">up to four times more likely</a> to develop altitude sickness symptoms. When going to elevations greater than 11,000 feet, multiple days of acclimatization are necessary. Experts generally recommend ascending <a href="https://doi.org/10.1089/ham.2010.1006">no more than 1,500 feet per day</a> once the threshold of 8,200 feet of elevation has been crossed. </p>
<p>Workers at high altitude, such as <a href="https://doi.org/10.1089/ham.2020.0004">porters in the Nepali Himalaya</a>, are at <a href="https://doi.org/10.1016/j.wem.2018.06.002">particular risk of altitude-related illness</a>. These workers often do not adhere to acclimatization recommendations in order to maximize earnings during tourist seasons; as a result, they are more likely to experience <a href="https://www.cdc.gov/travel/yellowbook/2024/environmental-hazards-risks/high-elevation-travel-and-altitude-illness#">severe forms of altitude sickness</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Five tents glow against the night sky with a tall mountain in the background." src="https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577771/original/file-20240225-24-nb9e6p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Adventure tourism is growing rapidly, but general awareness and education around altitude sickness and ways to prevent it remains low.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/milky-way-over-mitre-peak-view-from-concordia-camp-royalty-free-image/1936855402?phrase=mountain+adventure+travel&adppopup=true">Punnawit Suwuttananun/Moment via Getty Images</a></span>
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<h2>Effective medications</h2>
<p>For more than 40 years, <a href="https://doi.org/10.1056/nejm196810172791601">a medicine called acetazolamide</a> has been used to <a href="https://medlineplus.gov/druginfo/meds/a682756.html">prevent the development of altitude sickness</a> and to treat its symptoms. Acetazolamide is <a href="https://www.ncbi.nlm.nih.gov/books/NBK557838/">commonly used as a diuretic</a> and for the <a href="https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma#">treatment of glaucoma</a>, a condition that causes increased pressure within the eye.</p>
<p>If started <a href="https://doi.org/10.1378/chest.09-2445">two days prior</a> to going up to a high elevation, acetazolamide can <a href="https://doi.org/10.1378/chest.09-2445">prevent symptoms of acute illness</a> by speeding up the acclimatization process. Nonetheless, it does not negate the recommendations to ascend slowly, and it is <a href="https://doi.org/10.1016/j.wem.2019.04.006">routinely recommended only</a> when people cannot slowly ascend or for people who have a history of severe altitude sickness symptoms even with slow ascent.</p>
<p>Other medications, including ibuprofen, have <a href="https://doi.org/10.1016/j.wem.2012.08.001">shown some effectiveness</a> in treating acute mountain sickness, although <a href="https://doi.org/10.1016/j.amjmed.2018.10.021">not as well as acetazolamide</a>. </p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/2028586/">steroid medication called dexamethasone</a> is effective in both treating and preventing symptoms, but it does not improve acclimatization. It is <a href="https://doi.org/10.1016/j.wem.2019.04.006">recommended only when acetazolamide is not effective</a> or cannot be taken. </p>
<p>Additionally, it is important to <a href="https://wwwnc.cdc.gov/travel/page/travel-to-high-altitudes#">avoid alcohol during the first few days at higher altitudes</a>, as it impairs the body’s ability to acclimatize.</p>
<h2>Unproven therapies and remedies are common</h2>
<p>As high-altitude tourism becomes increasingly popular, multiple commercial products and remedies have emerged. Most of them are not effective or provide no evidence to suggest they work as advertised. Other options have mixed evidence, making them difficult to recommend.</p>
<p>Medications such as <a href="https://doi.org/10.1089/ham.2007.1037">aspirin</a>, <a href="https://doi.org/10.1183/13993003.01355-2017">inhaled steroids</a> and <a href="https://doi.org/10.1089/ham.2011.0007">sildenafil</a> have been proposed as possible preventive agents for altitude sickness, but on the whole they have not been found to be effective.</p>
<p><a href="https://doi.org/10.1093/qjmed/hcp026">Supplements and antioxidants have no proven benefit</a> in preventing or treating altitude sickness symptoms. Both normal and high-altitude exercise are popular ways to prepare for high elevations, especially among athletes. However, beyond <a href="https://doi.org/10.1097/jes.0b013e31825eaa33">certain pre-acclimatization strategies</a>, such as brief sojourns to high altitude, <a href="https://doi.org/10.1016/j.tmaid.2013.12.002">physical fitness and training is of little benefit</a>. </p>
<p><a href="https://missouripoisoncenter.org/canned-oxygen-is-it-good-for-you">Canned oxygen</a> has also exploded in popularity with travelers. While <a href="https://doi.org/10.1016/0140-6736(90)93240-p">continuously administered medical oxygen</a> in a health care setting can alleviate altitude sickness symptoms, portable oxygen cans <a href="https://doi.org/10.1016/j.wem.2019.04.006">contain very little oxygen gas</a>, casting doubt on their effectiveness.</p>
<p>Some high-altitude adventure travelers sleep in <a href="https://doi.org/10.2165/00007256-200131040-00002">specialized tents</a> that simulate increased elevation by lowering the quantity of available oxygen in ambient air. The lower oxygen levels within the tent are thought to accelerate the acclimatization process, but the tents aren’t able to decrease barometric pressure. This is an important part of the high-altitude environment that induces acclimatization. Without modifying ambient air pressure, these <a href="https://doi.org/10.1016/j.wem.2014.04.004">tents may take multiple weeks</a> to be effective. </p>
<p>Natural medicines, such as <a href="https://doi.org/10.1580/08-weme-br-247.1">gingko</a> and <a href="https://doi.org/10.1186/s40794-019-0095-7">coca leaves</a>, are touted as natural altitude sickness treatments, but few studies have been done on them. The modest benefits and significant side effects of these options makes their use <a href="https://doi.org/10.1016/j.wem.2019.04.006">difficult to recommend</a>. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/8469948/">Staying hydrated</a> is very important at high altitudes due to fluid losses from increased urination, dry air and increased physical exertion. <a href="https://doi.org/10.1186%2Fs12889-018-6252-5">Dehydration symptoms</a> can also mimic those of altitude sickness. But there is <a href="https://doi.org/10.1580/1080-6032(2006)17%5B215:AMSIOF%5D2.0.CO;2">little evidence that consuming excessive amounts of water</a> can prevent or treat altitude sickness.</p>
<p>The mountains have something for visitors of all interests and expertise and can offer truly life-changing experiences. While there are health risks associated with travel at higher elevations, these can be lessened by making basic preparations and taking time to slowly ascend.</p><img src="https://counter.theconversation.com/content/222057/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brian Strickland does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Whether you’re ascending to high altitudes for casual travel or for adventure tourism, there are specific strategies to help you acclimate and reduce the likelihood of altitude sickness.Brian Strickland, Senior Instructor in Emergency Medicine, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2190572024-02-28T12:33:37Z2024-02-28T12:33:37ZMental fatigue has psychological triggers − new research suggests challenging goals can head it off<figure><img src="https://images.theconversation.com/files/574501/original/file-20240208-20-qjkjml.jpg?ixlib=rb-1.1.0&rect=27%2C9%2C6108%2C4093&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Feeling wiped out by mental work has different causes than what drives physical fatigue.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/stressed-business-woman-working-from-home-on-laptop-royalty-free-image/1249628154">nensuria/iStock via Getty Images Plus</a></span></figcaption></figure><p>Do you ever feel spacey, distracted and worn down toward the end of a long work-related task – especially if that task is entirely a mental one? For over a century, psychologists have been trying to determine whether mental fatigue is fundamentally similar to physical fatigue or whether it is governed by different processes. </p>
<p>Some <a href="https://doi.org/10.1016/j.actpsy.2003.11.001">researchers have argued</a> that exerting mental effort depletes a limited supply of energy – the same way physical exertion fatigues muscles. The brain consumes <a href="https://doi.org/10.1037/0022-3514.92.2.325">energy in the form of glucose</a>, which can run low.</p>
<p><a href="https://doi.org/10.1037/h0069511">Other researchers</a> see mental fatigue as more of a psychological phenomenon. Mind-wandering means the current mental effort is not being sufficiently <a href="https://doi.org/10.1016/j.brainresrev.2008.07.001">rewarded</a> – or opportunities to do other, <a href="https://doi.org/10.1017/S0140525X12003196">more enjoyable activities are being lost</a>.</p>
<p><a href="https://scholar.google.com/citations?hl=en&user=JGWPdcMAAAAJ">My</a> <a href="https://scholar.google.com/citations?hl=en&user=1fv9jBIAAAAJ">colleagues</a> and <a href="https://scholar.google.com/citations?hl=en&user=I5HWMl8AAAAJ">I</a> have been <a href="https://doi.org/10.3758/s13414-023-02803-4">trying to resolve this question</a>. Our research suggests mental fatigue is in large part a psychological phenomenon – but one that can be modified by setting goals.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/577994/original/file-20240226-26-701pnc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="spiraling clock face suggesting infinity" src="https://images.theconversation.com/files/577994/original/file-20240226-26-701pnc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577994/original/file-20240226-26-701pnc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577994/original/file-20240226-26-701pnc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577994/original/file-20240226-26-701pnc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577994/original/file-20240226-26-701pnc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577994/original/file-20240226-26-701pnc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577994/original/file-20240226-26-701pnc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Tedious tasks can be especially hard to stick with diligently.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/rendering-classic-round-clock-with-infinity-time-royalty-free-image/1303651536">RB Stocker/iStock via Getty Images Plus</a></span>
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<h2>Vigilance is hard to sustain</h2>
<p>We began by reviewing the science related to mental fatigue. </p>
<p>Psychologists in the World War II era studied why soldiers monitoring radar were losing focus during their shifts. Psychologist Norman Mackworth designed the “<a href="https://doi.org/10.1080/17470214808416738">clock test,</a>” in which military participants were asked to watch a large “clock” on a wall for up to two hours. The second hand ticked at regular intervals. But rarely and unpredictably, it would jump twice the usual distance. The task was to detect those tiny variations. </p>
<p>Within the first 30 minutes, the subjects’ performance dropped dramatically – and then continued to decline more gradually. Psychologists named the necessary mental focus “vigilance” – and concluded it was fundamentally limited in humans. </p>
<p><a href="https://doi.org/10.1037/0033-2909.117.2.230">Decades of research</a> since has confirmed that vigilance is difficult to maintain, even over brief intervals. In studies, people report <a href="https://doi.org/10.1177/00187208211011333">feeling stressed and fatigued</a> following even a brief vigilance task. In 2021, one study even showed a <a href="https://doi.org/10.1177/00187208211011333">reduction of blood flow through the brain</a> during vigilance. </p>
<p>My colleagues and I wondered: Are all forms of mental work like vigilance? Surely, there are instances where people can engage with mental work without feeling fatigued. </p>
<h2>Setting goals</h2>
<p>We decided to study whether <a href="https://doi.org/10.1037/mot0000127">goal-setting</a> could improve mental focus and ran <a href="https://doi.org/10.3758/s13414-023-02803-4">three experiments</a> to test this idea. </p>
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<a href="https://images.theconversation.com/files/574499/original/file-20240208-26-nh4c3j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man in front of computer screen showing four horizontal lines, with an X on one of them." src="https://images.theconversation.com/files/574499/original/file-20240208-26-nh4c3j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/574499/original/file-20240208-26-nh4c3j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=799&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574499/original/file-20240208-26-nh4c3j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=799&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574499/original/file-20240208-26-nh4c3j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=799&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574499/original/file-20240208-26-nh4c3j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574499/original/file-20240208-26-nh4c3j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574499/original/file-20240208-26-nh4c3j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Where’s the X?</span>
<span class="attribution"><span class="source">Lauren D. Garner</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>In the first experiment, we showed 108 undergraduate students at the University of Oregon a screen with four empty white boxes against a gray background. Every one to three seconds, an X appeared in one of the four boxes. Their task was to indicate where that symbol appeared as quickly as possible. After each response, the participant was given feedback about both their accuracy and their speed, such as “Correct! Reaction time = 400 milliseconds.” </p>
<p>Periodically during the 26-minute test, we also asked participants to rank their mental state as task-focused, distracted or mind-wandering. This gave us data about how they felt, in addition to how they did.</p>
<p>We randomly gave half of them a specific goal: Keep their reaction times under 400 milliseconds while staying as accurate as possible. We gave no goal to the other half. </p>
<p><a href="https://doi.org/10.3758/s13414-023-02803-4">Our results</a> were mixed. People who were given a goal did not experience as many slow reaction times, but having goals didn’t increase their top speed. It also didn’t change how often people reported feeling distracted. </p>
<h2>Setting increasingly harder goals</h2>
<p>We decided to tweak the test for our second experiment. Again, we randomly assigned a goal to half of the 112 fresh participants and no goal to the other half. But this time, as the experiment progressed, we increased the difficulty of the goal from a 450-millisecond reaction time to 400 milliseconds and then to 350 by the final block. Setting these harder-over-time goals had a huge effect on performance. </p>
<p>Compared with the participants assigned a set goal in the first experiment, the participants assigned increasingly more difficult goals in the second experiment had faster reaction times by an average of 45 milliseconds – about a 10% improvement. Participants in the second experiment also reported fewer instances of mind-wandering and showed no slowing of reaction times throughout the experiment. In other words, they showed no signs of mental fatigue. And we didn’t have to make the task easier. In fact, we made it harder. </p>
<p>Our first two experiments were conducted online because of shutdowns related to COVID-19. Our third study – a repeat of our second study – was conducted in person. We got the same results. </p>
<p>These findings, combined with <a href="https://doi.org/10.1037/xhp0001148">other recent work</a> we’ve conducted, have changed the way my colleagues and I consider mental fatigue. It’s clear that when people strive for specific and hard-to-reach goals, they report feeling more motivated and <a href="https://doi.org/10.1037/mac0000141">they do not report feeling as drained</a> by mental work. </p>
<p>If you’re wondering how to implement these findings in your life, make simple, direct and specific goals for yourself. Mark when you complete the goals – the feedback can help you keep going. If you’re feeling particularly drained, take short breaks. Even <a href="https://doi.org/10.1016/j.cognition.2014.10.001">brief rests</a> of less than two minutes can restore capacity for mental work.</p><img src="https://counter.theconversation.com/content/219057/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Robison's laboratory receives funding from the U.S. Naval Research Laboratory and the Army Research Institute. </span></em></p>Setting specific, hard-to-reach goals seems to help people maintain motivation, while preventing them from feeling as drained by mental tasks.Matthew Robison, Assistant Professor of Psychology, University of Texas at ArlingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2208212024-01-11T17:16:05Z2024-01-11T17:16:05ZLong COVID: damaged mitochondria in muscles might be linked to some of the symptoms<figure><img src="https://images.theconversation.com/files/568825/original/file-20240111-27-danv4a.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5375%2C3524&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many long COVID sufferers find their symptoms worsen after exercise.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tired-man-wipes-sweat-his-face-1959349945">Miridda/ Shutterstock</a></span></figcaption></figure><p>It’s estimated <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/30march2023">around 3% of people</a> in the UK experience long COVID – persistent, long-lasting symptoms after a COVID-19 infection.</p>
<p>Long COVID encompasses a <a href="https://pubmed.ncbi.nlm.nih.gov/36639608/">range of health problems</a> that can begin after even a mild COVID infection. Some of these symptoms include extreme fatigue, shortness of breath, muscle aches and loss of smell. </p>
<p>For around 50% of long COVID sufferers, their symptoms also fit criteria for a diagnosis of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9844405/">myalgic encephalomyelitis</a> (ME), a neuro-immune disease characterised by depleted energy, muscle weakness and pain, cognitive dysfunction and dysautonomia (which affects blood pressure and heart rate). </p>
<p>A cardinal feature of ME is “<a href="https://journals.sagepub.com/doi/10.1177/1359105318784161">post-exertional malaise</a>” (PEM). This refers to a <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0197811">worsening of symptoms</a> that takes place around 24-48 hours after any form of exertion – whether that’s physical, cognitive or emotional. PEM may take days or weeks to subside.</p>
<p>PEM remains one of the most debilitating yet least understood features of both <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9844405/">ME and long COVID</a>. But <a href="https://www.nature.com/articles/s41467-023-44432-3">new research</a> may point to a probable explanation for why physical activity in particular worsens long COVID symptoms. The study found that people with long COVID exhibit alterations in their muscle structure. </p>
<p>To conduct their study, the researchers analysed muscle biopsies and blood plasma samples taken from 25 people with long COVID and 21 people who had had COVID but didn’t have long COVID. Participants in both groups were around 41 years old, on average. There was a 48% to 52% split between men and women. </p>
<p>The blood and muscle samples were taken before and after a controlled cycling test. Participants cycled for approximately 15 minutes, starting slowly and gradually increasing in intensity.</p>
<p>During the cycling test, those with long COVID exhibited poorer muscular strength and had lower oxygen uptake compared with the healthy participants – despite putting in the same amount of effort. These results echo the findings of <a href="https://pubmed.ncbi.nlm.nih.gov/34389297/">previous studies</a>, suggesting people with long COVID have significantly reduced exercise capacity. </p>
<p>When the researchers analysed the muscle samples of the participants, they found that those with long COVID had a higher proportion of fast-twitch glycolytic muscle fibres. These muscle fibres can work at high intensity in short bursts, but are <a href="https://journals.physiology.org/doi/epdf/10.1152/ajpcell.00368.2011">highly fatiguable</a> because they have fewer mitochondria (organelles which provide cells with the energy they need to function properly).</p>
<p>The researchers then conducted further tests on the mitochondria in these fibres. They found that exercise lowered mitochondrial function in the long COVID sufferers – indicating that as well as having a reduced capacity for exercise, their muscle tissue had acquired damage during the exercise test.</p>
<figure class="align-center ">
<img alt="A digital drawing of the mitochondria of a cell." src="https://images.theconversation.com/files/568826/original/file-20240111-23-n1134f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/568826/original/file-20240111-23-n1134f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568826/original/file-20240111-23-n1134f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568826/original/file-20240111-23-n1134f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568826/original/file-20240111-23-n1134f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568826/original/file-20240111-23-n1134f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568826/original/file-20240111-23-n1134f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Mitochondria provide our cells with energy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mitochondrion-235472659">Yurii Andreichyn/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Tests on molecules in muscle and plasma also revealed that people with long COVID had lower levels of vital molecules required for the process mitochondria use to provide cells with energy.</p>
<p>This is not the first time that mitochondrial dysfunction has been implicated in an illness featuring PEM. In fact, this was first proposed as the underlying mechanism in ME more than <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2425703/pdf/postmedj00252-0008.pdf">40 years ago</a>. </p>
<p>If the mitochondria in muscles are dysfunctional, this means the muscle cells don’t produce enough energy to meet the body’s demands. This may explain why people with long COVID experience worse symptoms after exercise.</p>
<h2>Muscle ‘microclots’</h2>
<p>Next, the authors studied whether there were clumps of mis-folded proteins present in the muscle samples. </p>
<p>Previous studies have shown these clumps, termed “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8380922/">microclots</a>”, are found at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381139/pdf/12933_2021_Article_1359.pdf">raised levels</a> in the plasma of people with long COVID. It’s been proposed that microclots may <a href="https://pubmed.ncbi.nlm.nih.gov/36043493/">block capillaries</a>, causing damage as blood re-enters tissues. This may also cause damage to the mitochondria. </p>
<p>The authors showed that people with long COVID did indeed have more microclots in their muscles compared with the control samples. The number of microclots also increased after exercise in all participants. However, they did not find evidence that they were blocking capillaries.</p>
<p>Finally, they looked at which immune cells were present in muscle tissue. They found increased numbers of macrophages and T-cells, which both <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6019499/">help with tissue repair</a>, in the samples of those with long COVID – even before they exercised. This indicates that long COVID sufferers have locally activated immune cells in their muscle tissue as a response to tissue damage.</p>
<p>It’s known that mitochondria can <a href="https://www.mdpi.com/1422-0067/22/21/11338">cause and also be damaged by inflammation</a> (which can be caused by an over-active immune system). This may be another reason why the mitochondria of long COVID sufferers are dysfunctional.</p>
<h2>Targeting mitochondria</h2>
<p>This study supports a growing body of research that has identified considerable abnormalities in the <a href="https://www.nature.com/articles/s41577-023-00904-7">metabolic, muscular and immune function</a> of people with long COVID (and, by extension, people with ME). It also suggests that targeting the mitochondria could help to improve symptoms.</p>
<p>Promisingly, many compounds have already been shown to positively affect mitochondrial function. Some of these are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9604531/">available without prescription</a>, such as coenzyme Q10 (which our body naturally produces). But placebo-controlled trials will need to be carried out to see if these compounds have any effect on long COVID symptoms.</p>
<p>These findings also highlight how important it is to exercise caution when designing rehabilitation strategies for people with long COVID.</p>
<p>Traditional programmes work on the basis that gradual increases in effort and difficulty <a href="https://www.nhs.uk/live-well/exercise/">build resilience and exercise capacity</a>. But for people with long COVID, the opposite is true. </p>
<p>This recent paper has now found why this may be the case, showing that for those with long COVID, pushing beyond their capabilities will provoke mitochondrial damage, reducing resilience and provoking a relapse of their condition. These findings are key when considering recommendations for rehabilitation or return to work strategies for long COVID sufferers.</p><img src="https://counter.theconversation.com/content/220821/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caroline Dalton receives funding from the Patient-Led Research Collaborative. </span></em></p>These findings may provide insights into better ways of managing long COVID.Caroline Dalton, Associate Professor of Neuroscience and Genetics, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2183422023-12-20T23:22:46Z2023-12-20T23:22:46ZFatigue? Unexplained weight gain and dry skin? Could it be Hashimoto’s disease?<figure><img src="https://images.theconversation.com/files/564443/original/file-20231208-17-9ln1uc.jpg?ixlib=rb-1.1.0&rect=35%2C44%2C5955%2C3943&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-thyroid-gland-control-senior-lady-1361088998">Shutterstock</a></span></figcaption></figure><p>Maybe you feel worn out. Perhaps you’re also having trouble losing weight. Generally, you just don’t feel 100%. </p>
<p>Could it be Hashimoto’s disease? This common autoimmune thyroid disorder is when your immune system (which fights off viruses and bacteria), mistakenly attacks a part of your body. In this case, it’s your thyroid – a gland located at the base of your neck – and can cause low thyroid hormones levels (hypothyroidism). </p>
<p><a href="https://www.racgp.org.au/getattachment/8f4fe235-0ae2-48c1-951a-6358c54e4469/Hypothyroidism.aspx">Hypothyroidism</a> affects one in 33 Australians and Hashimoto’s is one of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822815/">most common thyroid conditions</a> in first-world countries. </p>
<p>While symptoms can be subtle, untreated Hashimoto’s can cause long-term problems with your heart, memory and fertility. Here is what you need to know.</p>
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Read more:
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<h2>What happens when you have Hashimoto’s?</h2>
<p>Your <a href="https://www.healthdirect.gov.au/thyroid-gland">thyroid gland</a> is a butterfly-shaped gland in the neck. It is essential in regulating things like muscle function, digestion, metabolism, the heart and lungs. In children, thyroid hormones are also needed for normal growth and development.</p>
<p><a href="https://www.healthdirect.gov.au/hashimotos-disease">Hashimoto’s thyroid disease</a>, named after the <a href="https://www.jstage.jst.go.jp/article/endocrj/49/4/49_4_393/_pdf">Japanese doctor who discovered it</a> in 1912, is also known as Hashimoto’s thyroiditis or chronic lymphocytic thyroiditis. The disease can cause the immune system to mistakenly produce proteins called antibodies (thyroid peroxidase and thyroglobulin). These can cause inflammation and long-term damage to the thyroid gland. Over time, as thyroid tissue is inflamed and/or destroyed, there can be a decrease in the production of thyroid hormones (hypothyroidism). </p>
<p>Hashimoto’s can present subtly at first. If you only have antibodies with no change in thyroid levels, it is likely you won’t have any symptoms. </p>
<p>However, as the disease progresses, you may experience fatigue, weight gain (or difficulty losing weight), increased sensitivity to the cold, constipation, dry skin, muscle aches, irregular or heavy menstrual cycles, enlarged thyroid (goitre) and occasionally hair loss, including at the ends of your eyebrows. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/564455/original/file-20231208-19-6j9dc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman lies on exam table getting ultrasound of lower neck" src="https://images.theconversation.com/files/564455/original/file-20231208-19-6j9dc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564455/original/file-20231208-19-6j9dc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564455/original/file-20231208-19-6j9dc8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564455/original/file-20231208-19-6j9dc8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564455/original/file-20231208-19-6j9dc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564455/original/file-20231208-19-6j9dc8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564455/original/file-20231208-19-6j9dc8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The doctor might request an ultrasound of your thyroid gland.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-patient-receives-thyroid-diagnostics-treatment-1835866180">Shutterstock</a></span>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/why-am-i-so-tired-and-when-is-it-time-to-see-the-doctor-about-it-a-gp-explains-187984">Why am I so tired and when is it time to see the doctor about it? A GP explains</a>
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<hr>
<h2>What causes Hashimoto’s thyroid disease?</h2>
<p>Several risk factors can contribute to the development of Hashimoto’s including:</p>
<ul>
<li><p>genetic risk – <a href="https://pubmed.ncbi.nlm.nih.gov/28273382/">your risk is higher</a> if you have family members with Hashimoto’s</p></li>
<li><p>gender – women are up to <a href="https://pubmed.ncbi.nlm.nih.gov/35243857/">ten times more likely</a> than men to develop the disease</p></li>
<li><p>age – you are more likely to develop the disease from <a href="https://pubmed.ncbi.nlm.nih.gov/35243857/">30 to 50 years of age</a></p></li>
<li><p>autoimmune condition – having <a href="https://pubmed.ncbi.nlm.nih.gov/20103030/">another autoimmune condition</a> like systemic lupus, Type 1 diabetes and celiac disease increases your risk</p></li>
<li><p>excessive iodine intake and radiation exposure may also <a href="https://pubmed.ncbi.nlm.nih.gov/23436921/">increase risk</a> in people who are already genetically at greater risk. </p></li>
</ul>
<h2>What are the long-term risks?</h2>
<p>Long-term, untreated Hashimoto’s thyroiditis can cause <a href="https://pubmed.ncbi.nlm.nih.gov/28740582/">heart issues</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/8371604/">higher cholesterol levels</a>, nerve damage (peripheral neuropathy), reduced <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4136444/">cognition</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/10468932/">infertility</a>. </p>
<p>In pregnancy, Hashimoto’s has a higher risk of pre-eclampsia (high blood pressure affecting several organs), premature birth, placental abruption (when the placenta separates from the inner wall of the uterus before birth) and, in severe cases, <a href="https://www.frontiersin.org/articles/10.3389/fendo.2023.1081851/full">pregnancy loss</a>. </p>
<p>The disease has also been linked with an increased risk (but low incidence) of the lymphocytes of the thyroid turning into <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771433/">cancer cells</a> to cause thyroid lymphoma. </p>
<h2>How is Hashimoto’s diagnosed?</h2>
<p>Diagnosis can be confirmed with a blood test to check thyroid levels and antibodies. </p>
<p>Thyroid peroxidase antibodies are commonly present but about 5% of patients <a href="https://pubmed.ncbi.nlm.nih.gov/24743395/">test antibody-negative</a>. In those people, diagnosis depends on the thyroid levels, clinical presentation and ultrasound appearance of general inflammation. An ultrasound may not be required though, especially if the diagnosis is obvious. </p>
<p>Three hormone levels are tested to determine if you have Hashimoto’s. </p>
<p>Thyroid stimulating hormone (TSH) is produced by the brain to speak to the thyroid, telling it to produce two types of thyroid hormones – T3 and T4. </p>
<p>If you have either relative or absolute thyroid hormone deficiency, a test will show the stimulating hormones as high because the brain is trying to get the thyroid to work harder.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/564452/original/file-20231208-17-k39utf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="microscopic slide of cells in pink stain" src="https://images.theconversation.com/files/564452/original/file-20231208-17-k39utf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564452/original/file-20231208-17-k39utf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564452/original/file-20231208-17-k39utf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564452/original/file-20231208-17-k39utf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564452/original/file-20231208-17-k39utf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564452/original/file-20231208-17-k39utf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564452/original/file-20231208-17-k39utf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Hashimoto’s thyroiditis under the microscope. Antibodies against thyroid peroxidase and thyroglobulin were elevated.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Hashimoto%27s_thyroiditis,_HE_5.jpg">Patho/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<h2>Can it be treated?</h2>
<p>The management of Hashimoto’s depends on the severity of the thyroid levels. Up to 20% of the population can have antibodies but <a href="https://pubmed.ncbi.nlm.nih.gov/12519410/">normal thyroid levels</a>. This is still Hashimoto’s thyroid disease, but it is very mild and does not require treatment. There is no current treatment to reduce antibody levels alone. </p>
<p>Because thyroid peroxidase antibodies increase the risk of abnormal thyroid levels in the future, regular thyroid testing is recommended. </p>
<p>When the thyroid stimulating hormone is high with normal thyroid hormone levels it is termed “subclinical hypothyroidism”. When it is paired with low hormone levels it is called “overt hypothyroidism”. The first is a mild form of the disease and treatment depends on the <a href="https://pubmed.ncbi.nlm.nih.gov/24783053/">degree of stimulating hormone elevation</a>. </p>
<p>Overt hypothyroidism <a href="https://pubmed.ncbi.nlm.nih.gov/23246686/">warrants treatment</a>. The main form of this is thyroid hormone replacement therapy (levothyroxine) with the dose of the drug adjusted until thyroid levels are within the normal range. This is usually a lifelong treatment but, once the dose is optimised, hormone levels usually remain relatively stable. </p>
<p>In some people with very enlarged thyroid glands causing compressive symptoms (such as difficulty swallowing or breathing), thyroidectomy (surgical removal of the thyroid) is considered. </p>
<p>Hashimoto’s thyroiditis is a common condition caused by your body’s immune system incorrectly damaging to your thyroid and can go undetected. Long-term, untreated, it can cause issues with your heart, cognition, and fertility. It can be diagnosed with a simple blood test. Speak to your doctor if you have any concerns as early diagnosis and treatment can help prevent complications.</p>
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<img src="https://counter.theconversation.com/content/218342/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aakansha Zala does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While symptoms can be subtle, untreated Hashimoto’s can cause long-term problems with your heart, memory and fertility.Aakansha Zala, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2195042023-12-14T03:32:31Z2023-12-14T03:32:31ZWe followed 14 ‘long haulers’ for 3 months. Here’s what they told us about living with long COVID<figure><img src="https://images.theconversation.com/files/565680/original/file-20231214-29-kbdizh.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5875%2C3925&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-handsome-ill-sick-man-lying-2225051059">Yurii_Yarema/Shutterstock</a></span></figcaption></figure><p>At least <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00493-2/fulltext">65 million people</a> around the world are estimated to have <a href="https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition">long COVID</a>, which describes the continuation or development of symptoms at least three months after an initial COVID infection.</p>
<p>Long COVID is a complex, multi-system disease that can be disabling and may even <a href="https://time.com/6240713/long-covid-deaths/">be fatal</a> in some cases. We still don’t understand the exact causes of long COVID, and there’s no clear treatment for it.</p>
<p>Over three months, <a href="https://www.sciencedirect.com/science/article/pii/S0277953623008420">we followed 14 people</a> suffering from long COVID – or “long haulers” – to better understand their experiences. In particular, we wanted to see how their ability to manage their health (called agency) and the help they get from others (social support) influence how they fare.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-does-covid-become-long-covid-and-whats-happening-in-the-body-when-symptoms-persist-heres-what-weve-learnt-so-far-188976">When does COVID become long COVID? And what's happening in the body when symptoms persist? Here's what we've learnt so far</a>
</strong>
</em>
</p>
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<h2>A few key themes</h2>
<p>Participants recorded short videos about their daily lives, focusing on their symptoms, how they were coping, and any lifestyle changes they were making. </p>
<p>They experienced a range of symptoms, including fatigue, breathing difficulties and brain fog. Research has shown these are <a href="https://www.nature.com/articles/s41579-022-00846-2">common symptoms</a> among people with long COVID.</p>
<p>Participants faced psychological and social challenges, with some feeling lonely and hopeless, often made worse by social stigma around expressing mental distress. One participant said:</p>
<blockquote>
<p>Most of my family haven’t contacted me that much over the last five months. So I’ve really just been on my own 24/7, which does wear anyone down.</p>
</blockquote>
<p>Another said she had not</p>
<blockquote>
<p>reached out to my friends too much about it because I just feel like such a hypochondriac. </p>
</blockquote>
<figure class="align-center ">
<img alt="A senior woman sits on a couch looking out the window." src="https://images.theconversation.com/files/565678/original/file-20231214-29-a9b1jz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565678/original/file-20231214-29-a9b1jz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565678/original/file-20231214-29-a9b1jz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565678/original/file-20231214-29-a9b1jz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565678/original/file-20231214-29-a9b1jz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565678/original/file-20231214-29-a9b1jz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565678/original/file-20231214-29-a9b1jz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with long COVID may feel isolated.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/face-senior-caucasian-hoary-woman-looking-2264099993">Perfect Wave/Shutterstock</a></span>
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</figure>
<p>Some participants felt health-care professionals didn’t take their experiences and symptoms seriously or didn’t understand. One described “an overall very, very poor understanding of the pathophysiology of the condition which is harming patients like me”.</p>
<h2>Agency and social support</h2>
<p>Although each person had a unique experience with long COVID, we were able to group these experiences into clusters based on the social support they received and the agency they had in managing their condition. </p>
<p>Agency is a result of multiple factors that accumulate over time including socioeconomic background, education and health literacy. Agency can improve when people feel in control of their situation.</p>
<figure class="align-center ">
<img alt="A matrix divided into four quadrants representing the agency/social support clusters." src="https://images.theconversation.com/files/564600/original/file-20231209-25-6mmwxy.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564600/original/file-20231209-25-6mmwxy.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=460&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564600/original/file-20231209-25-6mmwxy.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=460&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564600/original/file-20231209-25-6mmwxy.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=460&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564600/original/file-20231209-25-6mmwxy.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=578&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564600/original/file-20231209-25-6mmwxy.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=578&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564600/original/file-20231209-25-6mmwxy.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=578&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We grouped participants into four clusters.</span>
<span class="attribution"><a class="source" href="https://www.sciencedirect.com/science/article/pii/S0277953623008420">Figueiredo et al., Social Science & Medicine, 2023</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>In general, those with high agency and high social support reported a better experience managing long COVID than those in the other clusters. </p>
<p>People with agency sought out information about their condition and potential treatments, followed through with prescribed treatment plans when available, monitored symptoms, sought support, and were involved in advocacy and research.</p>
<p>Social support was similarly important, manifesting in different ways – for example a spouse who helped their partner get dressed, or a manager who supported reducing work days. In some cases friends provided regular support, while family played a crucial role, often becoming long-term informal carers.</p>
<p>Having a wide group of supporters helped long haulers feel like less of a burden to others and avoided the fear of over-relying on an individual carer. One participant’s church group provided a helpful social network, and reinforced her self-belief. Online communities also offered support.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-diagnosis-to-services-and-support-how-australias-long-covid-response-is-falling-short-215056">From diagnosis to services and support: how Australia's long COVID response is falling short</a>
</strong>
</em>
</p>
<hr>
<p>Those who had low agency and low social support generally reported the worst experiences. One participant who we grouped in this category said:</p>
<blockquote>
<p>Long COVID has destroyed so many aspects of my life […] it’s impossible to overstate the negative impact that it’s had.</p>
</blockquote>
<h2>Our findings align with existing evidence</h2>
<p>Our study was confined to a small group, and participants were only from Australia, which limits how much the findings can be generalised. </p>
<p>That said, our findings align with broader evidence highlighting the complexity of long COVID as a condition with <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00501-X/fulltext">both physical and psychosocial dimensions</a>.</p>
<p>Our study’s emphasis on patient agency and social support also corresponds with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850205/">emerging literature</a> emphasising the important role these factors play in chronic disease management.</p>
<figure class="align-center ">
<img alt="A woman comforts another woman." src="https://images.theconversation.com/files/565679/original/file-20231214-27-iwujjf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565679/original/file-20231214-27-iwujjf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565679/original/file-20231214-27-iwujjf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565679/original/file-20231214-27-iwujjf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565679/original/file-20231214-27-iwujjf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565679/original/file-20231214-27-iwujjf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565679/original/file-20231214-27-iwujjf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Support from friends and family helps.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/shot-pretty-young-woman-supporting-comforting-2061681305">Josep Suria/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Supporting people with long COVID</h2>
<p>We suggest health-care professionals consider which “cluster” a person with long COVID falls into (low or high agency and low or high social support) and tailor the support they offer accordingly.</p>
<p>For example, long haulers who are more proactive (high agency) could benefit most from educational materials suggesting, for example, different ways to cope, safe exercise routines, diet tips, and strategies to manage mental health concerns.</p>
<p>Meanwhile, people with long COVID who find it hard to manage their health (low agency) but have good support from others (high social support), might benefit from educational materials that show their family and friends how to help them.</p>
<p>Being part of online communities could also help these patients. Although online groups can provide social support and improve a person’s sense of agency, not all information shared in these communities is accurate or reliable.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-physios-and-occupational-therapists-are-helping-long-covid-sufferers-195354">How physios and occupational therapists are helping long COVID sufferers</a>
</strong>
</em>
</p>
<hr>
<p>And what about people with low agency and low social support?</p>
<p>Providing clear, straightforward information about long COVID can enhance their participation in helping manage their health.</p>
<p>Connecting them with support groups, communities or counselling can improve social support. Evidence shows emotional connections <a href="https://bmjopen.bmj.com/content/13/3/e067166">help reduce feelings of distress</a> and boost wellbeing among people with long COVID.</p>
<p>Finally, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9648579/">case management services</a> can help long-haulers access and utilise community resources, and simplify their health-care journey.</p><img src="https://counter.theconversation.com/content/219504/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The project “EAT, MOVE, HEAL for Long-COVID” (Project ID: PRJ00000010) was funded by a 2022 Strategic Capability Deployment Fund, RMIT University, Victoria, Australia.</span></em></p><p class="fine-print"><em><span>Catherine Itsiopoulos has received funding from NHMRC for other research. She is a member of professional bodies including Dietitians Australia and The Australasian Society of Lifestyle Medicine. Catherine is a member of RMIT University 'Eat, Move Heal Network' researching to develop tools to support patients with long COVID19 at home.</span></em></p><p class="fine-print"><em><span>Jacob Sheahan receives funding from the Wellcome Trust, and the ACRC is funded by Legal and General.</span></em></p><p class="fine-print"><em><span>Zhen Zheng co-leads the Eat, Move, Heal for Long-COVID Program that aims to provide educational materials to people with long COVID and to health-care professionals. </span></em></p><p class="fine-print"><em><span>Magdalena Plebanski does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Participants recorded short videos about their daily lives, focusing on their symptoms, how they were coping, and any lifestyle changes they were making.Bernardo Figueiredo, Associate Professor of Marketing, RMIT UniversityCatherine Itsiopoulos, Professor and Dean, School of Health and Biomedical Sciences, RMIT UniversityJacob Sheahan, Research Fellow, Edinburgh College of Art, The University of EdinburghMagdalena Plebanski, Professor of Immunology, RMIT UniversityZhen Zheng, Associate Professor, STEM | Health and Biomedical Sciences, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2141162023-09-27T14:07:14Z2023-09-27T14:07:14ZCreatine supplement may help relieve some long COVID symptoms<figure><img src="https://images.theconversation.com/files/550562/original/file-20230927-19-58tdt9.jpg?ixlib=rb-1.1.0&rect=9%2C18%2C6011%2C3983&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Creatine helps muscles recover between workouts.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-image-healthy-fit-asian-woman-2359932819">BongkarnGraphic/Shutterstock</a></span></figcaption></figure><p>Creatine supplements are popular among fitness enthusiasts. It’s no wonder, with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8228369/">research showing</a> it may help improve strength and power, and support recovery between workouts. </p>
<p>Given its many benefits, a team of researchers recently decided to investigate whether it could help people with long COVID. They specifically wanted to know whether creatine could help <a href="https://onlinelibrary.wiley.com/doi/10.1002/fsn3.3597?utm_medium=email&utm_source=publicity&utm_content=WRH_9_18_23&utm_term=FSN3">combat fatigue</a>, which is one of the <a href="https://www.ucl.ac.uk/news/2023/jun/long-covid-can-impact-fatigue-and-quality-life-worse-some-cancers">most common and debilitating</a> long COVID symptoms.</p>
<p>The researchers from Serbia conducted a randomised controlled trial involving 12 people who’d had a recent long COVID diagnosis. This is the best study design to work out whether or not a treatment is effective.</p>
<p>Participants were randomly assigned to either receive a daily creatine supplement or a placebo (in this case inulin – a type of fibre). The treatment and placebo were an identical white powder that was mixed into water. This ensured neither the participants nor the researchers knew who’d received the creatine supplement until the trial was complete. The trial lasted over six months, ensuring the creatine had enough time to have an effect. </p>
<p>The researchers measured several outcomes – including how fatigued participants reported feeling and whether other long COVID symptoms (such as loss of smell) improved. The researchers also tracked how long participants could walk without feeling exhausted (an objective measure of fatigue), as well as levels of creatine in both muscle and brain tissues. This last outcome is important as it shows the supplement has made a measurable difference in the body – and shows participants adhered to the treatment. </p>
<p>Between 90-95% of participants took the supplement as directed for the duration of the study. Only one patient on creatine reported experiencing mild nausea.</p>
<p>After six months, the creatine group was shown to have higher concentrations of creatine in their muscles and brain tissue compared with the placebo group. But when the researchers looked at fatigue levels – both objective and self-reported – they found there was no difference between the placebo group and the creatine group.</p>
<p>However, the researchers did find that creatine may have some benefit when it comes to other long COVID symptoms (including loss of smell and taste, breathing difficulties, lung pain, body aches, headaches and trouble concentrating). </p>
<p>While all participants reported improvements in their long COVID symptoms by the end of the study, these improvements were greater in the creatine group. But it’s worth noting that it’s difficult to judge how severe these symptoms were to begin with or how great the improvements were as no information was provided on the scale the researchers used. </p>
<p>These results suggest that creatine appears to have had a positive effect on some self-reported long COVID symptoms. But creatine did not appear to have any effect on physical fatigue, which was a key focus of the trial.</p>
<figure class="align-center ">
<img alt="A fatigued woman sits in her bed." src="https://images.theconversation.com/files/550563/original/file-20230927-19-svvfgn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/550563/original/file-20230927-19-svvfgn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/550563/original/file-20230927-19-svvfgn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/550563/original/file-20230927-19-svvfgn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/550563/original/file-20230927-19-svvfgn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/550563/original/file-20230927-19-svvfgn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/550563/original/file-20230927-19-svvfgn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Creatine had no additional benefit for long COVID fatigue.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/depressed-woman-awake-night-she-touching-1285836277">Stock-Asso/ Shutterstock</a></span>
</figcaption>
</figure>
<p>The researchers suggest several potential mechanisms by which creatine could be causing these effects. One possible mechanism could be that it aids in <a href="https://www.bristol.ac.uk/Depts/Chemistry/MOTM/atp/atp1.htm">adenosine triphosphate</a> recycling in the brain and muscles. This molecule is important for energy production and release, and so creatine may make energy more available within these tissues. </p>
<p>Another potential mechanism could be that creatine <a href="https://www.mdpi.com/2072-6643/13/2/503">changes nerve regulation</a> by protecting the nerve cells and reducing nerve cell death, which might help brain symptoms. Creatine is also anti-inflammatory and has antioxidant effects, which may help prevent tissue damage – thereby preserving the function of the brain and muscle cells.</p>
<h2>Need for research</h2>
<p>This is the first study examining the use of creatine to treat symptoms of long COVID. The results are encouraging, and suggest it may be worth further exploration. But this is by no means enough evidence to warrant recommending this supplement to anyone who has long COVID. </p>
<p>Given the study used only a very few people, this means there’s still a lot we don’t know for certain when it comes to using creatine for long COVID symptoms – including whether sex differences affect a person’s response to the supplement, if creatine works equally well in people of all ages and what effect a person’s diet and exercise habits may have on how they respond to creatine.</p>
<p>Creatine is already shown to be safe and has minimal side-effects. It’s also reasonably inexpensive and easy to take each day. Given there are still limited treatments for long COVID, this is certainly a worthwhile area to investigate further. </p>
<p>Future research will now need to focus on replicating these results in larger, more diverse groups, and understanding how creatine produces these effects. Researchers may also want to specifically look at people with low creatine levels, as evidence suggests people with long COVID have <a href="https://www.jpgmonline.com/article.asp?issn=0022-3859;year=2023;volume=69;issue=3;spage=162;epage=163;aulast=Ranisavljev">lower creatine levels</a> – and this supplement could be of the most benefit to this group.</p><img src="https://counter.theconversation.com/content/214116/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mary Hickson receives funding from the British Dietetic Association General Education Trust, UKRI grant, and the National Institute of Health Research. She is a member of the British Dietetic Association and a Trustee for the Self-Care Forum. </span></em></p>But there was little effect on fatigue.Mary Hickson, Professor of Dietetics, University of PlymouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2115222023-09-20T20:06:25Z2023-09-20T20:06:25ZI’ve just been diagnosed with cancer, now what?<figure><img src="https://images.theconversation.com/files/548196/original/file-20230914-27-waipff.jpg?ixlib=rb-1.1.0&rect=111%2C222%2C6079%2C4102&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/sad-mature-businessman-thinking-about-problems-in-living-room-3772618/">Andrea Piacquadio/Unsplash</a></span></figcaption></figure><p>In one pivotal instant your life has changed and there will be no turning back. How will you accept, adjust and adapt to being “someone who has cancer”? </p>
<p>Well, first, you are still the same person. But now you have a definitive diagnosis calling for your immediate attention.</p>
<p>There are hundreds of kinds of cancer, <a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging">distinguished</a> and identified according to site, type of cell involved, aggressiveness and evidence of spread. These are the <a href="https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/cancer/overview">critical details</a> you need to know as you begin to understand what is going on in your body.</p>
<p>There will be much to learn and understand about the disease and prognosis; social, emotional, sexual and spiritual effects; treatments, therapies and their side-effects; work implications and how all these opportunities and challenges will be intertwined. </p>
<p>But you don’t need to do everything at once. In time, and with support, you’ll be able to move forward with poise, strength, calm and intelligence.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cancer-is-rising-in-under-50s-but-the-causes-are-a-mystery-212834">Cancer is rising in under-50s – but the causes are a mystery</a>
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</em>
</p>
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<h2>Emotions will vary – from you and others</h2>
<p>Whatever your usual demeanour and emotional state, be ready for some surprises. This will be a period of uncertainty. Expect to find yourself experiencing the full gamut of reactions such as shock, anger, grief and guilt, along with warm and deep feelings of love, compassion and gratitude for the people and environment that surround you.</p>
<p>In the first few days, you might want to limit who you tell about your diagnosis or keep your news private to give yourself a chance to adjust without interference. Because, although well meaning, some people will react in unexpected ways and might cause you distress rather than be truly supportive or helpful. </p>
<p>Some people will be inclined to ask lots of questions, but you may not have all the answers. They might want to tell you other people’s stories, which you might not want or be ready to hear yet.</p>
<figure class="align-center ">
<img alt="Person hugs their older relative" src="https://images.theconversation.com/files/548202/original/file-20230914-19-b2fa7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548202/original/file-20230914-19-b2fa7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548202/original/file-20230914-19-b2fa7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548202/original/file-20230914-19-b2fa7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548202/original/file-20230914-19-b2fa7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548202/original/file-20230914-19-b2fa7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548202/original/file-20230914-19-b2fa7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In the first few days, you might want to limit who you tell.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-comforting-desperate-girlfriend-and-embracing-gently-6382530/">Liza Summer/Pexels</a></span>
</figcaption>
</figure>
<p>You have the option to completely accept the guidance of health-care professionals, who will give you the information they think you need at the time and direct you to further diagnostic tests and appointments.</p>
<p>However, you may want to know more about the type of cancer you have, the treatments being recommended, all possible side effects and seek out other sources. This will place the information you have received into perspective and will inform further questions. It is important to find <a href="https://www.cancer.org.au/cancer-information">resources</a> that are <a href="https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/cancer/overview">credible</a>.</p>
<h2>Continuing work might be beneficial</h2>
<p>For working people, the decision about returning to work will depend on how you feel and the flexibility of your workplace. </p>
<p>Assuming your body is up to it and it’s not a period where you will be immunosuppressed and susceptible to harmful effects of infections, work done at a steady pace is usually not only a boost to finances, but will have <a href="https://www.cancer.net/navigating-cancer-care/young-adults-and-teenagers/school-and-work-during-cancer/going-work-during-and-after-cancer#:%7E:text=You%20might%20work%20as%20much,support%2C%20including%20health%20insurance%20benefits">cognitive, social and emotional benefits</a>. </p>
<p>The strategy here is to do a risk assessment of your job. Specify the challenges and discuss how they could be reduced with your manager. If you are your own boss, be flexible and kind.</p>
<h2>Responding to cancer-related fatigue</h2>
<p>The most common side effect of living with cancer (before, during and after all types of treatment) is a specific kind of extreme tiredness and lethargy called cancer-related fatigue. </p>
<p>Sometimes it appears alongside <a href="https://www.canceraustralia.gov.au/clinical-best-practice/psychosocial-care">non-clinical depression and hopelessness</a>. Some people can feel so awful they decline medical treatment, but for the majority, this type of fatigue gets in the way of enjoying life.</p>
<hr>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/we-asked-chatgpt-and-dr-google-the-same-questions-about-cancer-heres-what-they-said-201474">We asked ChatGPT and Dr Google the same questions about cancer. Here's what they said</a>
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<hr>
<p>Research on the most effective interventions to reduce cancer-related fatigue has <a href="https://pubmed.ncbi.nlm.nih.gov/20870636/">evaluated</a> a range of approaches, including medications and complementary therapies. Assuming the cause is not anaemia, which can be treated by a transfusion, the <a href="https://www.ncbi.nlm.nih.gov/books/NBK74155/">strongest evidence recommends</a> physical, moderately aerobic exercise, often defined as “enough to break a sweat”.</p>
<p>However, for those who are not able to exercise at a moderate level – for example, if the cancer has metastasised to bones or if lung capacity is compromised – less physically demanding approaches <a href="https://link.springer.com/chapter/10.1007/978-3-030-76932-1_4">can be valuable</a>. </p>
<h2>Prioritising things that bring you joy</h2>
<p>A “<a href="https://link.springer.com/book/10.1007/978-3-030-76932-1">joyful freedom</a>” approach to cancer-related fatigue aims to bring back vitality through subtle, lifestyle adjustments. It’s a framework researchers developed based on a series of studies.</p>
<p>The first task is to list activities that bring joy. Then categorise each joy according to five attributes of energy-restoring activities: </p>
<ul>
<li>purposeful</li>
<li>expansive</li>
<li>connecting</li>
<li>awe-inspiring </li>
<li>nourishing. </li>
</ul>
<p>This will raise awareness of how to best spend limited amounts of physical, emotional and cognitive energy.</p>
<p>Consider adding more of what brings joy into your life and remove some of the energy-depleting activities you do not enjoy. Making small changes can have a profound effect on your energy levels and give you the boost you need to live well with cancer.</p>
<p>In an ideal, well resourced national health service, GPs and specialist nurses would be available to provide holistic health promotion support for people with cancer. Realistically, this is rarely offered through mainstream public services. These services are more widely available in the private sector, or you may be able to find what you need through your <a href="https://www.cancer.org.au/">local Cancer Council</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/olivia-newton-john-gave-a-voice-to-those-with-cancer-and-shifted-the-focus-to-the-life-of-survivors-188444">Olivia Newton-John gave a voice to those with cancer and shifted the focus to the life of survivors</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/211522/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marilynne N Kirshbaum does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There’s a lot to learn, understand and organise when you receive a cancer diagnosis. But you don’t need to do it all at once.Marilynne N Kirshbaum, Professor and Chair of the Human Research Ethics Committee, Charles Darwin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2082802023-08-08T01:52:59Z2023-08-08T01:52:59ZWhat is POTS? And how is it related to long COVID?<figure><img src="https://images.theconversation.com/files/539703/original/file-20230727-19-zyb8o6.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C997%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-on-temples-young-unhappy-sadness-2217929751">Shutterstock</a></span></figcaption></figure><p>POTS or “postural orthostatic tachycardia syndrome” is a poorly recognised condition we’ve been <a href="https://www.smh.com.au/lifestyle/life-and-relationships/what-is-pots-and-how-is-it-related-to-covid-20230529-p5dc3v.html">hearing more</a> about recently.</p>
<p>When people stand up, get out of bed or off the sofa, their heart races and they feel dizzy and fatigued, severely impacting their quality of life. Everyday tasks, such as washing their hair in the shower or working, become challenging because people cannot stay upright.</p>
<p>Before COVID, this debilitating condition was not widely talked about. But during the pandemic, we’ve been learning about the strong similarities with long COVID. </p>
<p>In fact, our recent research shows more than <a href="https://www.amjmed.com/article/S0002-9343(23)00402-3/fulltext">three-quarters</a> of people with long COVID we studied had POTS.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-does-covid-become-long-covid-and-whats-happening-in-the-body-when-symptoms-persist-heres-what-weve-learnt-so-far-188976">When does COVID become long COVID? And what's happening in the body when symptoms persist? Here's what we've learnt so far</a>
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</em>
</p>
<hr>
<h2>What triggers it?</h2>
<p><a href="https://onlinelibrary.wiley.com/doi/10.1111/joim.12895">Multiple studies</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/37338634/">including our own</a>, have shown viral infection is the most common trigger for POTS. </p>
<p>Then came the pandemic, with <a href="https://covid19.who.int">almost 800 million people</a> infected so far with SARS-CoV-2, the virus that causes COVID. The World Health Organization <a href="https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition">says</a> 10-20% of people infected with COVID are likely to develop long COVID – when unexplained symptoms persist three months or more after the infection.</p>
<p>Now, more research is showing how long COVID resembles POTS. Many people with long COVID show similar symptoms.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1553878655536807936"}"></div></p>
<h2>What we and others have found</h2>
<p>Our recent study found <a href="https://www.amjmed.com/article/S0002-9343(23)00402-3/fulltext">nearly 80%</a> of people with long COVID had POTS. In people who had both and were of similar age, symptoms were indistinguishable from those who got POTS from other causes.</p>
<p>The people in our study either attended a specialist cardiology clinic for people with POTS or long COVID, or came via a long COVID support group on social media. So we cannot generalise our results to people managing their long COVID at home or with their GP. </p>
<p>Earlier this year, a <a href="https://www.nature.com/articles/s41569-023-00842-w">review</a> said about 30% of people with people with “highly symptomatic” long COVID also had POTS. <a href="https://www.onlinecjc.ca/article/S0828-282X(22)01091-1/fulltext">Most (73%)</a> met criteria for POTS and other types of dysfunction of the autonomic nervous system.</p>
<p>Taken together, we can conclude that many, but not all, cases of long COVID can be explained by POTS – a condition we’ve known about for years and know how to manage.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-can-learn-a-lot-about-long-covid-from-years-of-diagnosing-and-treating-chronic-fatigue-syndrome-196128">We can learn a lot about long COVID from years of diagnosing and treating chronic fatigue syndrome</a>
</strong>
</em>
</p>
<hr>
<h2>What happens if you have POTS?</h2>
<p>We suspect some cases of POTS result from a hyper-vigilant immune response to an invading pathogen, such as a virus. This, or another trigger, affects the autonomic nervous system.</p>
<p>This part of the nervous system balances a vast array of functions including maintaining blood flow to vital organs, digestion, temperature control, sweating and even sexual function. </p>
<p>Even if the autonomic nervous system is marginally disturbed, it leads to the physiological equivalent of anarchy. </p>
<p>The simplest of daily tasks – such as washing your hair in the shower – can result in profound symptoms of dizziness, a racing heart, breathlessness, brain fog and general exhaustion.</p>
<p>In other research <a href="https://link.springer.com/article/10.1007/s10286-023-00955-9">published</a> earlier this year, we found people with POTS have a poor quality of life – poorer than people with chronic illnesses such as HIV, cancer, or cardiovascular and kidney disease.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/539705/original/file-20230727-19-q8v1t8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man washing hair in shower, dark hair with shampoo suds" src="https://images.theconversation.com/files/539705/original/file-20230727-19-q8v1t8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539705/original/file-20230727-19-q8v1t8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539705/original/file-20230727-19-q8v1t8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539705/original/file-20230727-19-q8v1t8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539705/original/file-20230727-19-q8v1t8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539705/original/file-20230727-19-q8v1t8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539705/original/file-20230727-19-q8v1t8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Washing hair in the shower can leave people debilitated.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-man-washing-his-hair-taking-428660125">Shutterstock</a></span>
</figcaption>
</figure>
<h2>A long path to diagnosis</h2>
<p>Many patients are also forced to negotiate a diagnostic odyssey littered with tales of disbelief and dismissal by medical professionals, friends and family. Diagnosis can <a href="https://onlinelibrary.wiley.com/doi/10.1111/joim.12895">take years</a>.</p>
<p>In our <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/House/Health_Aged_Care_and_Sport/LongandrepeatedCOVID/Submissions">submission</a> to the parliamentary inquiry into long COVID, we shared the experiences of people with POTS symptoms and their frustration at the lack of recognition by the medical profession. One health worker said:</p>
<blockquote>
<p>I am a nurse myself and specifically brought up that I believed I had POTS after COVID infection. I was treated like a hypochondriac and told I had anxiety, which was absolutely ludicrous as I had physical symptoms […] I had many presentations to [the emergency department] with no help or diagnosis whatsoever.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-got-some-key-things-wrong-about-long-covid-here-are-5-things-weve-learnt-199974">We got some key things wrong about long COVID. Here are 5 things we've learnt</a>
</strong>
</em>
</p>
<hr>
<h2>We can do better</h2>
<p>Prompt diagnosis is vital in the face of what we suspect are rising numbers of newly diagnosed cases associated with long COVID. </p>
<p>Although many people with POTS report they were referred to <a href="https://onlinelibrary.wiley.com/doi/10.1111/joim.12895">multiple specialists</a> before they were diagnosed, this is not always necessary.</p>
<p>GPs can ask you to do a <a href="https://potsfoundation.org.au/wp-content/uploads/2023/03/NASA-Lean-Test-vFinal.pdf">ten-minute standing test</a> to help diagnose it. They can also exclude other common causes of POTS symptoms, such as lung and heart conditions. </p>
<p>There is no known cure for POTS. However, once diagnosed, there are <a href="https://www.ausdoc.com.au/therapy-update/postural-orthostatic-tachycardia-syndrome/">multiple things</a> that can improve and manage the condition. A <a href="https://potsfoundation.org.au/wp-content/uploads/2023/03/Malmo-POTS-Score-vFinal.pdf">questionnaire</a> your GP can give you can help prioritise which symptoms to manage. You then work with your trusted GP to manage these.</p>
<p>Increasing fluid and salt intake (under the supervision of your GP), and using full-length compression tights is recommended. These help control heart rate and blood pressure, and reduce dizziness.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/539706/original/file-20230727-23-d93682.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman adding salt to pot of boiling water on stove" src="https://images.theconversation.com/files/539706/original/file-20230727-23-d93682.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539706/original/file-20230727-23-d93682.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539706/original/file-20230727-23-d93682.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539706/original/file-20230727-23-d93682.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539706/original/file-20230727-23-d93682.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539706/original/file-20230727-23-d93682.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539706/original/file-20230727-23-d93682.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Eating more salt can help.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-adding-salt-boiling-water-pot-2183938315">Shutterstock</a></span>
</figcaption>
</figure>
<p>Avoiding triggers is important. These include avoiding standing still for extended periods, hot showers, large meals high in carbohydrates, and hot environments.</p>
<p>Many people also benefit from <a href="https://www.ausdoc.com.au/therapy-update/postural-orthostatic-tachycardia-syndrome/">medicines</a> to help control their blood pressure and heart rate.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-should-my-heart-rate-be-and-what-affects-it-98945">What should my heart rate be and what affects it?</a>
</strong>
</em>
</p>
<hr>
<h2>How about referral?</h2>
<p>If referral to specialist services are required, this can be complex and expensive. There are no specialised clinics for POTS in public hospitals. Instead, POTS is mainly managed in the private sector. </p>
<p>Referral options can be overwhelming. People may benefit from referral to a range of health professionals to manage their symptoms, including a physiotherapist, psychologist, occupational therapist or exercise physiologist – ideally ones familiar with POTS.</p>
<p>All these barriers means access to diagnosis and treatment largely depends on someone having sufficient money, or being confident enough to navigate the health system.</p>
<hr>
<p><em>If you have symptoms such as those we’ve described, see your GP for assessment. For more information about the condition, see the Australian POTS Foundation <a href="https://potsfoundation.org.au">website</a>, which also <a href="https://potsfoundation.org.au/clinician-directory/">lists</a> doctors and allied health professionals who are “POTS aware”.</em></p><img src="https://counter.theconversation.com/content/208280/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marie-Claire Seeley receives funding from The Australian Government Research Training Scholarship and Standing up to POTS . </span></em></p><p class="fine-print"><em><span>Celine Gallagher receives funding from The University of Adelaide and the Australian POTS Foundation. </span></em></p>Everyday tasks, such as washing your hair, become impossible.Marie-Claire Seeley, PhD Candidate, Australian Dysautonomia and Arrhythmia Research Collaborative, University of AdelaideCeline Gallagher, Postdoctoral Fellow, Australian Dysautonomia and Arrhythmia Research Collaborative, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2072572023-06-12T17:01:10Z2023-06-12T17:01:10ZLong COVID: effects on fatigue and quality of life can be comparable to some cancers – new research<figure><img src="https://images.theconversation.com/files/531289/original/file-20230612-15-4wkl2y.jpg?ixlib=rb-1.1.0&rect=57%2C9%2C6431%2C4264&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/unhappy-young-man-mental-health-issues-1891476715">Southworks/Shutterstock</a></span></figcaption></figure><p>As of March 2023, the <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/30march2023">Office for National Statistics</a> estimated that 1.7 million people in the UK were living with self-reported long COVID. This refers to symptoms, including fatigue and brain fog among many others, that continue for more than 12 weeks after the initial COVID infection.</p>
<p>Long COVID is causing significant concern across the UK and around the world due to the large number of people affected. <a href="https://doi.org/10.1038/s41579-022-00846-2">Research</a> and <a href="https://www.theguardian.com/society/2022/oct/25/long-covid-fight-guardian-readers">anecdotal reports</a> continue to show that the condition is causing severe symptoms. But we still need to learn more about how long COVID can affect a patient’s ability to carry out normal, everyday activities.</p>
<p>In a <a href="http://dx.doi.org/10.1136/bmjopen-2022-069217">new study</a>, my colleagues and I found that long COVID can cause fatigue and affect a person’s daily functioning more so than <a href="https://www.researchgate.net/publication/352381660_Health_state_utility_values_by_cancer_stage_a_systematic_literature_review">some cancers</a>. </p>
<p>Fatigue appears to be the dominant symptom driving the effect on long COVID patients’ capacity to function day-to-day, and is therefore an important focus for clinical care and the design of rehabilitation services.</p>
<p>Back in August 2020, we began a project to create a <a href="http://dx.doi.org/10.1136/bmjopen-2021-057408">digital health intervention</a> to help clinics remotely support long COVID patients. Our large, <a href="https://www.ucl.ac.uk/healthcare-engineering/living-covid-recovery-collaboration">multidisciplinary team</a> was created and led by the late Professor Elizabeth Murray. Over the two-year project, more than 8,000 patients from across 35 different NHS long COVID clinics in the UK used the Living With COVID Recovery mobile phone app.</p>
<p>The patients were encouraged to complete questionnaires on the app about how long COVID was affecting them, covering day-to-day activities, levels of fatigue, depression, anxiety, breathlessness and brain fog. This helped the patients track their symptoms over time and allowed clinicians to remotely monitor and support their patients.</p>
<p>The questionnaires also generated <a href="https://www.tandfonline.com/doi/abs/10.3109/13651501.2014.894072?journalCode=ijpc20">standardised scores</a> for each symptom. This allowed the clinicians to compare the long COVID scores to those from patients suffering from a variety of other diseases gathered from previous research. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-fatigue-cognitive-behavioural-therapy-could-help-people-manage-persistent-symptoms-new-research-205365">COVID fatigue: cognitive behavioural therapy could help people manage persistent symptoms – new research</a>
</strong>
</em>
</p>
<hr>
<h2>Analysing the data</h2>
<p>William Henley and Sarah Walker at the University of Exeter analysed the data from the questionnaires completed by the first 3,754 patients to use the app, and the findings from these patients are reported in our study.</p>
<p>We found that many of the long COVID patients were seriously unwell, and often their symptoms were keeping them from doing day-to-day activities such as simple household chores or caring for other people. The extent to which long COVID patients were affected in this regard was <a href="https://pubmed.ncbi.nlm.nih.gov/30266010/">comparable to patients</a> who had <a href="https://pubmed.ncbi.nlm.nih.gov/19010942/">had a stroke</a> or were suffering from <a href="https://www.diva-portal.org/smash/get/diva2:1429490/FULLTEXT01.pdf">Parkinson’s disease</a>.</p>
<p>Of all the symptoms studied, fatigue was associated with the biggest effect on long COVID patients’ daily lives, with average fatigue scores similar to or worse than people with cancer-related <a href="https://pubmed.ncbi.nlm.nih.gov/25980742/">anaemia</a> or severe <a href="https://pubmed.ncbi.nlm.nih.gov/26887433/">kidney disease</a>. The long COVID patients on average reported health-related quality of life scores which were lower than people with advanced metastatic cancers, such as stage 4 <a href="https://pubmed.ncbi.nlm.nih.gov/30208899/">lung cancer</a>. </p>
<p>The average long COVID patients we looked at were also suffering from anxiety, depression, breathlessness and brain fog, but these symptoms were not closely associated with an inability to carry out everyday activities in the same way as fatigue was.</p>
<figure class="align-center ">
<img alt="A woman at her computer appears stressed." src="https://images.theconversation.com/files/531291/original/file-20230612-149863-9grzv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/531291/original/file-20230612-149863-9grzv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531291/original/file-20230612-149863-9grzv1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531291/original/file-20230612-149863-9grzv1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531291/original/file-20230612-149863-9grzv1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531291/original/file-20230612-149863-9grzv1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531291/original/file-20230612-149863-9grzv1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Long COVID can be debilitating.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/exhausted-businesswoman-having-headache-office-mature-1324640339">Ground Picture/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Beyond the individual</h2>
<p>It’s likely that long COVID is also having a significant economic and social effect. Of the 3,754 long COVID patients in the study, 94% were of working age, and 51% said that they had missed at least one day of work in the previous month due to their symptoms. Further, 20% said they couldn’t work at all during the previous month.</p>
<p>Notably, 71% of the patients reporting symptoms were women. Women tend to have more responsibilities at home and are more likely to work <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandwellbeing/articles/fullstorythegendergapinunpaidcareprovisionisthereanimpactonhealthandeconomicposition/2013-05-16">in caring professions</a>, so long COVID will also have a large social impact.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/hair-loss-and-lower-libido-among-long-covid-symptoms-new-research-187504">Hair loss and lower libido among long COVID symptoms – new research</a>
</strong>
</em>
</p>
<hr>
<p>There were two main limitations in our study. First, our sample only comprises patients who were seen in a long COVID clinic, and this may not be representative of all patients with long COVID. Many long COVID sufferers may not have been referred to a clinic. The majority of patients in our study tended to be white, well-off and well-educated despite long COVID being more common in <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/30march2023">more deprived areas</a>. People with the characteristics found in our study are more likely to <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/mentalhealth/articles/sociodemographicdifferencesinuseoftheimprovingaccesstopsychologicaltherapiesserviceengland/april2017tomarch2018">seek out healthcare</a> than their counterparts (namely those who are <a href="https://www.sciencedirect.com/science/article/pii/S2666776222001211?via%3Dihub">non-white</a>, less well-off or less educated).</p>
<p>The second limitation is that the primary reason this data was collected was for clinicians to assess and treat patients, rather than for research. This led to substantial missing data as data was not collected in a systematic way. We didn’t ask participants for data that wasn’t deemed clinically essential, such as the severity of their initial COVID infection or COVID vaccination status as we didn’t want to over-burden long COVID patients with too many questions.</p>
<p>Nonetheless, we hope that this work will inform clinicians and the general public about how unwell many patients with long COVID actually are. In particular, post-COVID assessment services should consider focusing on assessing and treating fatigue to maximise recovery and return to work for sufferers of long COVID.</p><img src="https://counter.theconversation.com/content/207257/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Henry Goodfellow works as a clinical safety officer for Living With LtD. The project was funded by an NIHR grant (HSDR Project:NIHR132243).</span></em></p>Of all symptoms studied, fatigue was associated with the biggest effect on long COVID patients’ daily lives.Henry Goodfellow, NIHR Clinical Lecturer in eHealth, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2051822023-05-22T11:34:44Z2023-05-22T11:34:44ZWhat is fatigue? Understanding fatigue among students with disabilities can help schools moderate it<figure><img src="https://images.theconversation.com/files/527047/original/file-20230518-23-532y9r.jpg?ixlib=rb-1.1.0&rect=1824%2C521%2C3287%2C2623&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fatigue has been associated with a variety of psychoeducational issues, such as slower educational progress and more frequent school absences. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>During the COVID-19 pandemic, we heard about people experiencing different kinds of fatigue, whether related <a href="https://theconversation.com/4-steps-to-teacher-recovery-from-compassion-fatigue-and-burnout-during-covid-19-and-beyond-151407">to burnout</a>, <a href="https://apps.who.int/iris/bitstream/handle/10665/335820/WHO-EURO-2020-1160-40906-55390-eng.pdf">being unmotivated to follow pandemic restrictions</a> or <a href="https://doi.org/10.1016/S2666-7568(22)00029-0">as a symptom of</a> infection. But what exactly is fatigue? </p>
<p>Fatigue is <a href="https://wwwha.tcd.ie/disability/assets/doc/pdf/Balancing%20the%20Books_Fatigue%20booklet.pdf">not synonymous with tiredness</a>. When one is tired, sleep helps. Fatigue results when cognitive, emotional or physical attentiveness is required for prolonged periods of time resulting in feelings of <a href="https://europepmc.org/article/MED/27355763">tiredness, exhaustion or lack of energy or desire to continue a task</a>. It is not resolved by a nap.</p>
<p>Fatigue regularly includes difficulties in concentration, feelings of anxiety and increased distractibility. Medical professionals and researchers currently define fatigue by differentiating types of exertion: <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603232/">physical, cognitive</a> and as it has more recently been conceptualized, <a href="https://doi.org/10.1080/08870440310001627135">social-emotional</a>.</p>
<p>I am working with colleagues to provide a means for students with disabilities and their educational teams to understand the impact of fatigue, <a href="https://hdl.handle.net/20.500.14078/3044">to advocate for appropriate strategies and programs</a> and to moderate fatigue in educational contexts. </p>
<figure class="align-center ">
<img alt="Students seen sitting in a classroom listening." src="https://images.theconversation.com/files/527039/original/file-20230518-23-ljxaty.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/527039/original/file-20230518-23-ljxaty.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/527039/original/file-20230518-23-ljxaty.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/527039/original/file-20230518-23-ljxaty.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/527039/original/file-20230518-23-ljxaty.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/527039/original/file-20230518-23-ljxaty.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/527039/original/file-20230518-23-ljxaty.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Understanding students’ experiences of fatigue and the impact of it matters to students’ lives.</span>
<span class="attribution"><span class="source">(Allison Shelley/EDUimages)</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<h2>Fatigue in school-aged children</h2>
<p>Fatigue among school-aged children can have many negative effects. One study based in Japan found about 16 per cent of elementary and 34 per cent of junior high school students <a href="https://pubmed.ncbi.nlm.nih.gov/20846803/">reported experiencing fatigue throughout a typical school week</a>. In this study, self-reported fatigue was associated with difficulties with motor processes and executive functions, inevitably leading to poorer academic performance. </p>
<p>The same researchers also found that decreasing cognitive functioning was also related to a <a href="https://pubmed.ncbi.nlm.nih.gov/21235802/">decrease in intrinsic motivation</a> and consequently, poor academic performance. </p>
<p>In addition, fatigue has been associated with a variety of psychoeducational issues, such as <a href="https://pubmed.ncbi.nlm.nih.gov/16818483/">reduced physical activity</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4096811/">slower educational progress</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/24146285/">more frequent school absences</a>, <a href="https://doi.org/10.1111/j.1469-7610.2004.00244.x">less socializing with friends and family</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5831094/">increased stress in children</a>.</p>
<h2>Students with disabilities</h2>
<figure class="align-right ">
<img alt="A girl is seen touching a hearing aid behind her ear." src="https://images.theconversation.com/files/526276/original/file-20230515-26296-odirz2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/526276/original/file-20230515-26296-odirz2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=625&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526276/original/file-20230515-26296-odirz2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=625&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526276/original/file-20230515-26296-odirz2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=625&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526276/original/file-20230515-26296-odirz2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=785&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526276/original/file-20230515-26296-odirz2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=785&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526276/original/file-20230515-26296-odirz2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=785&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The cumulative effects of fatigue related to constant effort for listening and communicating can lead to poorer quality of life outcomes.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>In educational settings, <a href="https://pubmed.ncbi.nlm.nih.gov/11000775/">fatigue is frequently</a> experienced by <a href="https://doi.org/10.1177/0040059915626135">people with disabilities</a>.</p>
<p>Research has documented how <a href="https://doi.org/10.1044/hhdc24.2.25">young students who are deaf or hard of hearing experience fatigue daily</a> related to the need for constant and ongoing physical, social-emotional or mental effort for: </p>
<ul>
<li><p>Listening and watching both their teacher and classroom support personnel such as a sign language interpreter or educational assistant;</p></li>
<li><p>Communicating with peers through a communication device or lip/speech reading;</p></li>
<li><p>Attending to classroom instruction through an amplification device. </p></li>
</ul>
<p>The cumulative effects of such experiences lead to <a href="https://www.igi-global.com/chapter/examining-fatigue-for-students-who-are-deaf-or-hard-of-hearing-through-universal-design-for-learning/294152">poorer quality of life outcomes</a> for these students, including limiting educational and vocational choices, increased mental health concerns and negative impacts on family and friend relationships. </p>
<h2>Poorly understood impact</h2>
<p>Currently, the impact of fatigue in educational settings for students with disabilities is poorly understood by teachers, administrators, policymakers and parents or caregivers and students themselves. </p>
<p>Educators frequently <a href="https://academic.oup.com/jdsde/article/17/4/518/393395">fail to understand the importance of providing educational supports to mitigate fatigue</a>, or mislabel symptoms of fatigue with terms like laziness, stubbornness or a behavioural problem.</p>
<p>Students often <a href="https://hdl.handle.net/20.500.14078/3044">fail to recognize fatigue symptoms</a>, lack understanding of how their learning is compromised by fatigue and have limited coping strategies. As a result, they frequently cannot or do not openly name or express their fatigue. </p>
<p>There have been some efforts made within educational systems to address acknowledging and responding to fatigue to support student engagement and wellness (such as options for flexible scheduling or periodic breaks). Yet, our research team found when we interviewed junior high and high school students who are deaf or hard of hearing that <a href="https://doi.org/10.18848/2327-0128/CGP/v23i03/23-31">none of the students we interviewed</a> were consistently afforded such accommodations. </p>
<p>Instead, students were left to cope with increased levels of fatigue on their own.</p>
<figure class="align-center ">
<img alt="A student seen sitting at a desk holding their head while people are talking behind them." src="https://images.theconversation.com/files/526277/original/file-20230515-30399-e5v3f4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526277/original/file-20230515-30399-e5v3f4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=383&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526277/original/file-20230515-30399-e5v3f4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=383&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526277/original/file-20230515-30399-e5v3f4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=383&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526277/original/file-20230515-30399-e5v3f4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=481&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526277/original/file-20230515-30399-e5v3f4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=481&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526277/original/file-20230515-30399-e5v3f4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=481&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A study found that no junior high and high school students who were deaf or hard of hearing were afforded accommodations to mitigate their fatigue.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Next research steps</h2>
<p>As a next step towards better understanding the impact of fatigue for students with disabilities, my colleagues and I designed the Fatigue in Educational Contexts (FEC) survey. </p>
<p>The purpose of the survey is to accurately identify, describe and interpret the presence and intensity of fatigue and to inform how students’ fatigue can be alleviated in educational contexts. Our current focus is on students who are deaf or hard of hearing, but we plan to expand our focus to all students once the survey is refined.</p>
<p>Most available fatigue surveys examine workplace or injury related fatigue in adult populations. A commonly used standardized survey designed for children and adolescents, <a href="https://doi.org/10.1002/cncr.10428">the PedsQL-MFS</a>, has significant limitations for our purposes: </p>
<ul>
<li>It was not developed for individuals with disabilities nor is it inclusive of the heterogeneity of the disabled student population; </li>
<li>None of the items on the survey specifically address fatigue in classrooms.</li>
</ul>
<h2>Including wider student, family responses</h2>
<p>The child version of the recently published <a href="https://www.vumc.org/vfs/pediatric-scales-and-user-guide">Vanderbilt Fatigue Scale</a> includes some survey questions addressing fatigue in classroom environments. However, it focuses exclusively on fatigue as a result of auditory effort (for deaf or hard of hearing individuals using amplification devices and spoken language) and is accessible only in written text format. </p>
<p>Currently, there is no survey suitable for a diversity of students with disabilities, including among deaf students who are sign language users and/or who are dual language users, meaning they both sign and use spoken language, but not simultaneously.</p>
<p>The FEC survey will be innovative because it will be designed to capture experiences of these students, and it will include the perspectives of students, their families and educational teams about how they understand and see student fatigue.</p>
<p>This research can help educators and policymakers propose relevant changes in education, such as policy or curricular changes, educator training or resource allocation or protocols for relating with students, families or communities to better respond to and mitigate students’ fatigue.</p><img src="https://counter.theconversation.com/content/205182/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natalia Rohatyn-Martin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Capturing the experiences of students who are deaf or hard of hearing is important so schools can address fatigue related to listening and communicating efforts.Natalia Rohatyn-Martin, Assistant Professor, Department of Human Services and Early Learning, MacEwan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2053652023-05-16T13:29:00Z2023-05-16T13:29:00ZCOVID fatigue: cognitive behavioural therapy could help people manage persistent symptoms – new research<figure><img src="https://images.theconversation.com/files/525968/original/file-20230512-19-m5k7y1.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5664%2C3770&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/visit-psychologist-man-sits-on-couch-2249853239">YURII MASLAK/Shutterstock</a></span></figcaption></figure><p>While COVID is no longer regarded as <a href="https://www.who.int/news/item/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic">a global health emergency</a>, it remains <a href="https://www.bmj.com/content/379/bmj.o2516#:%7E:text=Is%20covid%2D19%20really%20getting,for%20anyone%20without%20prior%20immunity.">a serious disease</a>. Notably, even mild cases can result in persistent symptoms known as <a href="https://www.england.nhs.uk/coronavirus/post-covid-syndrome-long-covid/">long COVID</a>, which can have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9111447/">wide-reaching effects</a> on physical health, mental health and quality of life.</p>
<p>Fatigue is a common symptom of both COVID and long COVID – around <a href="https://health-study.joinzoe.com/post/covid-symptoms-fatigue-tiredness">eight in ten adults</a> report experiencing it during a COVID infection. And while many people find their fatigue improves within a few weeks, this is not the case for everyone. Estimates suggest that between one in ten and one in three people still have fatigue <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8496765/">six months post-COVID</a>. They may or may not have received a formal diagnosis of long COVID.</p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/37155736/">recent study</a> has suggested that cognitive behavioural therapy (CBT), a widely used form of “talking therapy”, could help people experiencing persistent fatigue after COVID. So what can we make of this?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/overweight-women-may-be-at-highest-risk-of-long-covid-new-research-195478">Overweight women may be at highest risk of long COVID – new research</a>
</strong>
</em>
</p>
<hr>
<p>CBT is commonly used to treat mental health issues such as anxiety and depression, but it can also be used for fatigue. For example, CBT has been used as a treatment for people with <a href="https://theconversation.com/we-can-learn-a-lot-about-long-covid-from-years-of-diagnosing-and-treating-chronic-fatigue-syndrome-196128">chronic fatigue syndrome</a>, which has features that overlap with post-COVID fatigue. </p>
<p>CBT for persistent fatigue is based on the idea that by changing what we think, feel and do about our symptoms, we can improve functioning and quality of life.</p>
<p>A review of the evidence on <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028002/">CBT for fatigue</a> published in 2008 indicated that this approach was effective in reducing symptoms of fatigue. However, these conclusions have since been challenged due to inconsistent findings and concerns about the quality of evidence. </p>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6498783/">more recent review</a> from 2019 concluded that the benefits of CBT for chronic fatigue syndrome are typically modest and short-lived. And around one in five patients who have received CBT for chronic fatigue report worsening health following therapy.</p>
<p>UK guidelines on the management of <a href="https://www.nice.org.uk/guidance/ng206/chapter/Recommendations#managing-mecfs">chronic fatigue syndrome</a> recommend that CBT be discussed as an option for people living with the condition to support them with managing their symptoms, improving functioning, and reducing the distress associated with persistent fatigue. However, it should be made clear to people considering CBT that it will not cure their condition. </p>
<p>In the absence of evidence to support one approach over another in the context of post-COVID fatigue, <a href="https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2023.1">World Health Organization</a> clinical guidelines also recommend discussing CBT as an option with patients who have persistent fatigue after COVID to support coping and improve functioning.</p>
<figure class="align-center ">
<img alt="A woman lying on a bed with her hands over her face." src="https://images.theconversation.com/files/525948/original/file-20230512-23918-qjsrry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525948/original/file-20230512-23918-qjsrry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525948/original/file-20230512-23918-qjsrry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525948/original/file-20230512-23918-qjsrry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525948/original/file-20230512-23918-qjsrry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525948/original/file-20230512-23918-qjsrry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525948/original/file-20230512-23918-qjsrry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Persistent fatigue can be debilitating.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fatigued-woman-lying-bedstead-599864105">True Touch Lifestyle/Shutterstock</a></span>
</figcaption>
</figure>
<h2>What about this new study?</h2>
<p>Across multiple centres in <a href="https://pubmed.ncbi.nlm.nih.gov/37155736/">the Netherlands</a>, 114 patients who had severe fatigue three to 12 months after COVID were randomly assigned either to a CBT intervention or to care as usual. Usual care might include supervision by their GP, specialist physiotherapy and occupational therapy. </p>
<p>On average, the 57 people in the CBT group underwent 18.7 weeks of therapy with a psychologist. The treatment was delivered through a combination of video, email, face-to-face and telephone consultations, which enabled therapy to continue if physical distancing restrictions were in place. </p>
<p>The CBT programme focused on <a href="https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-021-05569-y/tables/2">providing personalised support</a> which addressed factors that can perpetuate fatigue using education, goal setting, and building skills to manage fatigue. There was also a focus on addressing unhelpful beliefs about fatigue, worries about COVID, coping with pain, and improving relationships.</p>
<p>The researchers found that people in the CBT group reported less severe fatigue after the treatment than people in the care-as-usual group, and this was sustained at a six-month follow-up. The CBT group also reported being chronically fatigued less often, fewer problems with concentration, less severe physical symptoms, and improved physical and social functioning after completing CBT and six months later. </p>
<h2>Some things to keep in mind</h2>
<p>While these results are promising, this was a relatively small study, and most participants referred themselves to the trial. As such, they may have been more motivated to take part in CBT than people with long COVID routinely accessing outpatient services.</p>
<p>Also, the care as usual comparison group doesn’t control for placebo effects or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2794993/">general benefits</a> of seeing a therapist, such as receiving motivation, warmth and encouragement. Without a control group that can account for these effects – such as having people spend time with a therapist without undergoing an “active” form of therapy, or having them receive an alternative type of psychological therapy – it’s difficult to know for sure whether differences observed between the groups were specific to the CBT. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/chronic-fatigue-syndrome-new-evidence-of-biological-causes-108854">Chronic fatigue syndrome: new evidence of biological causes</a>
</strong>
</em>
</p>
<hr>
<p>New or worsening symptoms since starting therapy were recorded for eight people in the CBT group and 20 people in the care-as-usual group. While CBT compared well with usual care in this sense, this highlights the need to consider potential risks as well as benefits of CBT in the management of post-COVID fatigue.</p>
<p>CBT may well prove to be useful as part of multi-disciplinary care for people with post-COVID fatigue. But we need more high-quality evidence using appropriate control groups, and ensuring that potential harms as well as benefits of CBT are fully considered. </p>
<p>And importantly, while CBT could play a role in supporting people with post-COVID fatigue, it doesn’t treat or cure the underlying condition. Long COVID is a <a href="https://www.nature.com/articles/s41579-022-00846-2">complex condition</a> potentially caused by multiple factors such as damage to the organs from COVID, dysfunctional immune responses, and chronic viral infection. It’s vital that we learn more about prevention and treatment of long COVID generally.</p><img src="https://counter.theconversation.com/content/205365/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rhiannon Phillips receives funding from Welsh Government, Public Health Wales, Medical Research Council, Health and Care Research Wales, Cancer Research UK, and the National Institute for Health Research. She is affiliated with the British Psychological Society. </span></em></p>Could CBT, a widely used form of ‘talking therapy’, help people who have persistent fatigue after having COVID? A recent study suggests it could.Rhiannon Phillips, Reader in Health Psychology, Cardiff Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2025142023-04-04T20:20:59Z2023-04-04T20:20:59ZDriving on less than 5 hours of sleep is just as dangerous as drunk-driving, study finds<figure><img src="https://images.theconversation.com/files/519188/original/file-20230404-22-fyk2dy.jpg?ixlib=rb-1.1.0&rect=52%2C64%2C3748%2C2520&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Yellowj/Shutterstock</span></span></figcaption></figure><p>What if you could be fined or lose your license for driving tired? Our new study <a href="https://doi.org/10.2147/NSS.S392441">just published in Nature and Science of Sleep</a> has found if you had less than five hours of sleep last night, you are just as likely to have a vehicle crash as if you were over the legal limit for alcohol. </p>
<p>We know about 20% of all vehicle crashes <a href="https://www.aaa.asn.au/wp-content/uploads/2021/10/Fatigue-Driving-Literature-Review-FINAL.pdf">are caused by fatigue</a>. Over the past 20 years, the number of crashes caused by alcohol <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074684/">has decreased significantly</a>.</p>
<p>However, there has been little progress over this same period in decreasing the number of crashes caused by fatigue. We wanted to know – can this be changed?</p>
<h2>A ‘line in the sand’ on impaired driving</h2>
<p>Recent decreases in alcohol-related car crashes have happened for a few reasons:</p>
<ul>
<li> a significant investment in public education</li>
<li> drivers have easy-to-follow guidance on how to decide if they are too intoxicated to drive (for example, <a href="https://www.forgov.qld.gov.au/mail-facilities-and-vehicles/vehicles/driver-safety-in-the-workplace/fitness-to-drive/alcohol-and-drugs">the advice to have</a> “two drinks in the first hour, and one drink every hour after that”)</li>
<li> strong enforcement strategies, including roadside testing</li>
<li> highly publicised drunk-driving legal cases.</li>
</ul>
<p>Additionally, drivers are legally deemed to be impaired if their blood alcohol concentration is over 0.05%, regardless of their driving performance. This blood alcohol limit is an effective “line in the sand”, determining whether someone is <em>legally</em> permitted to drive.</p>
<p>We did a study to find out if we could reduce the number of fatigue-related crashes on Australian roads by following a similar strategy. Is there a point at which we could deem a driver to be impaired due to fatigue?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/519183/original/file-20230404-24-w0roze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A road sign that reads 'fatigue zone question - highest mountain in Queensland?'" src="https://images.theconversation.com/files/519183/original/file-20230404-24-w0roze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519183/original/file-20230404-24-w0roze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519183/original/file-20230404-24-w0roze.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519183/original/file-20230404-24-w0roze.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519183/original/file-20230404-24-w0roze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519183/original/file-20230404-24-w0roze.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519183/original/file-20230404-24-w0roze.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">On some highways in Queensland, ‘fatigue zone trivia’ signs were installed to help combat driver fatigue.</span>
<span class="attribution"><span class="source">ribeiroantonio/Shutterstock</span></span>
</figcaption>
</figure>
<h2>A minimum amount of shuteye?</h2>
<p>To do this, we evaluated the scientific evidence from laboratory and field studies that looked at how much prior sleep you need to drive safely.</p>
<p>After synthesising the findings of 61 unique studies, we found having less than four to five hours of sleep in the previous 24 hours is associated with an approximate doubling of the risk of a vehicle crash. This is the same risk of a crash seen when drivers have a <a href="https://www.safetylit.org/citations/index.php?fuseaction=citations.viewdetails&citationIds%5B%5D=citjournalarticle_246699_38">blood alcohol concentration of 0.05%</a>. </p>
<p>Not only this, but a driver’s risk of a crash significantly increases with each hour of sleep lost the night before. Some studies even suggested that when a driver had between zero and four hours of sleep the previous night, they may be up to 15 times <a href="https://academic.oup.com/sleep/article/41/10/zsy144/5067408?fbclid=IwAR0AjP-AnjhQ8CL7GELL4WIBwyPp9a_2AcIslfd5lqJsoyjofnmwA7wKh7I&login=false#122160242%20%20%20%20https://pubmed.ncbi.nlm.nih.gov/12643949/">more likely to have a crash</a>. </p>
<p>Our review suggests that based on the scientific evidence, it may be reasonable to require drivers to have a certain amount of sleep before getting behind the wheel. If we were to align with the degree of risk considered acceptable for intoxication, we may consider requiring a minimum of four to five hours of sleep prior to driving. </p>
<p>However, we must consider more than just the scientific evidence. For the most part, drinking alcohol is something individuals choose to do. Many people cannot decide to get more sleep – for example, <a href="https://www.sciencedirect.com/science/article/pii/S1369847822001310">new parents</a>, <a href="https://academic.oup.com/occmed/article/53/2/89/1519783">shift workers</a> and <a href="https://www.researchgate.net/profile/Harleen-Kaur-31/publication/328228834_Insomnia_Chronic/links/5cebd70e92851c4eabc183c8/Insomnia-Chronic.pdf">people with sleep disorders</a>. Not only that, but for fatigued driving to be regulated, there would need to be significant public support. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-is-it-time-to-stop-driving-will-mandatory-assessments-of-older-drivers-make-our-roads-safer-200352">When is it time to stop driving? Will mandatory assessments of older drivers make our roads safer?</a>
</strong>
</em>
</p>
<hr>
<h2>Is the law even an option?</h2>
<p>We must also consider how such a law would be implemented. There is no current way to evaluate fatigue at the roadside – no breath test or blood test that can evaluate how much sleep you have had, or how impaired you are. As a result, regulating fatigue would likely need to happen in the event of a crash. Was the driver impaired due to fatigue at the time, and are they therefore legally responsible? </p>
<p>Regulating fatigued driving is not a new idea. In New Jersey, “Maggie’s Law” legislation finds drivers to be legally impaired if they have had zero hours of sleep in the previous 24 hours. This law, implemented in 2003 after a fatigued driver killed a college student, <a href="https://www.psychologytoday.com/au/blog/sleepless-in-america/200811/maggies-law">would be considered by many to be quite permissive</a>. That is, a lot of people would expect you would need more than zero hours of sleep in the previous 24 hours to be able to drive safely. However, in Australia in 2023, there is no similar requirement to ensure you are sufficiently rested to get behind the wheel.</p>
<p>We are currently consulting with a range of community members and road safety stakeholders on what the next step might be for regulating fatigued driving in Australia. Preliminary findings indicate that at the very least, more specific public education and guidance for drivers on how to avoid driving while fatigued would be welcomed. For example, easy-to-follow advice on how to decide whether or not you are too fatigued to drive would likely be well received. </p>
<p>While Australia might be a little while off legislating how much sleep to get before getting behind the wheel, we suggest keeping the amount of sleep you’ve had in the previous 24 hours in mind. If you’ve slept less than five hours, you probably shouldn’t drive. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-do-people-tailgate-a-psychology-expert-explains-whats-behind-this-common-and-annoying-driving-habit-193462">Why do people tailgate? A psychology expert explains what's behind this common (and annoying) driving habit</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/202514/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Madeline Sprajcer receives funding from the Office of Road Safety. </span></em></p><p class="fine-print"><em><span>Drew Dawson receives research funding from a range of government and private organisations. These typically involve funding to research the adverse effects of insufficient sleep on workplace health and safety and ways to minimise negative outcomes. He also receives royalty income from licensing arrangements for software products that help organisations measure and mitigate fatigue-related risk (the FAID and FatigueFit product suites). Finally, he is a subject matter expert for a variety of Australian and international safety regulators on matters relating to the identification, measurement and mitigation of fatigue-related risk. </span></em></p>There’s a blood alcohol limit for legally being permitted to drive. Should we have a ‘fatigue limit’?Madeline Sprajcer, Lecturer in Psychology, CQUniversity AustraliaDrew Dawson, Director, Appleton Institute, CQUniversity AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2002272023-03-01T20:55:22Z2023-03-01T20:55:22ZCurious Kids: What happens to your brain if you don’t get enough sleep?<figure><img src="https://images.theconversation.com/files/512986/original/file-20230301-16-qnlajq.jpg?ixlib=rb-1.1.0&rect=0%2C511%2C5595%2C3476&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A common symptom of not getting enough quality sleep is ‘brain fog’ — when thoughts aren’t as clear and focused as they should be. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=293&fit=crop&dpr=1 600w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=293&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=293&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=368&fit=crop&dpr=1 754w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=368&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=368&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>Curious Kids is a series for children of all ages. Have a question you’d like an expert to answer? Send it to <a href="mailto:curiouskidscanada@theconversation.com">CuriousKidsCanada@theconversation.com</a>.</em></p>
<blockquote>
<p><strong>What happens to your brain if you don’t get enough sleep? — Avery, age 7, Napanee, Ont.</strong></p>
</blockquote>
<p>Sleep may be the single biggest factor in maintaining a <a href="https://doi.org/10.1002/da.22769">healthy brain and positive mental health</a>. This is especially true if you are under the age of 20. </p>
<p>What is interesting — and problematic — is that most of us live with a sleep debt: in essence we are not getting enough sleep, so we are <a href="https://www.cdc.gov/niosh/emres/longhourstraining/debt.html#">constantly sleep deprived</a>. And living with a sleep debt has a negative impact on brain function. </p>
<figure class="align-right ">
<img alt="A boy in pyjamas rubbing his eye, carrying a pillow" src="https://images.theconversation.com/files/512992/original/file-20230301-17-ak6abg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/512992/original/file-20230301-17-ak6abg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512992/original/file-20230301-17-ak6abg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512992/original/file-20230301-17-ak6abg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512992/original/file-20230301-17-ak6abg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512992/original/file-20230301-17-ak6abg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512992/original/file-20230301-17-ak6abg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Having a sleep debt can impair all of your brain’s systems — the ones that support perception, memory, attention, decision-making and even learning.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>One of the most common signs of having a sleep debt is <a href="https://www.healthline.com/health-news/foggy-brain-lack-of-sleep">feeling like you are in a brain fog</a>, where things are not as clear and focused as they should be. A lack of sleep can also make us more emotional and can contribute to depression. Further, having a sleep debt can impair all of your brain’s systems — the ones that support perception, memory, attention, decision-making and even learning. </p>
<p>As a neuroscientist, I am extremely interested in the factors that impact brain health and function. Research by my own laboratory, the <a href="http://www.krigolsonlab.com">Theoretical and Applied Neuroscience Laboratory</a> at the University of Victoria, demonstrated that sleep is the <a href="https://doi.org/10.3389/fnins.2021.634147">single biggest predictor of your brain’s ability to form new memories</a>.</p>
<h2>How much sleep do people need?</h2>
<p>You might wonder what a normal amount of sleep is or if you are getting enough sleep. Doctors and researchers recommend <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/oversleeping-bad-for-your-health">between seven and nine hours of sleep per night for adults</a>. If you sleep more than that, it is worth talking with a doctor because oversleeping can be bad for you as well. </p>
<p>However, it is different for kids. Just after they are born, babies might need to sleep <a href="https://www.sleepfoundation.org/children-and-sleep/how-much-sleep-do-kids-need">up to 17 hours a day</a>, and they will not reach the seven-to-nine-hours range until the end of adolescence. School aged children (ages six to 12) typically need nine to 12 hours of sleep per night, and teenagers need between eight and 10 hours of sleep a night. </p>
<p>One interesting thing that science has shown us is that the circadian rhythm — our bodies’ natural clock cycle that determines when we sleep — <a href="https://www.sleepfoundation.org/teens-and-sleep">is different for teenagers than younger children and adults</a>. Teens’ desire to stay up late and sleep in is completely natural. </p>
<h2>How sleep works, and how it affects brain function</h2>
<p>Humans cycle through <a href="https://doi.org/10.1111/j.1749-6632.2009.04416.x">five different stages of sleep each night</a>: NREM1, NREM2, NREM3, NREM4 and REM sleep. </p>
<figure class="align-center ">
<img alt="Graph showing stages of sleep" src="https://images.theconversation.com/files/512972/original/file-20230301-1800-imzk9y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/512972/original/file-20230301-1800-imzk9y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512972/original/file-20230301-1800-imzk9y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512972/original/file-20230301-1800-imzk9y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512972/original/file-20230301-1800-imzk9y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512972/original/file-20230301-1800-imzk9y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512972/original/file-20230301-1800-imzk9y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People cycle through the stages of sleep several times per night.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>REM stands for “rapid eye movement” and this is when we dream. NREM stands for “non rapid eye movement” and the stages are ranked from light sleep to deep sleep. Light — especially NREM2 — is a critical stage of sleep when memories form. NREM3 and NREM4 are crucial for your body to recover from injuries and to have energy for the next day. </p>
<p>In terms of how a lack of sleep impacts brain function, the most prominent working theory is that when we are sleep deprived, it reduces the ability of neurons — the cells that make up our brain — to communicate with each other. That means our brains do not function as effectively, which leads to <a href="https://doi.org/10.1007/s00018-007-6457-8">reduced brain function, poor brain health and potentially even mental health issues</a>. </p>
<h2>How to get quality sleep</h2>
<p>What can we do to improve the quality of our sleep and avoid having a sleep debt? First, try to go to bed at the same time every night and try waking up at the same time every day. A good metric of having good “sleep health” is the ability to wake up at close to the same time every day without needing an alarm clock. </p>
<figure class="align-center ">
<img alt="A child wearing glasses reading a book with a flashlight under a blanket" src="https://images.theconversation.com/files/512980/original/file-20230301-1750-251jxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/512980/original/file-20230301-1750-251jxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512980/original/file-20230301-1750-251jxk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512980/original/file-20230301-1750-251jxk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512980/original/file-20230301-1750-251jxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512980/original/file-20230301-1750-251jxk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512980/original/file-20230301-1750-251jxk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">For quality sleep, avoid screens such as phones, tablets or televisions before bed.</span>
<span class="attribution"><span class="source">(Pexels/Kampus Production)</span></span>
</figcaption>
</figure>
<p>It’s important to know that <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/oversleeping-bad-for-your-health">you cannot oversleep to make up for a lack of sleep</a>. In fact, sleeping in on the weekend is one of the worst things you can do to recover from a sleep deficit. </p>
<p>Another thing you can do to improve the quality of your sleep is to avoid looking at screens — phones, computers, TVs — before you go to bed. The technology used to make these screens has been <a href="https://www.sleepfoundation.org/how-sleep-works/how-electronics-affect-sleep">shown to increase alertness, making it hard to fall asleep</a>. </p>
<p>Also, make sleep a priority — it is better to go to sleep and let your brain recover than it is to stay up late studying. In fact, one of the best things you can do at school to improve how well you learn is to get a good night’s sleep. </p>
<p>Finally, having a healthy, <a href="https://doi.org/10.1183/16000617.0110-2016">well-balanced diet and getting sufficient exercise</a> have also been shown to improve sleep health and sleep quality.</p>
<p>So make sure you get enough sleep. Not getting enough sleep is associated with reduced brain health and function, and can even lead to mental health problems such as anxiety and depression.</p><img src="https://counter.theconversation.com/content/200227/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Olave Krigolson receives funding from the Natural Sciences and Engineering Research Council of Canada.</span></em></p>We live in a world where we frequently do not get enough sleep, but we need sleep if our brains are going to stay healthy and function efficiently.Olave Krigolson, Professor, Neuroscience, University of VictoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1975072023-01-13T01:23:29Z2023-01-13T01:23:29ZSitting all day is terrible for your health – here’s a relatively easy way to counteract it<figure><img src="https://images.theconversation.com/files/504122/original/file-20230111-47543-s7tq98.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C5112%2C3403&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Researchers have long known that sitting at your desk hour after hour is an unhealthy habit.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/business-man-working-on-computer-royalty-free-image/475967873?phrase=sitting%20at%20desk&adppopup=true">Morsa Images/Digital Vision via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>To reduce the harmful health effects of sitting, take a five-minute light walk every half-hour. That’s the key finding of <a href="https://journals.lww.com/acsm-msse/Abstract/9900/Breaking_Up_Prolonged_Sitting_to_Improve.200.aspx">a 2023 study</a> that my colleagues and I published in the journal Medicine & Science in Sports & Exercise.</p>
<p>We asked 11 healthy middle-aged and older adults to sit in our lab for eight hours – representing a standard workday – over the course of five separate days. On one of those days, participants sat for the entire eight hours with only short breaks to use the bathroom. On the other days, we tested a number of different strategies to break up a person’s sitting with light walking. For example, on one day, participants walked for one minute every half-hour. On another day, they walked for five minutes every hour. </p>
<p>Our goal was to find the least amount of walking one could do to offset the harmful health effects of sitting. In particular, we measured changes in blood sugar levels and blood pressure, two important <a href="https://doi.org/10.1161/CIRCULATIONAHA.109.192703">risk factors for heart disease</a>.</p>
<p>We found that a five-minute light walk every half-hour was the only strategy that reduced blood sugar levels substantially compared with sitting all day. In particular, five-minute walks every half-hour reduced the blood sugar spike after eating by almost 60%. </p>
<p>That strategy also reduced blood pressure by four to five points compared with sitting all day. But shorter and less frequent walks improved blood pressure too. Even just a one-minute light walk every hour reduced blood pressure by five points.</p>
<p>In addition to physical health benefits, there were also mental health benefits to the walking breaks. During the study, we asked participants to rate their mental state by using a questionnaire. We found that compared with sitting all day, a five-minute light walk every half-hour reduced feelings of fatigue, put participants in a better mood and helped them feel more energized. We also found that even walks just once every hour were enough to boost mood and reduce feelings of fatigue. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/iOqLwftSffE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Along with short, frequent walks, a long daily walk could add years to your life.</span></figcaption>
</figure>
<h2>Why it matters</h2>
<p>People who sit for hours on end develop chronic diseases <a href="https://doi.org/10.1249/MSS.0000000000001935">including diabetes, heart disease, dementia and several types of cancer</a> at much higher rates than people who move throughout their day. A sedentary lifestyle also puts people at a much greater risk of <a href="https://www.acpjournals.org/doi/full/10.7326/M17-0212">early death</a>. But just exercising daily may not reverse <a href="http://dx.doi.org/10.1136/bjsports-2020-102345">the harmful health effects of sitting</a>. </p>
<p>Because of technological advances, the amount of time adults in industrialized countries like the U.S. spend sitting has been <a href="https://doi.org/10.1146/annurev.publhealth.26.021304.144437">steadily increasing for decades</a>. Many adults now spend the majority of their day sitting. This problem has only gotten worse since the <a href="http://dx.doi.org/10.1136/bmjsem-2020-000960">start of the COVID-19 pandemic</a>. With the migration to more remote work, people are less inclined to venture out of the house these days. So it’s clear that strategies are needed to combat a growing 21st century public health problem. </p>
<p>Current guidelines recommend that <a href="https://doi.org/10.1001/jama.2018.14854">adults should “sit less, move more</a>.” But these recommendations don’t provide any specific advice or strategies for how often and how long to move. </p>
<p>Our work provides a simple and affordable strategy: Take a five-minute light walk every half-hour. If you have a job or lifestyle where you have to sit for prolonged periods, this one behavior change could reduce your health risks from sitting.</p>
<p>Our study also offers clear guidance to employers on how to promote a healthier workplace. While it may seem counterintuitive, taking regular walking breaks can actually help workers be more productive than working without stopping. </p>
<h2>What still isn’t known</h2>
<p>Our study primarily focused on taking regular walking breaks at a light intensity. Some of the walking strategies – for example, one-minute light walks every hour – did not lower blood sugar levels. We don’t know if more rigorous walking would have provided health benefits at these doses. </p>
<h2>What’s next</h2>
<p>We are currently testing over 25 different strategies for offsetting the health harms of prolonged sitting. Many adults have jobs, such as driving trucks or taxis, where they simply cannot walk every half-hour. Finding alternative strategies that yield comparable results can provide the public with several different options and ultimately allow people to pick the strategy that works best for them and their lifestyle.</p><img src="https://counter.theconversation.com/content/197507/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Keith Diaz receives funding from the National Institutes of Health. </span></em></p>Short, frequent walks throughout the day are key to helping prevent the harmful effects of a sedentary lifestyle.Keith Diaz, Associate Professor of Behavioral Medicine, Columbia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1927142022-11-23T13:18:04Z2022-11-23T13:18:04ZVitamin B12 deficiency is a common health problem that can have serious consequences – but doctors often overlook it<figure><img src="https://images.theconversation.com/files/494905/original/file-20221111-12-d6vtg1.jpg?ixlib=rb-1.1.0&rect=61%2C12%2C7983%2C5395&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fatigue can be a sign of a potential B12 deficiency.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/unhappy-african-american-woman-suffering-from-royalty-free-image/1387710368?adppopup=true">Maca and Naca/E+ via Getty Images</a></span></figcaption></figure><p>For several months during the summer of 2022, my dog Scout vomited at 3 a.m. nearly every day. If you have a dog, you know the sound. And each time, she gobbled up her mess before I could get to it, making diagnosis of the cause difficult.</p>
<p>The vet and I eventually settled on my hydrangeas as the source of the problem – but keeping Scout away from them didn’t work. She started to seem tired all the time – highly concerning in a typically hyper yellow Lab puppy. </p>
<p>Then one day Scout vomited up a hairball – but not just any hairball. In dogs, hair normally passes easily through the digestive system, but this hairball was wrapped around a brillo pad that was too big to move through. Once this foreign object was removed, the overnight vomiting ended. Scout still needed treatment, though, for a different and surprising reason: The object had inhibited a step in her body’s absorption of vitamin B12. B12 is an essential nutrient involved in proper functioning of blood cells, nerves and many other critical processes in the body. </p>
<p>I’m a registered dietitian, and <a href="https://s.wayne.edu/cress/">I teach nutrition and food science</a> to college students, but still I missed the B12 deficiency that was causing my puppy’s fatigue. Doctors can just as easily be blind to it in people – even though B12 deficiency is a common health problem that affects an estimated <a href="https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/">6% to 20%</a> of the U.S. population. </p>
<p>B12 is scarce in the diet, and it is found only in foods from animal sources. Fortunately, humans need only <a href="https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/">2.4 micrograms of B12 daily</a>, which is equivalent to one ten-millionth of an ounce – a very, very small amount. Without adequate B12 in the body, overall health and quality of life are negatively affected. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An overhead shot of an array of B12-containing foods, including oysters, fish, eggs, red meat and more." src="https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=524&fit=crop&dpr=1 754w, https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=524&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/496595/original/file-20221121-22-n793sh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=524&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">An array of vitamin B12-rich foods – all of which come from animals.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/vitamin-b12-containing-foods-royalty-free-image/511052342?phrase=B12%20foods&adppopup=true">photka/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>Signs and symptoms</h2>
<p>One primary symptom of B12 deficiency is fatigue – a level of tiredness or exhaustion so deep that it affects daily life activities. </p>
<p>Other symptoms are neurological and may include tingling in the extremities, confusion, memory loss, depression and difficulty maintaining balance. Some of these <a href="https://doi.org/10.1182/blood-2016-10-569186">can be permanent</a> if the vitamin deficiency is not addressed.</p>
<p>However, since there can be so many causes for these symptoms, health care providers may overlook the possibility of a B12 deficiency and fail to screen for it. Further, having a healthy diet may seem to rule out any vitamin deficiency. Case in point: Because I knew Scout’s diet was sound, I didn’t consider a B12 deficiency as the source of her problems. </p>
<h2>How B12 is absorbed</h2>
<p>Research is clear that people who consume plant-based diets <a href="https://doi.org/10.1080/10408398.2022.2107997">must take B12 supplements</a> in amounts typically provided by standard multivitamins. However, hundreds of millions of Americans who do consume B12 may also be at risk because of conditions that could be hampering their body’s absorption of B12.</p>
<p>B12 absorption is a <a href="https://doi.org/10.1038/nrgastro.2012.76">complex multistep process</a> that begins in the mouth and ends at the far end of the small intestine. When we chew, our food gets mixed with saliva. When the food is swallowed, a substance in saliva called <a href="https://doi.org/10.3390/nu12123838">R-protein</a> – a protein that protects B12 from being destroyed by stomach acid – travels to the stomach along with the food. </p>
<p>Specific cells in the stomach lining, called parietal cells, secrete two substances that are important to B12 absorption. One is stomach acid – it splits food and B12 apart, allowing the vitamin to bind to the saliva’s R-protein. The other substance, called intrinsic factor, mixes with the stomach’s contents and travels with them into the first part of the small intestine – the duodenum. Once in the duodenum, pancreatic juices release B12 from R-protein and hand it to intrinsic factor. This pairing allows B12 to be absorbed into cells, where it can then help maintain nerve cells and form healthy red blood cells.</p>
<p>A B12 deficiency typically involves a breakdown at one or more of these points on the way to absorption.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/ANd8trfNvKQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Dr. Darien Sutton explains symptoms of B12 deficiency in this December 2021 segment of the ABC TV show ‘Good Morning America.’</span></figcaption>
</figure>
<h2>Risk factors for B12 deficiency</h2>
<p>Without saliva, B12 will not bind to the saliva’s R-protein, and the body’s ability to absorb it is inhibited. And there are hundreds of different <a href="https://ostrowon.usc.edu/medications-that-cause-dry-mouth/">drugs that can cause dry mouth</a>, resulting in too little saliva production. They include opioids, inhalers, decongestants, <a href="https://doi.org/10.3389/fpsyt.2020.00035">antidepressants</a>, <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6914a1.htm">blood pressure drugs</a> and <a href="https://doi.org/10.1176%2Fappi.ps.201800321">benzodiazepines</a>, like Xanax, used to treat anxiety. </p>
<p>The last three categories alone account for easily 100 million prescriptions in the U.S. each year. </p>
<p>Another potential contributor to B12 deficiency is low levels of stomach acid.
Hundreds of millions of Americans take <a href="https://www.drugs.com/condition/gastric-ulcer.html?page_number=2">anti-ulcer medications</a> that reduce ulcer-causing stomach acids. Researchers have firmly linked the use of these drugs to <a href="https://doi.org/10.1093/advances/nmy023">B12 deficiency</a> – although that possibility <a href="https://doi.org/10.1053/j.gastro.2017.01.031">may not outweigh the need for the medication</a>. </p>
<p>Production of stomach acid <a href="https://doi.org/10.1093/ajcn/nqab193">can also decrease with aging</a>. More than 60 million people in the U.S. are <a href="https://acl.gov/sites/default/files/aging%20and%20Disability%20In%20America/2020Profileolderamericans.final_.pdf">over age 60</a>, and some 54 million are over the age of 65. This population faces a higher risk of B12 deficiency – which may be further increased by use of acid-reducing medications. </p>
<p>Production of gastric acid and intrinsic factor by the specialized parietal cells in the stomach is critical for B12 absorption to occur. But damage to the stomach lining can prevent production of both. </p>
<p>In humans, impaired stomach lining stems from gastric surgery, chronic inflammation or <a href="https://doi.org/10.1038/ajg.2009.231">pernicious anemia</a> – a medical condition characterized by fatigue and a long list of other symptoms.</p>
<p>Another common culprit of B12 deficiency is inadequate <a href="https://doi.org/10.1172/jci108924">pancreas function</a>. About one-third of patients with poor pancreas function <a href="https://doi.org/10.1097/00006676-199009000-00011">develop a B12 deficiency</a>. </p>
<p>And lastly, Metformin, a drug used by around <a href="https://www.statista.com/statistics/780332/metformin-hydrochloride-prescriptions-number-in-the-us/">92 million Americans</a> to treat Type 2 diabetes, has been associated with <a href="https://doi.org/10.1136%2Fbmj.2.5763.685">B12 deficiency for decades</a>.</p>
<h2>Treatment for B12 deficiency</h2>
<p>While some health care providers routinely measure B12 and other vitamin levels, a typical well-check exam includes only a complete blood count and a metabolic panel, neither of which measures B12 status. If you experience potential symptoms of a B12 deficiency and also have one of the risk factors above, you should see a doctor to be tested. A proper lab workup and discussion with a physician are necessary to discover or rule out whether inadequate B12 levels could be at play.</p>
<p>In the case of my dog Scout, her symptoms led the vet to run two blood tests: a complete blood count and a B12 test. These are also good starting points for humans. Scout’s symptoms went away after a few months of taking oral B12 supplements that also contained an active form of the B vitamin folate.</p>
<p>In humans, the type of treatment and length of recovery depend on the cause and severity of the B12 deficiency. Full recovery can take up to a year but is very possible with appropriate treatment. </p>
<p><a href="https://doi.org/10.3389/fphar.2022.972468">Treatment for B12 deficiency</a> can be oral, applied under the tongue or administered through the nose, or it may require various types of injections. A B12 supplement or balanced multivitamin may be enough to correct the deficiency, as it was for Scout, but it’s best to work with a health care provider to ensure proper diagnosis and treatment.</p><img src="https://counter.theconversation.com/content/192714/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Diane Cress does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The symptoms of B12 deficiency resemble a lot of other health problems, putting millions of Americans at risk of a misdiagnosis.Diane Cress, Associate Professor of Nutrition and Food Science, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1879842022-08-08T20:03:06Z2022-08-08T20:03:06ZWhy am I so tired and when is it time to see the doctor about it? A GP explains<figure><img src="https://images.theconversation.com/files/476813/original/file-20220801-24-vmtt8t.jpg?ixlib=rb-1.1.0&rect=0%2C141%2C7839%2C5741&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Everyone feels tired sometimes. But how do you know whether your tiredness is a problem worth seeing a doctor about? And with all the mental and emotional strain we have been under from the pandemic, isn’t it just normal to feel tired?</p>
<p>Tiredness is subjective; what’s normal for one person won’t be for the next. Many people see their GPs reporting tiredness (a recent study in Ireland found that it was <a href="https://www.researchgate.net/publication/11376157_Prevalence_of_fatigue_in_general_practice">present in 25% of patients</a>). </p>
<p>As a GP, my first question to someone who feels tired is: “how well can you function?”. </p>
<p>If tiredness is interfering with your everyday life and your ability to do what you like to do, it should be explored further.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/476809/original/file-20220801-22375-w5zbiu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman looks tired at work." src="https://images.theconversation.com/files/476809/original/file-20220801-22375-w5zbiu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/476809/original/file-20220801-22375-w5zbiu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/476809/original/file-20220801-22375-w5zbiu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/476809/original/file-20220801-22375-w5zbiu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/476809/original/file-20220801-22375-w5zbiu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/476809/original/file-20220801-22375-w5zbiu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/476809/original/file-20220801-22375-w5zbiu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If your level of tiredness is outside the range of normal for you, chat to a GP about it.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
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Read more:
<a href="https://theconversation.com/fatigue-after-covid-is-way-more-than-just-feeling-tired-5-tips-on-what-to-do-about-it-179478">Fatigue after COVID is way more than just feeling tired. 5 tips on what to do about it</a>
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<h2>Some common causes of persistent tiredness</h2>
<p>Poor sleep is an obvious and very common cause of tiredness. Often patients tell me “Oh, lack of sleep is not the cause, I sleep fine, possibly too much!” But on questioning they admit they don’t wake up feeling refreshed.</p>
<p>That’s a bit of a giveaway because it means their sleep quality is poor, even if the quantity seems enough. They could be suffering from sleep <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/sleep-apnoea">apnoea</a>, where breathing stops and starts while a person is asleep. Apnoea can lead to serious long-term health problems, so it’s worth investigating.</p>
<p>Alcohol can also wreak havoc on a person’s sleep quality and they wake feeling unrefreshed.</p>
<p>Another common cause of tiredness is depression – and don’t forget, someone can be depressed without feeling they have low mood. For example, they may feel <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/depression#symptoms-of-depression">irritable or frustrated, or struggle to concentrate</a>. This is concerning, because such patients may fly under the radar and not realise this is actually depression. Unexplained tiredness may be the predominant symptom of depression, with other symptoms only coming to light with careful questioning. </p>
<p>Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a serious long-term illness that, among other symptoms, causes people to feel extreme fatigue – well beyond the range of “normal” tiredness. It can begin with patients noticing a degree or type of tiredness different from their past experience, and can be difficult to diagnose in the early stages.</p>
<p>There are other potential causes of tiredness – problems such as low iron, thyroid disease, diabetes, kidney disease, heart disease and many more. Treatment for these can alleviate the tiredness too.</p>
<p>Tiredness also accompanies many illnesses, but should not persist after recovery.</p>
<p>The take-home message is this: if tiredness is interfering with your life, there are many possible causes and it’s worth speaking to a GP about it.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/476810/original/file-20220801-67813-uha9wt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/476810/original/file-20220801-67813-uha9wt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/476810/original/file-20220801-67813-uha9wt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/476810/original/file-20220801-67813-uha9wt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/476810/original/file-20220801-67813-uha9wt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/476810/original/file-20220801-67813-uha9wt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/476810/original/file-20220801-67813-uha9wt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/476810/original/file-20220801-67813-uha9wt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Poor sleep is a very common cause of tiredness.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What does ‘interfering with life’ actually look like?</h2>
<p>Screening tools for a concerning level of tiredness include the <a href="https://nasemso.org/wp-content/uploads/neuro-epworthsleepscale.pdf">Epworth Sleepiness Scale</a> and the <a href="https://www.mdcalc.com/calc/3992/stop-bang-score-obstructive-sleep-apnea">STOP-BANG</a> score. You can do both tests at home and take the results to your GP.</p>
<p>But even if you have normal scores, your tiredness is worth investigating if you:</p>
<ul>
<li><p>feel too tired to exercise (this can be a vicious cycle because regular exercise can actually give you more energy – however, it can be <a href="https://www.npr.org/sections/health-shots/2017/10/02/554369327/for-people-with-chronic-fatigue-syndrome-more-exercise-isnt-better">risky</a> for people with ME/CFS to exercise, so caution is required for these patients)</p></li>
<li><p>feel too tired to go out, see friends or do activities you once enjoyed</p></li>
<li><p>hit the alarm snooze button a lot because you don’t wake feeling refreshed</p></li>
<li><p>doze off in front of the TV regularly</p></li>
<li><p>spend the whole day wishing you could go back to bed.</p></li>
</ul>
<p>If, along with tiredness, you also have any of the following “red flags”, it is vital you see a GP sooner rather than later: unexplained weight loss, shortness of breath, recurrent fevers, bleeding from your bowels or gums, swollen and sore joints, or other new symptoms concerning you.</p>
<p>I sometimes get asked if wanting an afternoon nap is a red flag. That’s a tricky one; a late afternoon energy slump is pretty normal physiologically (we have whole cultures built around the idea of a siesta, and I often wish Australia was more open to the idea!).</p>
<p>And, of course, many of us lead busy lives and are subject to crushing expectations around work, study and parenting. Tiredness may not always be sign of a physical health problem, but rather that the balance between work and rest is not right.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/476812/original/file-20220801-9120-s4sk8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/476812/original/file-20220801-9120-s4sk8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/476812/original/file-20220801-9120-s4sk8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/476812/original/file-20220801-9120-s4sk8l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/476812/original/file-20220801-9120-s4sk8l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/476812/original/file-20220801-9120-s4sk8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/476812/original/file-20220801-9120-s4sk8l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/476812/original/file-20220801-9120-s4sk8l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Do you feel refreshed when you wake up?</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>OK, I’m starting to realise my tiredness might be a problem. What now?</h2>
<p>Talk to your doctor. What happens next depends on the individual and unique factors at play. </p>
<p>Some people need investigating immediately if possible serious underlying causes are suspected.</p>
<p>However, there are often obvious ways to address lifestyle factors, and we’d start there. Is alcohol or caffeine interfering with your sleep? Do you have good <a href="https://www.cci.health.wa.gov.au/%7E/media/CCI/Mental-Health-Professionals/Sleep/Sleep---Information-Sheets/Sleep-Information-Sheet---04---Sleep-Hygiene.pdf">sleep hygiene habits</a>? Is your exercise level appropriate and your diet not <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071235/">too high in sugar</a>?</p>
<p>After we’ve tackled lifestyle factors, we can look at whether to investigate for health conditions that might be contributing to the tiredness. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/476814/original/file-20220801-20-yzxuzi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/476814/original/file-20220801-20-yzxuzi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/476814/original/file-20220801-20-yzxuzi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/476814/original/file-20220801-20-yzxuzi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/476814/original/file-20220801-20-yzxuzi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/476814/original/file-20220801-20-yzxuzi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/476814/original/file-20220801-20-yzxuzi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/476814/original/file-20220801-20-yzxuzi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Do you often fall asleep on the couch watching TV?</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What about post-COVID fatigue?</h2>
<p>As I have <a href="https://theconversation.com/fatigue-after-covid-is-way-more-than-just-feeling-tired-5-tips-on-what-to-do-about-it-179478">written</a> before, fatigue is about more than feeling just tired:</p>
<blockquote>
<p>Tiredness can get better with enough rest, while fatigue persists even if someone is sleeping and resting more than ever.</p>
</blockquote>
<p>If you’re especially concerned about fatigue after recovering from COVID and are worried about long COVID, definitely talk to a doctor. </p>
<p>The factors at play are complex and unique to the individual, so a good doctor can help you work out when tiredness has crossed over into true fatigue.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/still-coughing-after-covid-heres-why-it-happens-and-what-to-do-about-it-179471">Still coughing after COVID? Here's why it happens and what to do about it</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/187984/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natasha Yates is affiliated with the RACGP</span></em></p>A good doctor can help you work out when tiredness has crossed over into true fatigue.Natasha Yates, Assistant Professor, General Practice, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1838242022-06-27T19:50:56Z2022-06-27T19:50:56ZWe need to brace for a tsunami of long COVID. But we’re not quite sure the best way to treat it<figure><img src="https://images.theconversation.com/files/470224/original/file-20220622-23-nhhq3p.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C1911%2C1279&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/0QEG_xOoY7Y">Matt Paul Catalano/Unsplash</a></span></figcaption></figure><p>Australia’s Omicron wave earlier this year was much larger than we thought, <a href="https://www.ncirs.org.au/national-antibody-study-confirms-covid-19-cases-higher-reported">recent research</a> has confirmed. We also heard Health Minister Mark Butler <a href="https://twitter.com/BigBadDenis/status/1539033414182916096/photo/1">acknowledge</a> Australia can expect a “<a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/minister-butler-interview-with-david-koch-sunrise-21-june-2022">very big wave</a>” of people with long COVID over the next few years.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1538992134573166592"}"></div></p>
<p>Doctors and researchers have been <a href="https://theconversation.com/we-calculated-the-impact-of-long-covid-as-australia-opens-up-even-without-omicron-were-worried-168662">warning</a> about the growing threat of long COVID, as restrictions ease and case numbers climb.</p>
<p>So we need to take an urgent look at how we manage and treat it.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-calculated-the-impact-of-long-covid-as-australia-opens-up-even-without-omicron-were-worried-168662">We calculated the impact of 'long COVID' as Australia opens up. Even without Omicron, we're worried</a>
</strong>
</em>
</p>
<hr>
<h2>Remind me again, what’s long COVID?</h2>
<p>More than <a href="https://www.health.gov.au/health-alerts/covid-19/case-numbers-and-statistics">7 million</a> Australians have had COVID; most have recovered from the acute illness. But some have lingering symptoms for months, or longer.</p>
<p>The World Health Organization <a href="https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-(covid-19)-post-covid-19-condition">defines</a> long COVID as symptoms present three months after infection, lasting at least two months, that cannot be attributed to other diagnoses.</p>
<p>The most common symptoms include: fatigue, especially after activity, shortness of breath, brain fog or difficulty concentrating, sleep problems, chronic cough, muscle aches and pains, loss of smell or taste, depression and anxiety.</p>
<p>But there is no one test that diagnoses long COVID. So this multitude of complex symptoms makes it a difficult condition to track down, study and treat.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fatigue-after-covid-is-way-more-than-just-feeling-tired-5-tips-on-what-to-do-about-it-179478">Fatigue after COVID is way more than just feeling tired. 5 tips on what to do about it</a>
</strong>
</em>
</p>
<hr>
<h2>Who’s more likely to get long COVID?</h2>
<p>The risk of long COVID <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8611223/">is increased</a> <a href="https://www.sciencedirect.com/science/article/pii/S0140673620326568">in people</a> <a href="https://www.sciencedirect.com/science/article/pii/S2213260021003830">who have had</a> more severe COVID, women and people with a chronic illness, such as diabetes, or chronic lung or heart disease. </p>
<p>A <a href="https://www.nature.com/articles/s41467-021-26513-3">US study</a> looked at 4.5 million people treated in the community or in hospital, and followed them to see if they developed long COVID. At six months, 7% had symptoms. </p>
<p>Worryingly this study also suggests being vaccinated only reduced the risk of long COVID <a href="https://www.nature.com/articles/d41586-022-01453-0#ref-CR1">by 15%</a>. Symptoms such as brain fog and fatigue were present and vaccination seemed only partly protective against them.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1537307855141076993"}"></div></p>
<h2>How do we treat long COVID?</h2>
<p>Australia’s National COVID-19 Clinical Evidence Taskforce’s <a href="https://covid19evidence.net.au/wp-content/uploads/FLOWCHART-POST-COVID-19.pdf?=220606-212218">recommendations</a> for treating long COVID were updated in May. But these borrow heavily from UK recommendations and the evidence backing these recommendations is at best weak.</p>
<p><a href="https://bjgp.org/content/71/712/e815?onwardjourney=584162_v1">In the UK</a> “long COVID clinics” have adopted a medical-led holistic model of care. This involves GPs, specialists and allied health workers, such as physiotherapists, occupational therapists and exercise physiologists. Similar clinics have been <a href="https://www.svhlunghealth.com.au/about-us/whats-new/new-post-acute-long-covid-clinic">set up</a> in Australia.</p>
<p>However, the advice for such clinics is based on consensus and experience of similar conditions, such as chronic fatigue, and what we know about how people recover after leaving intensive care, rather than the results of robust studies focusing on long COVID. </p>
<p>UK advice for treating long COVID <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/jmv.27309">involves</a> looking for and managing COVID complications that may affect the lungs, lead to heart disease and managing other existing conditions, such as obesity and diabetes. It also recommends assessing and managing anxiety and depression, which not surprisingly is common in people with long COVID. </p>
<p><a href="https://www.nice.org.uk/guidance/ng188">UK guidelines advise</a> supporting people to manage their own symptoms, including getting support from their GP, then referral to specialist services when needed.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-tips-for-young-people-dealing-with-long-covid-from-a-gp-180464">Five tips for young people dealing with long COVID – from a GP</a>
</strong>
</em>
</p>
<hr>
<p>If people had COVID pneumonia – especially those who went to intensive care, still have breathing problems and are weak – there is some limited evidence pulmonary rehabilitation helps. This is out-patient care with specialist physiotherapists and nurses, involving breathing exercises, education and support.</p>
<p>Two small trials have shown <a href="https://openres.ersjournals.com/content/7/2/00108-2021.short">pulmonary rehabilitation</a>, <a href="https://www.karger.com/Article/Abstract/522118">improves</a> breathlessness, exercise capacity, fatigue and quality of life. So this is now recommended. </p>
<h2>How to manage fatigue, pain and brain fog?</h2>
<p>However, breathing problems are only <a href="https://www.medrxiv.org/content/10.1101/2022.05.24.22275398.abstract">one component</a> of long COVID.</p>
<p>For people with long COVID and severe fatigue or pain following exertion, a standard exercise program may make things worse. Here, the <a href="https://academic.oup.com/ptj/article-abstract/102/4/pzac005/6506311?login=false">recommendation is</a> for an initial period of rest then incremental increase in activity, often over many months. However, the optimal approach is not defined. </p>
<p>Neurological symptoms of poor concentration or brain fog, sleep disturbance and altered taste are common, but as yet there are <a href="https://www.sciencedirect.com/science/article/pii/S0022510X22000211">no agreed or proven therapies</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/has-covid-affected-your-sleep-heres-how-viruses-can-change-our-sleeping-patterns-184323">Has COVID affected your sleep? Here’s how viruses can change our sleeping patterns</a>
</strong>
</em>
</p>
<hr>
<p>Some people with the most severe neurological symptoms and fatigue develop a disabling condition known as <a href="https://link.springer.com/article/10.1007/s10286-021-00798-2?fbclid=IwAR2rXpeV6UnFYM8rSWS0GkJaDyv1T1LsA7Sf2h8PIQR5hBTYJuECGArbsZU">postural orthostatic tachycardia syndrome</a> or POTS. When people stand up, their heart races and blood pressure falls. This leads to severe fatigue, headaches and difficulty concentrating.</p>
<p>This condition <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/postural-orthostatic-tachycardia-syndrome-pots">can be treated</a> by modifying someone’s diet and taking medication. We know this because we see POTS after other infectious diseases or other prolonged, severe diseases that lead to hospitalisation. However, we need clinical trials for these therapies for long COVID to see which treatments work and for whom.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1537418045769015303"}"></div></p>
<h2>What’s in the future</h2>
<p>There are many aspects of long COVID that health authorities, doctors and researchers have yet to pin down.</p>
<p>We still don’t know what causes long COVID, we don’t have a universally accepted definition of it, robust data to say how many Australians are or will be affected, nor a concrete plan of how to manage the many thousands of cases we can expect. So evidence-based treatments for long COVID are only part of the picture.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1537811500282298376"}"></div></p>
<p>But the problem we face is here now. We cannot wait for gold-standard evidence to come in before we start treating people.</p>
<p>In the meantime, people need reliable information about the symptoms of long COVID, what to expect and where to go for help. And health professionals need to take their symptoms seriously. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/social-media-activism-trucker-caps-the-fascinating-story-behind-long-covid-168465">Social media, activism, trucker caps: the fascinating story behind long COVID</a>
</strong>
</em>
</p>
<hr>
<p>Health professionals also need training in how to manage people with long COVID, targeting appropriate investigations and treatments that will benefit people the most.</p>
<p>That does not just mean specialised long COVID clinics in capital cities, though it is likely we will need these to help people with the most debilitating problems. </p>
<p>Our response will also need to leverage help from a range of existing health providers, and a coordinated response to deal with symptoms that range from mild to severely debilitating. People need support for rehabilitation, mental health and return to work or study. </p>
<p>If we do not start planning and preparing now, the problem will only worsen.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/first-covid-hit-disadvantaged-communities-harder-now-long-covid-delivers-them-a-further-blow-183908">First, COVID hit disadvantaged communities harder. Now, long COVID delivers them a further blow</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/183824/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Wark receives funding from NHMRC Australia, MRFF and NIH.</span></em></p>We need to take an urgent look at how we manage and treat long COVID. If we don’t start planning now, the problem will only get worse.Peter Wark, Conjoint Professor, School of Medicine and Public Health, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1794782022-04-06T02:54:34Z2022-04-06T02:54:34ZFatigue after COVID is way more than just feeling tired. 5 tips on what to do about it<figure><img src="https://images.theconversation.com/files/455686/original/file-20220331-27172-kj80a.jpg?ixlib=rb-1.1.0&rect=13%2C18%2C3069%2C2297&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/SevjX8pf_tQ">Mel Elias/Unsplash</a></span></figcaption></figure><p>People are often surprised by how fatigued they are during a COVID infection. </p>
<p>Fatigue is more than being worn out or sleepy. It’s an excessive tiredness that persists <a href="https://www.healthdirect.gov.au/fatigue">despite resting or good sleep</a>. It’s likely a result of our body’s strong immune response to the virus. </p>
<p>But in some people the fatigue drags on even when the infection is gone. This can be debilitating and frustrating. Simply resting more makes no difference. </p>
<p>Here’s what we know about post-COVID fatigue, and what can help.</p>
<h2>Fatigue or tiredness? What’s the difference?</h2>
<p>The term fatigue can mean different things to different people.
Some people mean their muscles are easily weakened. Walking to the mailbox feels like they have run a marathon. Others describe a generalised exhaustion, whether they are moving or not. People can experience <a href="https://academic.oup.com/brain/article/140/8/2240/3924144?login=false">physical, mental or emotional</a> fatigue, or any combination of these.</p>
<p>The difference between tiredness and fatigue is this: tiredness can get better with enough rest, while <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/fatigue">fatigue persists</a> even if someone is sleeping and resting more than ever.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/still-coughing-after-covid-heres-why-it-happens-and-what-to-do-about-it-179471">Still coughing after COVID? Here's why it happens and what to do about it</a>
</strong>
</em>
</p>
<hr>
<h2>How big a problem is this?</h2>
<p>Because there is no agreed definition of post-COVID fatigue, it is impossible to give exact numbers of how many people experience it.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1508887460973060099"}"></div></p>
<p>Estimates vary considerably worldwide. <a href="https://academic.oup.com/ofid/article/8/10/ofab440/6367589">One review of 21 studies</a> found 13-33% of people were fatigued 16-20 weeks after their symptoms started. This is a worryingly widespread problem. </p>
<h2>When should I see my GP?</h2>
<p>There are many potential causes of fatigue. Even before the pandemic, fatigue was one of the most <a href="https://www.racgp.org.au/afp/2014/july/fatigue#ref-7">common reasons to see a GP</a>. </p>
<p>Most serious causes can be ruled out when your GP asks about your symptoms and examines you. Sometimes your GP will investigate further, perhaps by ordering blood tests.</p>
<p>Symptoms that should raise particular concern include fevers, unexplained weight loss, unusual bleeding or bruising, pain (anywhere) that wakes you from sleep, or drenching night sweats. </p>
<p>If your fatigue is getting worse rather than better, or you cannot care for yourself properly, you really should seek medical care.</p>
<h2>Is it like long COVID?</h2>
<p>Early in the pandemic, we realised some patients had a cluster of debilitating symptoms that dragged on for months, which we now call long COVID. </p>
<p>Some <a href="https://onlinelibrary.wiley.com/doi/10.1002/acn3.51350">85%</a> of long COVID patients experience fatigue, making it one of the most common long COVID symptoms.</p>
<p>However, people with long COVID have a range of other symptoms, such as “brain fog”, headaches and muscle aches. Patients with long COVID therefore experience more than fatigue, and sometimes don’t have fatigue at all. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/social-media-activism-trucker-caps-the-fascinating-story-behind-long-covid-168465">Social media, activism, trucker caps: the fascinating story behind long COVID</a>
</strong>
</em>
</p>
<hr>
<h2>Is this like chronic fatigue syndrome?</h2>
<p>We knew about <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/chronic-fatigue-syndrome-cfs">chronic fatigue syndrome</a>, otherwise known as myalgic encephalomyelitis, <a href="https://pubmed.ncbi.nlm.nih.gov/7978722/">well before COVID</a>. </p>
<p>This often develops after a viral infection (for instance after infection with <a href="https://pubmed.ncbi.nlm.nih.gov/2578266/">Epstein-Barr virus</a>). So, understandably, there has been concern around the coronavirus potentially triggering chronic fatigue syndrome.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-chronic-fatigue-syndrome-17204">Explainer: what is chronic fatigue syndrome?</a>
</strong>
</em>
</p>
<hr>
<p>There are striking similarities between chronic fatigue syndrome and long COVID. Both involve debilitating fatigue, brain fog and/or muscle aches.</p>
<p>But at this stage, researchers are still <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180841/">untangling any link</a> between post-COVID fatigue, long COVID and chronic fatigue syndrome.</p>
<p>For now, we know many people will have post-COVID fatigue but thankfully do not go on to develop long COVID or chronic fatigue syndrome.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/455687/original/file-20220331-15-3n0889.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Fatigued woman lying on sofa clutching her head" src="https://images.theconversation.com/files/455687/original/file-20220331-15-3n0889.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/455687/original/file-20220331-15-3n0889.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/455687/original/file-20220331-15-3n0889.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/455687/original/file-20220331-15-3n0889.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/455687/original/file-20220331-15-3n0889.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/455687/original/file-20220331-15-3n0889.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/455687/original/file-20220331-15-3n0889.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many people will have post-COVID fatigue but do not not develop long COVID or chronic fatigue syndrome.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/upset-depressed-young-woman-lying-on-1283704306">Shutterstock</a></span>
</figcaption>
</figure>
<h2>What helps me manage my fatigue?</h2>
<p>Expect you or a loved one may develop post-COVID fatigue, <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240784">regardless of how unwell you or they were</a> during the actual infection. </p>
<p>Vaccines help reduce the risk of post-COVID fatigue by lowering the chance of catching COVID in the first place. Vaccinated people who do catch COVID are <a href="https://www.medrxiv.org/content/10.1101/2022.01.05.22268800v2">less likely to report fatigue</a> and are <a href="https://ukhsa.koha-ptfs.co.uk/cgi-bin/koha/opac-retrieve-file.pl?id=fe4f10cd3cd509fe045ad4f72ae0dfff">less likely to develop long COVID</a>.</p>
<p>However, vaccination is not 100% protective and there are plenty of fully vaccinated people who go on to <a href="https://www.nature.com/articles/d41586-021-03495-2#ref-CR2">develop longer term fatigue</a>.</p>
<p>The evidence for what helps you recover from post-COVID fatigue is in its infancy. However, a few things do help:</p>
<p><strong>1. pace yourself:</strong> adjust the return to normal activities to your energy levels. <a href="https://publicdocuments.sth.nhs.uk/pil4828.pdf">Choose your priorities</a> and focus on what you can do rather than what you can’t</p>
<p><strong>2. return to exercise gradually:</strong> a <a href="https://bjsm.bmj.com/content/54/19/1174?fbclid=IwAR1f15hP9KwmEfqFPTNsIV8vRg6z9SWzLMEVGg2lMvyoj0lhnI_s-A_UrBw">gradual return to exercise</a> may help your recovery, but you may need some support about how to manage or avoid fatigue afterwards. Some therapists – occupational therapists, physiotherapists and exercise physiologists – specialise in this. So ask your GP for a recommendation</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1507970136858365955"}"></div></p>
<p><strong>3. prioritise sleep:</strong> rather than feeling guilty about sleeping so much, remind yourself that while you sleep, your body <a href="https://pubmed.ncbi.nlm.nih.gov/21059762/">conserves energy</a> and <a href="https://www.health.qld.gov.au/news-events/news/7-amazing-things-that-happen-to-your-body-while-you-sleep">heals</a>. Disrupted sleep patterns are an unfortunate COVID symptom. Having a strict bedtime, while also resting when you feel tired during the day, is important</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1509235614398394368"}"></div></p>
<p><strong>4. eat a range of nutritious foods:</strong> loss of smell, taste and appetite from COVID can make this tricky. However, try to view food as a way of fuelling your body with both energy and the micronutrients it needs to heal. Be careful not to spend a fortune on unproven “remedies” that often look good in small studies, but more robust research finds <a href="https://www.mayoclinic.org/diseases-conditions/chronic-fatigue-syndrome/expert-answers/chronic-fatigue/faq-20058033">make little difference</a> </p>
<p><strong>5. monitor your fatigue:</strong> keep a diary to monitor your fatigue, and look for a gradual improvement. You will have good days and bad days, but overall there should be a slow trajectory towards recovery. If you are going backwards, get input from a health professional, such as your GP.</p><img src="https://counter.theconversation.com/content/179478/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natasha Yates is affiliated with the RACGP</span></em></p>Fatigue can drag for weeks, even when the infection is gone, and sleep doesn’t fix it. But there are simple steps you can take to ride it out.Natasha Yates, Assistant Professor, General Practice, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1754242022-03-10T13:25:56Z2022-03-10T13:25:56ZLong COVID leaves newly disabled people facing old barriers – a sociologist explains<figure><img src="https://images.theconversation.com/files/450779/original/file-20220308-19-f03qhr.jpeg?ixlib=rb-1.1.0&rect=0%2C7%2C4918%2C3266&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some COVID-19 patients experience months of debilitating symptoms.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/desert-road-thunderstorm-royalty-free-image/157713818">sharply_done/E+ via Getty Images</a></span></figcaption></figure><p>Up to <a href="https://doi.org/10.1001/jamanetworkopen.2021.0830">one-third of COVID-19 survivors</a> will acquire the condition known as <a href="https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html">long or long-haul COVID-19</a>. The American Academy of Physical Medicine and Rehabilitation estimates that long COVID will add as many as <a href="https://pascdashboard.aapmr.org/">22 million individuals</a> to the U.S. population of disabled people. </p>
<p>I am a <a href="https://scholar.google.com/citations?user=U8wbfDgAAAAJ&hl=en&oi=ao">sociologist and researcher</a> focusing on disability. I am aware of the challenges awaiting newly disabled people living with what scientists call post-acute sequelae of SARS-CoV-2 infection, a condition in which someone with COVID-19 continues to have symptoms for weeks or months after infection. One of those challenges is qualifying for <a href="https://www.ssa.gov/benefits/ssi/">Social Security Supplemental Income</a>, the program that provides financial support to disabled people with limited resources. </p>
<p>To receive support, applicants generally must show that they have a condition that greatly limits their ability to work. The program routinely denied the majority of applicants before the pandemic. Between 2009 and 2018, the program denied <a href="https://www.ssa.gov/policy/docs/statcomps/di_asr/2019/di_asr19.pdf">66% of applicants</a>. </p>
<p>But the impact of long COVID, a newly discovered condition, is difficult to measure. Its symptoms are difficult to prove, varying in type, intensity and duration, between individuals or over time in the same person.</p>
<h2>Survival at a price</h2>
<p>While most people recover from their initial acute infection, some survivors experience continued or newly developed symptoms. <a href="https://doi.org/10.1038/s41598-021-95565-8">Long COVID symptoms</a> can include shortness of breath, fatigue and brain problems, such as difficulty concentrating, remembering or making decisions.</p>
<p>The Centers for Disease Control and Prevention defines disability as “any <a href="https://www.cdc.gov/ncbddd/disabilityandhealth/disability.html">condition of the body or mind</a> that makes it more difficult for the person with the condition to do certain activities and interact with the world around them.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/450541/original/file-20220307-85251-hbfhgf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man at table, face partially obscured by laptop, leaning his forehead into his hand." src="https://images.theconversation.com/files/450541/original/file-20220307-85251-hbfhgf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450541/original/file-20220307-85251-hbfhgf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450541/original/file-20220307-85251-hbfhgf.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450541/original/file-20220307-85251-hbfhgf.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450541/original/file-20220307-85251-hbfhgf.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450541/original/file-20220307-85251-hbfhgf.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450541/original/file-20220307-85251-hbfhgf.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Long COVID patients report that fatigue and thinking difficulties limit their ability to work.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/middle-aged-man-sitting-in-the-kitchen-at-the-glass-royalty-free-image/1218624911">Fiordaliso/Moment via Getty Images</a></span>
</figcaption>
</figure>
<p>Long COVID sufferers report lingering symptoms that are <a href="https://doi.org/10.1038/d41586-020-02598-6">seriously debilitating</a>. They tell researchers that the condition makes it <a href="https://doi.org/10.1101/2022.01.21.22269671">hard to live their lives</a> as they had before the illness. Some patients describe needing hours of <a href="https://doi.org/10.1186/s12913-020-06001-y">extra sleep after standing</a> or walking a short distance. One study showed <a href="https://doi.org/10.1001/jamanetworkopen.2021.30645">cognitive deficits</a>, or “brain fog,” in patients with long COVID. They had poor recall ability or were slow in processing information. These problems, they told researchers, limited their capacity to work. </p>
<p>A 2021 study of long COVID patients in the UK found that <a href="https://www.tuc.org.uk/research-analysis/reports/workers-experiences-long-covid">28% were out of work</a> because of their condition. Another study showed that <a href="https://doi.org/10.1016/j.eclinm.2021.101019">46% reduced their work hours</a> because of long COVID symptoms. </p>
<h2>Undefined and indeterminate</h2>
<p>Although the World Health Organization has issued a <a href="https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1">definition of long COVID</a>, the U.S. medical community has not defined it, especially the “long” part. In fact, in a study that has not yet been peer-reviewed, researchers estimated that approximately <a href="https://doi.org/10.1101/2021.11.15.21266377">43% of COVID-19 survivors</a> may experience long COVID, which the study defined as having symptoms lasting 28 days or more. In another study, half of COVID-19 survivors reported <a href="https://doi.org/10.1001/jamanetworkopen.2021.28568">symptoms beyond six months</a>.</p>
<p>But since long COVID symptoms involve different systems in the body, and there is no simple way to test for it, getting a diagnosis <a href="https://www.gao.gov/products/gao-22-105666">can be difficult</a>. This adds an extra challenge to qualifying for Social Security. </p>
<p>The Center on Budget and Policy Priorities, a nonpartisan research and policy institute, previously noted <a href="https://www.cbpp.org/ssa-needs-more-funding-to-support-essential-services">decades of underinvestment</a> in the Social Security Administration before the pandemic. The institute is now <a href="https://www.cbpp.org/blog/ssa-needs-large-funding-boosts-following-pandemic-years-of-underinvestment">calling for renewed investment</a> to cope with rising numbers of disabled people.</p>
<p>It is also hard to predict which COVID-19 patients will develop long COVID, or predict the long-term outcomes for those who do. Greater likelihood of severe disease has been found to correlate with a higher risk of <a href="https://doi.org/10.1371/journal.pmed.1003773">long COVID</a>. Complicating matters, however, is the fact that long COVID can emerge from <a href="https://doi.org/10.1016/j.cell.2022.01.014">relatively mild cases</a> as well.</p>
<h2>Unpredictable and uncertain</h2>
<p>Symptoms seen in patients with long COVID look a lot like symptoms of other <a href="https://doi.org/10.1016/j.socscimed.2005.06.018">hard-to-diagnose</a>
and disabling conditions. One reason may be the <a href="https://doi.org/10.1097/bor.0000000000000776">molecular and physiological similarities</a> researchers recently found between long COVID and diseases like multiple sclerosis, rheumatoid arthritis and <a href="https://dx.doi.org/10.1007%2Fs10067-020-05376-x">lupus</a>.</p>
<p>Long COVID appears to be the newest in a long line of <a href="https://doi.org/10.1371/journal.pone.0054074">“invisible” or episodic conditions</a> not immediately
diagnosed as disabilities. They include fibromyalgia, Lyme disease and chronic obstructive pulmonary disease. </p>
<p>People with fibromyalgia, for example, often struggle with <a href="https://www.cdc.gov/me-cfs/symptoms-diagnosis/symptoms.html">symptoms similar</a> to long COVID, including fatigue or thinking difficulties. Despite a history dating back to the 19th century, the criteria for diagnosing fibromyalgia have existed only since 1990. It remains a controversial illness with few accepted treatments, but that began to change as patients <a href="https://doi.org/10.1525/sp.2002.49.3.279">shared their experiences</a> with the condition. Nevertheless, people with conditions like these cope with doctors, social workers and others who might assume that their <a href="https://doi.org/10.1177/1742395317718035">illness isn’t real</a>, and they <a href="https://www.nytimes.com/2021/10/27/us/long-covid-disability-benefits.html">face obstacles</a> obtaining financial support, housing and responsive health care. </p>
<h2>Disbelief and denial</h2>
<p>Currently, <a href="https://www.ssa.gov/policy/docs/chartbooks/fast_facts/2021/fast_facts21.pdf">approximately 8 million</a> people receive Social Security Supplemental Income. But surveys show the Social Security Administration <a href="https://www.disabilitysecrets.com/resources/survey-statistics-who-is-most-likely-to-get-approved-for-social-security-disability-benefits.html">still denies</a> many applicants, which studies have linked to stereotypes about disabled people as “<a href="https://doi.org/10.1111/lasr.12437">conning the system</a>.” </p>
<p>A February 2021 study showed that negative attitudes toward people with significant disabilities are common <a href="https://doi.org/10.1377/hlthaff.2020.01452">among health care providers</a>, affecting the ability of those with long COVID to get the care they need.
Speaking of care, research on long COVID has led to proposed <a href="https://dx.doi.org/10.3390%2Fijerph18084350">treatment guidelines</a>, which promise to help people live better with the condition. </p>
<p>In another promising development, the Department of Health and Human Services and the Civil Rights Division of the Department of Justice <a href="https://www.hhs.gov/civil-rights/for-providers/civil-rights-covid19/guidance-long-covid-disability/index.html">recently announced</a> that long COVID can qualify as a disability under the Americans with Disabilities Act.</p>
<p>This means that those with long COVID can qualify for <a href="https://acl.gov/covid19/resources-people-experiencing-long-covid">community resources</a>. Those still in the workforce can get employment-related <a href="https://www.eeoc.gov/wysk/what-you-should-know-about-covid-19-and-ada-rehabilitation-act-and-other-eeo-laws">reasonable accommodations</a>, such as flexible work times and remote work. For now, that’s all they can count on. </p>
<p>[<em>Get fascinating science, health and technology news.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=science&source=inline-science-fascinating">Sign up for The Conversation’s weekly science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/175424/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Mauldin received a Rapid Response to Covid-19 grant from the Social Science Research Council to support research on the pandemic's effects on spousal caregivers and their disabled partners.</span></em></p>As COVID-19 survivors join the ranks of people with disabilities, they could have a long wait to get the support they need.Laura Mauldin, Associate Professor of Women's Gender & Sexuality Studies and Human Development & Family Sciences, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1738452022-02-11T13:34:32Z2022-02-11T13:34:32ZIn research studies and in real life, placebos have a powerful healing effect on the body and mind<figure><img src="https://images.theconversation.com/files/445014/original/file-20220208-19-1dce055.jpg?ixlib=rb-1.1.0&rect=38%2C76%2C5078%2C3322&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The concept of placebos – which are sometimes called "sugar pills" – has been around since the 1800s.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/pharmaceutical-research-conceptual-image-royalty-free-image/185760489?adppopup=true">Wladimir Bulgar/Science Photo Library via Getty Images</a></span></figcaption></figure><p>Did you ever feel your own shoulders relax when you saw a friend receive a shoulder massage? For those of you who said “yes,” congratulations, your brain is using its power to create a “placebo effect.” For those who said “no,” you’re not alone, but thankfully, the brain is trainable. </p>
<p>Since the 1800s, <a href="https://doi.org/10.1001/jama.1955.02960340022006">the word placebo</a> has been used to refer to a fake treatment, meaning one that does not contain any active, physical substance. You may have heard of placebos referred to as “sugar pills.” </p>
<p>Today, placebos play a crucial role in medical studies in which some participants are given the treatment containing the active ingredients of the medicine, and others are given a placebo. These types of studies help tell researchers which medicines are effective, and how effective they are. Surprisingly, however, in some areas of medicine, placebos themselves provide patients with <a href="https://doi.org/10.1016/S0140-6736(09)61706-2">clinical improvement</a>. </p>
<p>As two psychologists interested in how <a href="https://scholar.google.com/citations?hl=en&user=LFOKsvwAAAAJ&view_op=list_works&gmla=AJsN-F7HTmfem-T2-tGORhXc3ZwClbf_3X8_ap-HWeyTOTMcJPTzWkutZ6ZL85CJwi2v87spWvAQmnmkjzKIh4ULAdFAV8KVFSBRBC6VQ8ky36RvnyreDoY">psychological factors affect physical conditions</a> and <a href="https://ihpi.umich.edu/our-experts/schrodeh">beliefs about mental health</a>, we help our patients heal from various <a href="https://ihpi.umich.edu/our-experts/ehpatter">threats to well-being</a>. Could the placebo effect tell us something new about the power of our minds and how our bodies heal?</p>
<h2>Real-life placebo effects</h2>
<p>Today, scientists define these <a href="http://programinplacebostudies.org/">so-called placebo effects</a> as the positive outcomes that cannot be scientifically explained by the physical effects of the treatment. Research suggests that the placebo effect is caused by <a href="https://doi.org/10.1038/nrn3976">positive expectations</a>, the provider-patient relationship and the <a href="https://doi.org/10.1016/S0140-6736(09)61706-2">rituals around receiving medical care</a>.</p>
<p>Depression, pain, fatigue, allergies, <a href="https://doi.org/10.1186/s13063-017-1964-x">irritable bowel syndrome</a>, Parkinson’s disease and even <a href="https://doi.org/10.1056/nejmoa013259">osteoarthritis of the knee</a> are just <a href="https://doi.org/10.1159/000490354">a few of the conditions</a> that <a href="https://www.npr.org/2020/05/11/853753307/all-the-worlds-a-stage-including-the-doctor-s-office">respond positively to placebos</a>. </p>
<p>Despite their effectiveness, there is stigma and debate about <a href="https://doi.org/10.1159/000514435">using placebos in U.S. medicine</a>. And in routine medical practice, they are rarely used on purpose. But based on new understanding of how non-pharmacological aspects of care work, safety and patient preferences, some experts have begun recommending <a href="https://doi.org/10.1159/000490354">increasing the use of placebos in medicine</a>.</p>
<p>The U.S. Food and Drug Administration, the organization that regulates which medicines are allowed to go to the consumer market, requires that all new medicines be tested in randomized controlled trials that show they are <a href="https://www.regdesk.co/fdas-guidance-on-placebos/#">better than placebo treatments</a>. This is an important part of ensuring the public has access to high-quality medications. </p>
<p>But studies have shown that the placebo effect is so strong that many drugs don’t provide more relief <a href="https://doi.org/10.1017/S2045796018000240">than placebo treatments</a>. In those instances, drug developers and researchers sometimes see placebo effects as a nuisance that masks the treatment benefits of the manufactured drug. That sets up an incentive for drug manufacturers to try to do away with placebos so that drugs pass the FDA tests.</p>
<p>Placebos are such a problem for the enterprise of drug development that a company has developed a <a href="https://verasci.com/the-placebo-control-reminder-script-now-available-on-pathway/">coaching script to discourage patients</a> who received placebos from <a href="https://doi.org/10.1038/s41386-020-00911-5">reporting benefits</a>.</p>
<h2>Treating depression</h2>
<p>Prior to the COVID-19 pandemic, about 1 in 12 U.S. adults had a <a href="https://www.cdc.gov/nchs/products/databriefs/db303.htm">diagnosis of depression</a>. During the pandemic, those numbers rose to <a href="https://www.bu.edu/articles/2021/depression-rates-tripled-when-pandemic-first-hit/">1 in 3 adults</a>. That sharp rise helps explain why <a href="https://www.businesswire.com/news/home/20210426005303/en/Global-Antidepressants-Market-Report-2021-COVID-19-Causes-a-Surge-in-Demand-for-Antidepressant-Drugs-as-Mental-Health-Problems-Rise---ResearchAndMarkets.com">US$26.25 billion worth of antidepressant medications</a> were used across the globe in 2020.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/REaiu-7wRvs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Brain-imaging studies show that the brain has an identifiable response to the expectations and context that come with placebos.</span></figcaption>
</figure>
<p>But according to psychologist and placebo expert Irving Kirsch, who has studied placebo effects for decades, a large part of <a href="https://doi.org/10.3389/fpsyt.2019.00407">what makes antidepressants helpful</a> in alleviating depression is the placebo effect – in other words, the belief that the medication will be beneficial. </p>
<p>Depression is not the only condition for which medical treatments are actually functioning at the level of placebo. Many well-meaning clinicians offer treatments that appear to work based on the fact that patients get better. But a recent study reported that <a href="https://www.sciencealert.com/around-90-percent-of-your-medical-treatments-isn-t-backed-by-high-quality-evidence">only 1 in 10</a> <a href="https://doi.org/10.1016/j.jclinepi.2020.08.005">medical treatments sampled</a> met the standards of what is considered by some to be the gold standard of high quality evidence, according to <a href="https://www.cochrane.org/evidence">a grading system</a> by an international nonprofit organization. This means that many patients improve even though the treatments they receive have not actually been proved to be better than the placebo. </p>
<h2>How does a placebo work?</h2>
<p>The power of the placebo comes down to the power of the mind and a person’s skill at harnessing it. If a patient gets a <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/headache/tension-headaches">tension headache</a> and their trusted doctor gives them a medicine that they feel confident will treat it, the relief they expect is likely to decrease their stress. And since <a href="https://www.mayoclinic.org/diseases-conditions/tension-headache/in-depth/headaches/art-20046707">stress is a trigger for tension headaches</a>, the magic of the placebo response is not so mysterious anymore.</p>
<p>Now let’s say that the doctor gives the patient an expensive brand-name pill to take multiple times per day. Studies have shown that it is even more likely to make them feel better because all of those elements subtly convey the message that they <a href="https://doi.org/10.1016/bs.irn.2018.07.014">must be good treatments</a>.</p>
<p>Part of the beauty of placebos is that <a href="https://www.nytimes.com/2016/01/25/books/review-in-cure-accepting-the-minds-role-in-a-bodys-health.html">they activate existing systems</a> of <a href="https://www.aapb.org/i4a/pages/index.cfm?pageID=3386">healing within the mind and body</a>. Elements of the body once thought to be outside of an individual’s control are now known to be modifiable. A legendary example of this is Tibetan monks who <a href="https://doi.org/10.1371/journal.pone.0058244">meditate to generate enough body heat</a> to dry wet sheets in 40-degree Fahrenheit temperatures.</p>
<p>A field called <a href="https://bensonhenryinstitute.org/mission-history/">Mind Body Medicine</a> developed from the work of cardiologist Herbert Benson, who observed those monks and other experts mastering control over automatic processes of the body. It’s well understood in the medical field that <a href="https://us.macmillan.com/books/9780805073690#">many diseases are made worse</a> by the automatic changes that <a href="https://www.hsph.harvard.edu/nutritionsource/stress-and-health/">occur in the body under stress</a>. If a placebo interaction reduces stress, it can <a href="https://www.apa.org/topics/stress/body#">reduce certain symptoms</a> in a scientifically explainable way. </p>
<p>Placebos also work by creating expectations and conditioned responses. Most people are familiar with <a href="https://pubmed.ncbi.nlm.nih.gov/29262194/">Pavlovian conditioning</a>. A bell is rung before giving dogs meat that makes them salivate. Eventually, the sound of the bell causes them to salivate even when they do not receive any meat. A recent study from Harvard Medical School successfully used the same conditioning principle to help patients <a href="https://doi.org/10.1097/j.pain.0000000000002185">use less opioid medication for pain following spine surgery</a>. </p>
<p>Furthermore, multiple brain imaging studies demonstrate changes in the brain in response to successful placebo treatments for pain. This is excellent news, given the <a href="https://theconversation.com/oxycontin-created-the-opioid-crisis-but-stigma-and-prohibition-have-fueled-it-167100">ongoing opioid epidemic</a> and the need for effective pain management tools. There is even evidence that individuals who respond positively to placebos <a href="https://doi.org/10.1126/science.1093065">show increased activity in areas of the brain</a> that release naturally occurring opioids. </p>
<p>And emerging research suggests that even when people know they are receiving a placebo, the inactive treatment still has <a href="https://doi.org/10.1038/s41467-020-17654-y">effects on the brain and reported levels of improvement</a>. </p>
<h2>Placebos are nontoxic and universally applicable</h2>
<p>In addition to the ever-increasing body of evidence surrounding their effectiveness, placebos offer multiple benefits. They have no side effects. They are cheap. They are not addictive. They provide hope when there might not be a specific chemically active treatment available. They mobilize a person’s own ability to heal through multiple pathways, including those studied in the <a href="https://www.pnirs.org/">field of psychoneuroimmunology</a>. This is the study of relationships between the immune system, hormones and the nervous system. </p>
<p>By defining a placebo as the act of setting positive expectations and providing hope through psychosocial interactions, it becomes clear that placebos can enhance traditional medical treatments.</p>
<h2>Using placebos to help people in an ethical way</h2>
<p>The placebo effect is recognized as being powerful enough that the American Medical Association considers it <a href="https://www.ama-assn.org/delivering-care/ethics/use-placebo-clinical-practice#">ethical to use placebos</a> to enhance healing on their own or with standard medical treatments if the patient agrees to it.</p>
<p>Clinically, doctors use the principles of placebo in a more subtle way than it is used in research studies. A 2013 study from the U.K. found that <a href="https://doi.org/10.1371/journal.pone.0058247">97% of physicians</a> acknowledged in a survey having used some form of placebo during their career. This might be as simple as expressing a strong belief in the likelihood that a patient will feel better from whatever treatment the doctor prescribes, even if the treatment itself is not chemically powerful. </p>
<p>There is now even an international <a href="https://placebosociety.org/home">Society for Interdisciplinary Placebo Studies</a>. They have written <a href="https://doi.org/10.1159/000490354">a consensus statement</a> about the use of placebos in medicine and recommendations for <a href="https://doi.org/10.1159/000510738">how to talk with patients about it</a>. In the past, patients who improved from a placebo effect might have felt embarrassed, as if their ailment were not real. </p>
<p>But with the medical field’s growing acceptance and promotion of placebo effects, we can envision a time when patients and clinicians take pride in their skill at harnessing the placebo response.</p>
<p>[<em>Get fascinating science, health and technology news.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=science&source=inline-science-fascinating">Sign up for The Conversation’s weekly science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/173845/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Drug manufacturers often shun the use of placebos in clinical trials. But research suggests that placebos could play an important role in the treatment of depression, pain and other maladies.Elissa H. Patterson, Clinical Assistant Professor of Psychiatry and Neurology, University of MichiganHans Schroder, Clinical Assistant Professor of Psychiatry, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1733082021-12-15T12:04:35Z2021-12-15T12:04:35ZHow workers become seduced by the cult of ‘optimal busyness’<p>The consultant was on her way to a demanding client meeting when she realised she had had a miscarriage. But she did not interrupt her day. Instead, she went on to complete the meeting at her client’s offices.</p>
<p>The woman, who works at an elite professional service firm in London, was one of the professionals we interviewed as part of <a href="https://pubsonline.informs.org/doi/abs/10.1287/orsc.2021.1486">our recent study</a> of the work life of highly educated professionals.</p>
<p>When we began our study in 2014, we set out to investigate how workers in demanding jobs managed their work-life balance. But soon after we started the interviews, we realised we needed to revise our focus, because it became clear that our interviewees were not seeking to balance their work and private life.</p>
<p>Instead, we found these workers were driven by a compulsion to be busy at all times, which meant they were also willing to sacrifice their family lives in important ways.</p>
<p>As one of our participants told us: “You become a little bit of a junkie for a deadline and work. It’s quite hard to switch off”.</p>
<p>While a common narrative in <a href="https://academic.oup.com/jcr/article-abstract/45/6/1142/4999270">research</a> and the <a href="https://hbr.org/2021/09/who-is-driving-the-great-resignation">media</a> is that people want to slow down their lifestyles these days, our findings reveal a strikingly different story.</p>
<p>The desire to work fewer hours among our interviewees was uncommon. Instead they were in pursuit of something else: “optimal busyness”.</p>
<h2>The quest for optimal busyness</h2>
<p>We interviewed 81 people who work in some of the biggest consulting and law firms in London. Half of the workers were women, half were men, and nearly all of them had at least one child. All of the professionals we interviewed suffered from time famine – constantly having too little time to do what they had to do.</p>
<p>To deal with this problem, they were drawn toward a compelling state of busyness, one in which they felt in control of their time. We call this “optimal busyness” – an attractive, accelerated temporal experience that is difficult to achieve and maintain.</p>
<p>Overall, we identified three different kinds of experiences of busyness: optimal busyness, excessive busyness, and quiet time. Optimal busyness is an elating and enjoyable temporal flow in which the workers felt at their best and most productive. This buzzing feeling gave them adrenaline and positive energy, which was exciting. When they were in this state, they felt nothing could stop them, and that they could, for example, save a company from going bankrupt.</p>
<p>Such an attraction toward busyness can be understood as a kind of <a href="https://academic.oup.com/jcr/article/44/1/118/2736404">status symbol</a> or badge of honour, a phenomenon that has been described in previous research.</p>
<p>But we found that this drive went far deeper than mere social signalling. The desired buzzing feeling was itself inherently addictive. One participant told us:</p>
<blockquote>
<p>“I love the intensity of it, usually. I get a buzz out of it, that’s why I do the job that I do. I like it.”</p>
</blockquote>
<p>We observed the pleasurable and positive state of optimal busyness often tipped over and became excessive. In such instances, professionals’ feelings of being in control of their time vanished. This is where busyness became overwhelming and sometimes depressing.</p>
<p>When the energising buzz of optimal busyness continued for too long without break, it became unbearable. Connection with family was often the first casualty. One participant went on a work trip and despite promises to call her family in the evening failed to do so – for the entire week.</p>
<p>We observed a similar pattern in the case of quiet time – that is, when the busy work period was suddenly interrupted by downtime, or typically, a holiday period. Quiet time was experienced as something undesirable and meaningless. It also caused boredom and even depression. The thought of a slower pace at work was a source of concern. One told us:</p>
<blockquote>
<p>“When I don’t have deadlines I get bored. I’m much less productive because I like working on adrenaline.”</p>
</blockquote>
<p>As well as interviewing busy knowledge workers, we also spoke to some of their partners. One partner said:</p>
<blockquote>
<p>“My wife is terrible. If she wakes up to go to toilet in the middle of the night, she checks her emails – even at 3 AM.”</p>
</blockquote>
<h2>The conditions for optimal busyness</h2>
<p>On one hand, workplaces produce the conditions that drive the quest for optimal busyness. We identified a number of mechanisms that did this, including unrealistic deadlines, performance metrics, time sheets, and the working culture itself – companies and peers expected everyone to be available to work at all times via their smartphones.</p>
<p>The firms we studied are elite institutions that hire the best university students with the highest grades. New recruits wanted to survive the impossible pressure because they knew it was the only way to get a promotion or to become an associate in the company. Busy working culture soon absorbed them and normalised unnatural working hours.</p>
<p>On the other hand, we found individuals themselves were also creating the conditions for optimal busyness. Some boosted their capacity to work with coffee, drugs, or physical exercise. Others went as far as isolating themselves in a hotel room so they could work without interruptions.</p>
<p>A common strategy was for workers to think: “This is only a short period and once I am through I will relax”. For most, the relaxation never happened.</p>
<h2>A culture of overwork</h2>
<p>For decades, scholars have observed the persistence of long working hours, overwork, and <a href="https://journals.sagepub.com/doi/10.2307/2667031">time famine</a>. These problems are ingrained in many professional work contexts, not only in consulting, audit or law firms.</p>
<p>Academia is another striking example: studies consistently show that researchers’ poor mental well-being is linked to increased performance expectations, competitive ethos, and meticulous metrics that produce <a href="https://journals.sagepub.com/doi/full/10.1177/1350508418805283">non-stop busyness</a>.</p>
<p>Our research offers a new way of understanding this phenomenon. The quest for optimal busyness is a vicious cycle. However, until recently there has been limited research that would uncover our everyday experiences of time and how they can take a hold of us.</p>
<p>The individuals we studied, albeit in an arguably extreme context, were often unaware what was happening to them. Perhaps it is time for us all to reflect on how and why we are so addicted to feeling busy.</p><img src="https://counter.theconversation.com/content/173308/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Les auteurs ne travaillent pas, ne conseillent pas, ne possèdent pas de parts, ne reçoivent pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'ont déclaré aucune autre affiliation que leur organisme de recherche.</span></em></p>Elite employers have created an atmosphere where workers constantly seek to be as busy as possible. Families are often the first casualty of this culture.Joonas Rokka, Professeur en marketing, EM Lyon Business SchoolIoana Lupu, Associate Professor, ESSEC Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1647542021-08-16T12:08:30Z2021-08-16T12:08:30ZDeciphering the symptoms of long COVID-19 is slow and painstaking – for both sufferers and their physicians<figure><img src="https://images.theconversation.com/files/415730/original/file-20210811-21-1xw5nik.jpg?ixlib=rb-1.1.0&rect=758%2C100%2C4801%2C3567&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People suffering from long-term effects of COVID-19 face uncertainty about the nature of their symptoms and how long they might last.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/portrait-of-senior-woman-with-face-mask-standing-royalty-free-image/1256056382?adppopup=true"> Halfpoint Images/Moment via Getty Images</a></span></figcaption></figure><p>My first patient that day was a woman in her early 40s, an avid marathon runner who had contracted COVID-19 in March 2020. Now, 13 months later, she noted that she still felt fatigued and short of breath. She also noticed her heart was racing whenever she walked around. She reported having daily headaches, numbness and tingling in her legs, and difficulty with memory, which had affected her work.</p>
<p>This woman was coming in to see me, a <a href="https://www.researchgate.net/scientific-contributions/Allison-Navis-2131988399">neurologist specializing in infectious diseases</a>, for symptoms that we physicians now all-too-commonly know as long, or long-haul, COVID-19.</p>
<p>While we have yet to determine a precise definition for long COVID-19, we typically consider it the persistence or development of new symptoms that last more than <a href="https://doi.org/DOI:%2010.1136/bmj.m3026">four weeks after COVID-19 recovery</a>. Long COVID-19 often involves a constellation of symptoms affecting many parts of the body, but the <a href="https://www.sciencedirect.com/science/article/abs/pii/S0025619621003566">most commonly reported</a> are fatigue, shortness of breath, chest pains, cognitive changes, headaches, sensory changes and pain. </p>
<p>A year and a half into the COVID-19 pandemic, it remains unclear how many people are affected by long COVID-19. Some data suggests <a href="https://doi.org/10.1038/s41591-021-01292-y">4.5% of people</a> infected with COVID-19, or about 1 in 22, will have symptoms beyond eight weeks post-COVID, while other studies point to <a href="https://doi.org/10.1186/s12879-021-06359-2">closer to 49%</a>. Some studies show that among people hospitalized for COVID-19, <a href="https://doi.org/10.1016/S0140-6736(20)32656-8">up to 63%</a> continued to have symptoms – specifically fatigue or muscle weakness – six months later.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Doctors treating elderly man during COVID-19 pandemic" src="https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415727/original/file-20210811-23-2v6nue.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People hospitalized with COVID-19 have a far greater chance of developing long COVID-19.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctors-checking-patient-in-ward-during-covid-19-royalty-free-image/1296010649?adppopup=true">Morsa Images/DigitalVision via Getty Images</a></span>
</figcaption>
</figure>
<p>In April 2020, because of the overwhelming number of patients we had, I was pulled from my regular duties as a neurologist and asked to take care of patients on a COVID-19 unit in the hospital. It was my first experience seeing how sick people were and the extent of harm the virus could cause. Given the severity of illness, we were concerned that many people would need long-term care. </p>
<p>So my institution, Mount Sinai, decided to open one of the <a href="https://www.mountsinai.org/about/covid19/center-post-covid-care">first multidisciplinary centers for post-COVID care</a>. I was asked to be the lead clinical neurologist for the center. Since then, I have personally seen several hundred long COVID-19 patients and worked on research studies with the aim of untangling the complexities of <a href="https://doi.org/10.1056/NEJMp2109285">what is happening with the condition</a>.</p>
<h2>The puzzling nature of long COVID-19</h2>
<p>While data on long COVID-19 has <a href="https://doi.org/10.1038/s41591-021-01433-3">started to emerge</a>, less is known about the neurological symptoms. The most common neurological symptoms appear to be <a href="https://doi.org/10.1002/acn3.51350">cognitive changes</a>, including “brain fog” – such as sluggishness and lack of sharpness – as well as headaches, sensory changes, muscle or nerve pain and loss of smell. </p>
<p>We are also seeing many cases of “dysautonomia,” or impaired regulation of the nervous system that controls heart rate and blood pressure – the “fight or flight” part of the nervous system. This condition can lead to sensations of a racing heart and dizziness.</p>
<p>Part of the challenge in understanding long COVID-19 is that many of the symptoms, like fatigue and brain fog, can stem from a variety of conditions from hormonal or metabolic changes to sleep disruption or depression. Trying to determine a direct line between cause and effect in the general public, regardless of COVID-19 infection, often does not lead to clear answers. </p>
<p>Although many long COVID-19 sufferers tend to report the same general symptoms, it is likely that there are different underlying causes leading to these symptoms in different people. For example, <a href="https://doi.org/10.1515/jtim-2016-0016">post-intensive care syndrome</a> (PICS) can occur in anyone who has had a prolonged stay in the ICU, whether or not it was related to COVID-19. PICS is caused by prolonged immobility, mechanical ventilation and metabolic changes that occur during severe illness or infection. The symptoms of PICS often overlap with those of long COVID. </p>
<p>For other symptoms, such as joint or back pain, doctors might be able to pinpoint a cause, like arthritis or a pinched nerve. But the question remains whether that was present before the COVID-19 infection and the infection simply triggered a response that caused the pain to be unmasked, or whether these are new developments in a patient’s body.</p>
<p>What’s more, many diagnostic tests come back normal, or they show common and nonspecific changes. We are not observing widespread strokes, lesions or inflammatory changes on imaging. We may see small changes in blood vessels, known as <a href="https://doi.org/10.1111/j.1749-6632.2010.05758.x">microvascular ischemic changes</a>, but these are extremely common in anyone with high blood pressure, diabetes or even migraines. And tests of the nerves in the arms and legs may show damage in some cases – what we call neuropathy. But that is not always the case, and these can occur regardless of COVID-19 status. This makes it challenging to draw a direct link to COVID-19.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Screens displaying coronavirus and brain wave research" src="https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415751/original/file-20210811-27-1rqjqjv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Brain imaging has so far yielded inconclusive evidence about what is causing long COVID-19.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/laboratory-equipment-coronavirus-and-brainwave-royalty-free-image/1295324817?adppopup=true">janiecbros/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>What we do know</h2>
<p>This doesn’t mean we are at a complete loss about what is happening. The constellation of symptoms resembles a <a href="https://www.healthline.com/health-news/fauci-warns-about-post-viral-syndrome-after-covid-19">post-viral syndrome</a>, which refers to prolonged symptoms after an infection. Sometimes the infection might be from a known source, <a href="http://dx.doi.org/10.1136/pgmj.64.753.559">such as Epstein-Barr virus (which causes mononucleosis)</a>, but often symptoms follow a general viral illness. </p>
<p>Many people suffering from those conditions will report experiencing some viral-type illness and afterward having persistent fatigue, brain fog and other symptoms that we now often see with sufferers of long COVID-19. The similarity in symptoms suggests that long COVID-19 may not be unique to COVID-19 but rather a general post-infectious process. </p>
<p>Long COVID-19 symptoms can also closely resemble those of <a href="https://www.cdc.gov/me-cfs/index.html">myalgic encephalomyelitis</a>, often known as chronic fatigue syndrome, or another poorly understood disease called <a href="https://doi.org/10.1161/CIRCULATIONAHA.112.144501">postural orthostatic tachycardia syndrome</a>. Both of these are associated with fatigue, dysautonomia and brain fog, among other symptoms. We researchers don’t yet understand what causes either condition. But medications for symptoms, pacing of exercise and physical therapy <a href="https://www.cdc.gov/me-cfs/treatment/index.html">can be helpful</a> for both myalgic encephalomyelitis and long COVID-19.</p>
<h2>Where do researchers go from here?</h2>
<p>I often tell my patients that normal test results don’t mean everything is normal. Our tests may not be sensitive enough, or we are looking at the wrong thing, or we need to develop new tests. <a href="https://doi.org/10.1002/acn3.51350">Neuropsychological evaluations</a> can provide formal information on cognitive functioning and may show changes in memory, attention, language or problem-solving. These results can be helpful in determining rehabilitation strategies for brain fog, but unfortunately, they are not designed to explain why these changes are occurring. </p>
<p>Imaging of the brain, with MRI or CT scans, has so far not provided much information on the underlying cause. It could be that they are not sensitive enough to pick up on small changes; if this is the case, different types of scans – such as functional MRIs – that are either able to get better pictures or look at metabolic changes in the brain might be helpful. However, these are not commonly available outside of research. </p>
<p>Other studies that might enlighten us about the underlying cause of symptoms include bloodwork that might show <a href="https://doi.org/10.1093/cid/ciab611">elevations in autoimmune markers</a> or <a href="https://doi.org/10.1007/s11910-021-01130-1">changes in hormones</a>. The immune system involves a balance of many factors, and impaired regulation of this system after an infection can cause inflammation; this, combined with hormonal or metabolic changes, could potentially lead to long COVID-19 symptoms. While these are not answers, they offer potential leads and further clues for researchers to explore.</p>
<p>To better understand long COVID-19, we need to have a clear picture of who is affected. While communities of color have often been <a href="https://doi.org/10.1001/jamanetworkopen.2020.21892">more severely affected</a> by COVID-19, they are also <a href="https://www.pbs.org/newshour/show/in-medical-research-racial-diversity-is-a-matter-of-life-or-death">likely to be</a> <a href="https://doi.org/DOI:%2010.3390/jcm9082442">underrepresented in studies</a>. </p>
<p>As a result, we researchers need to engage broadly across communities to ensure we fully understand who is affected by long COVID-19, as well as what risk factors might be at play in determining long-term outcomes. Research needs to also focus on gaining a better understanding of the less understood diseases like myalgic encephalomyelitis, as they seem to most resemble what we are seeing.</p>
<p>The ultimate goal in understanding long COVID-19 is to figure out how to prevent it from happening – and prevent as much suffering as we can. While I have seen people get better from long COVID-19, I have many patients who continue to suffer over a year later. It has also affected the health care workers whose goal is to help others heal, but are left with few answers to provide. Until research yields more answers on what could be causing long-COVID, we are left with trying to minimize symptoms and waiting.</p><img src="https://counter.theconversation.com/content/164754/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Allison Navis receives funding from the NIH Loan Repayment Program</span></em></p>Researchers are piecing together clues to better understand the puzzling array of symptoms in those who never seem to fully recover from COVID-19.Allison Navis, Assistant Professor of Neurology, Icahn School of Medicine at Mount SinaiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1581542021-04-06T04:48:04Z2021-04-06T04:48:04ZLockdown mental fatigue rapidly reversed by social contact, study finds<figure><img src="https://images.theconversation.com/files/393083/original/file-20210401-13-f7w8p.jpeg?ixlib=rb-1.1.0&rect=0%2C0%2C5414%2C3571&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Emerging from isolation has a profound effect on our cognitive functions.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/girl-social-phobia-hides-her-face-647654332">Koldunova Anna/Shutterstock</a></span></figcaption></figure><p>Many of us are looking forward to a summer of relative freedom, with road-mapped milestones that will grant us more opportunities to see our friends and family. But we’ll be carrying the effects of months of isolation into those meetings, including a sense that our social skills will need dusting off, and our wits will need sharpening.</p>
<p>The mental effects of lockdown have been profound. Social isolation has been shown to cause people’s <a href="https://pubmed.ncbi.nlm.nih.gov/16594799/">mental health to deteriorate</a> even if they have no history of <a href="https://www.theguardian.com/society/2020/may/16/uk-lockdown-causing-serious-mental-illness-in-first-time-patients">previous psychological problems</a>. Alongside this drop in mood, loneliness has been linked with a host of cognitive problems, including <a href="https://theconversation.com/here-is-why-you-might-be-feeling-tired-while-on-lockdown-135502">fatigue</a>, <a href="https://www.ucl.ac.uk/news/2020/jun/anxiety-depression-levels-fall-lockdown-eased">stress</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/24729533/">problems with concentration</a>.</p>
<p>In our <a href="https://onlinelibrary.wiley.com/doi/10.1002/acp.3821">recent study</a>, we set out to understand how people recovered from last year’s period of social isolation, tracking their cognitive function as the UK transitioned from a full lockdown to reduced social restrictions in summer 2020. Promisingly, we found that people swiftly recovered from cognitive issues when given the chance to blow away the cobwebs by socialising once again.</p>
<h2>Mass isolation</h2>
<p>Lockdowns have given psychologists a unique opportunity to study the effects of social isolation on the general population. Such effects are normally only studied in <a href="https://content.iospress.com/articles/journal-of-alzheimers-disease/jad180501">older adults</a>, or in very special groups of people such as <a href="https://doi.org/10.1016/j.actaastro.2012.08.013">astronauts</a>, <a href="https://bjsm.bmj.com/content/40/6/556">desert trekkers</a> and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0272494409000723?via%3Dihub">polar explorers</a>. But for over a year now, ordinary people of all ages have been experiencing prolonged periods with minimal social contact.</p>
<p>We know that humans derive many benefits from socialising. These range from <a href="https://doi.org/10.1016/S1474-4422(04)00767-7">preventing dementia</a> and <a href="https://doi.org/10.1016/S0277-9536(02)00075-8">enhancing memory</a> to improvements in <a href="https://doi.org/10.1016/j.archger.2018.12.014">concentration and the ability to think clearly</a>. When our social lives shrank last March, we lost these cognitive payouts too. </p>
<p>To investigate what happens when these payouts return, we <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2020.588604/full">surveyed</a> hundreds of Scottish adults between May and July 2020: a period when strict national lockdown restrictions were gradually eased. It was the perfect time to observe how the benefits of socialising might change how people think and feel. </p>
<p>Unsurprisingly, we found that people’s moods were lowest when we first approached them in May. Those who were shielding or living alone suffered the most and only began to feel better when the final restrictions were eased towards the end of our survey period in July. But our study was most interested in other psychological indicators: those that would show whether people’s cognitive abilities improved when they had more opportunities to socialise.</p>
<h2>Psychological recovery</h2>
<p>To measure this, we asked our survey participants to complete <a href="https://onlinelibrary.wiley.com/doi/10.1002/acp.3821">a series of online tests</a> to assess changes in their <a href="https://www.sciencedirect.com/topics/psychology/flanker-task">attention</a>, learning ability, <a href="https://www.psychologytoday.com/us/basics/memory/working-memory">working memory</a> – and even their perception of time.</p>
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Read more:
<a href="https://theconversation.com/a-year-of-blursdays-how-coronavirus-distorted-our-sense-of-time-in-2020-151512">A year of blursdays: how coronavirus distorted our sense of time in 2020</a>
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<p>Attention, learning ability and working memory are all essential for tasks we might perform at work or while studying. They’re indicators of how well we remember things we’ve learned, how long we can concentrate on a task, and how many tasks we can juggle in our heads at one time. </p>
<p>All of these indicators improved rapidly as lockdown restrictions eased, with clear week-on-week improvements each time we returned to our study participants for more data. This suggests that we’re likely to enjoy a similarly speedy boost in our ability to work when lockdown restrictions ease this time around. </p>
<figure class="align-center ">
<img alt="A couple with a picnic basket chatting with masks on at a social distance" src="https://images.theconversation.com/files/393122/original/file-20210401-19-1hjak87.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393122/original/file-20210401-19-1hjak87.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=271&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393122/original/file-20210401-19-1hjak87.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=271&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393122/original/file-20210401-19-1hjak87.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=271&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393122/original/file-20210401-19-1hjak87.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=341&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393122/original/file-20210401-19-1hjak87.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=341&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393122/original/file-20210401-19-1hjak87.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=341&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Socialising helps us sharpen our wits and boost our moods.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/couple-have-date-during-coronavirus-lockdown-1779001934">Maksim Shmeljov/Shutterstock</a></span>
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<p>We’ve all been experiencing varying degrees of loneliness and isolation, so it’s no wonder that we’re running low on the benefits that socialising can bring. Our findings offer concrete proof that lockdown makes us all a little more distracted, sluggish and fatigued – cognitive problems that may be affecting our performance at work and our social interactions outside of it. </p>
<p>But the speed at which we witnessed cognitive function improve once people began socialising again last summer shows that there’s hope. As days lengthen, the weather improves, and society reopens, our study suggests that renewed social contact will quickly and thoroughly reverse any cognitive decline we’ve experienced during the most recent lockdown.</p>
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Read more:
<a href="https://theconversation.com/hope-isnt-mere-wishful-thinking-its-a-valuable-tool-we-can-put-to-work-in-a-crisis-146271">'Hope' isn't mere wishful thinking – it's a valuable tool we can put to work in a crisis</a>
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<p>Our findings extend beyond the unique circumstances brought about by the pandemic. While there’s no denying that humans are social creatures, psychologists are only now beginning to recognise just how integral social interaction is to every aspect of our wellbeing and mental ability – and how isolation, whether for elderly people or those with extreme vocations, can affect our mental health and aptitude across so many measures.</p><img src="https://counter.theconversation.com/content/158154/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Hand receives funding from the Chief Scientist Office (Scotland).</span></em></p><p class="fine-print"><em><span>Dr Greg Maciejewski receives funding from the Chief Scientist's Office, Royal Society of Edinburgh, Experimental Psychology Society, and EU.</span></em></p><p class="fine-print"><em><span>Dr Joanne Ingram receives funding from the Chief Scientist Office and The Royal Society of Edinburgh. Dr Ingram is a member of the Scottish Green Party and a trustee of the Awesome Foundation Glasgow. </span></em></p>The study found people bounce back from their mental sluggishness soon after emerging from isolation.Christopher Hand, Lecturer, Psychology, Glasgow Caledonian UniversityGreg Maciejewski, Lecturer in Psychology, University of the West of ScotlandJoanne Ingram, Lecturer in Psychology, University of the West of ScotlandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1543312021-02-17T13:18:57Z2021-02-17T13:18:57ZHow many people get ‘long COVID’ – and who is most at risk?<figure><img src="https://images.theconversation.com/files/384050/original/file-20210212-13-1s0v1e4.jpg?ixlib=rb-1.1.0&rect=0%2C353%2C4977%2C3337&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fatigue, brain fog, breathing problems and many other COVID-19 symptoms can persist for months</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/an-exhausted-male-cyclist-leans-over-his-touring-royalty-free-image/464665401?adppopup=true"> Kyle Sparks via Getty Images</a></span></figcaption></figure><p>A few months ago, a young athletic guy came into my clinic where I’m an <a href="https://labs.vetmedbiosci.colostate.edu/ryan/">infectious disease physician and COVID-19 immunology researcher</a>. He felt tired all the time, and, importantly to him, was having difficulty mountain biking. Three months earlier, he had tested positive for COVID-19. He is the kind of person you might expect to have a few days of mild symptoms before recovering fully. But when he walked into my clinic, he was still experiencing symptoms of COVID-19 and he could not mountain bike at the level he was able to before. </p>
<p>Tens of millions of Americans <a href="https://coronavirus.jhu.edu/map.html">have been infected with and survived COVID-19</a>. Thankfully, many survivors get back to normal health within two weeks of getting sick, but for some COVID-19 survivors – including my patient – symptoms can persist for months. These survivors are sometimes dubbed <a href="https://theconversation.com/im-a-covid-19-long-hauler-and-an-epidemiologist-heres-how-it-feels-when-symptoms-last-for-months-143676">long-haulers</a>, and the disease process is termed “long COVID” or post-acute COVID-19 syndrome. A long-hauler is anyone who has continued symptoms after an initial bout of COVID-19.</p>
<p>Numerous studies over the past few months have shown that about 1 in 3 people with COVID-19 will have symptoms that last longer than the typical two weeks. These symptoms affect not only people who were very sick and hospitalized with COVID-19, but also those with milder cases. </p>
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<a href="https://images.theconversation.com/files/384051/original/file-20210212-23-1v65ugz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A doctor treating a patient in a hospital bed, both wearing masks." src="https://images.theconversation.com/files/384051/original/file-20210212-23-1v65ugz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384051/original/file-20210212-23-1v65ugz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384051/original/file-20210212-23-1v65ugz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384051/original/file-20210212-23-1v65ugz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384051/original/file-20210212-23-1v65ugz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384051/original/file-20210212-23-1v65ugz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384051/original/file-20210212-23-1v65ugz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Patients who were hospitalized for COVID-19 are most likely to experience long-lasting symptoms.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctors-caring-for-patient-in-emergency-care-unit-royalty-free-image/1217819939?adppopup=true">Westend61 via Getty Images</a></span>
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<h2>Long COVID is similar to COVID-19</h2>
<p>Many long-haulers experience the same symptoms they had during their <a href="https://doi.org/10.7326/M20-5926">initial fight with COVID-19</a>, such as fatigue, cognitive impairment (or brain fog), difficulty breathing, headaches, difficulty exercising, depression, sleep difficulty and loss of the sense of taste or smell. In my experience, patients’ symptoms seem to be less severe than when they were initially sick.</p>
<p>Some long-haulers <a href="https://theconversation.com/im-a-covid-19-long-hauler-and-an-epidemiologist-heres-how-it-feels-when-symptoms-last-for-months-143676">develop new symptoms as well</a>. These can vary widely person to person, and there are reports of everything from <a href="https://doi.org/10.1101/2020.12.24.20248802">hair loss to rapid heart rates to anxiety</a>. </p>
<p>Despite persistent symptoms, SARS-CoV-2 – the virus itself – is <a href="https://doi.org/10.1001/jama.2020.12603">not detectable in most long-haulers</a>. And without an active infection, they can’t spread the virus to others. </p>
<h2>Who are the long-haulers?</h2>
<p>Patients who were hospitalized for COVID-19 are the most likely to have persistent long-term symptoms. </p>
<p>In a study published in July 2020, Italian researchers followed 147 patients who had been hospitalized for COVID-19 and found that <a href="https://doi.org/10.1001/jama.2020.12603">87% still had symptoms 60 days</a> after they were discharged from the hospital. A more recent study, published in January, found that 76% of hospitalized COVID-19 patients in Wuhan, China, were still experiencing symptoms <a href="https://doi.org/10.1016/S0140-6736(20)32656-8">six months after first getting sick</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/384596/original/file-20210216-21-19h8f05.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A CT scan of lungs" src="https://images.theconversation.com/files/384596/original/file-20210216-21-19h8f05.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/384596/original/file-20210216-21-19h8f05.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=472&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384596/original/file-20210216-21-19h8f05.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=472&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384596/original/file-20210216-21-19h8f05.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=472&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384596/original/file-20210216-21-19h8f05.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=593&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384596/original/file-20210216-21-19h8f05.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=593&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384596/original/file-20210216-21-19h8f05.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=593&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Ground-glass opacities (the shading where the arrows are pointing) are among the effects of COVID-19.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Ground-glass_opacity#/media/File:COVID-19-Longontsteking.jpg">Opzwartbeek via Wikipedia</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>This Wuhan study was particularly interesting because the researchers used objective measures to evaluate the people reporting lingering symptoms. People in the study were still reporting persistent breathing problems six months after getting sick. When researchers performed CT scans to look at the patients’ lungs, many of the scans showed splotches called <a href="https://doi.org/10.21037/tlcr.2017.01.02">ground-glass opacities</a>. These likely represent inflammation where SARS-CoV-2 had caused viral pneumonia. Additionally, the people in this study who had severe COVID-19 could not walk as fast as those whose illnesses were less severe – these lung problems reduced how much oxygen was moving from their lungs into their bloodstream. And remember, this was all measured six months after infection.</p>
<p>Other researchers have <a href="https://doi.org/10.1016/j.eclinm.2020.100463">found similar objective health effects</a>. One study found evidence of <a href="https://doi.org/10.1148/radiol.2021203153">ongoing viral pneumonia</a> three months after patients left the hospital. Another study of 100 German COVID-19 patients found that <a href="https://doi.org/10.1001/jamacardio.2020.3557">60% had heart inflammation two to three months</a> after initial infection. These German patients were relatively young and healthy – the average age was 49, and many had not needed hospitalization when they had COVID-19.</p>
<p>The sickest COVID-19 patients are not the only ones to suffer from long COVID. Patients who had a milder initial case that didn’t result in hospitalization can also have persistent symptoms.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>According to a recent survey done by the Centers for Disease Control and Prevention, <a href="http://dx.doi.org/10.15585/mmwr.mm6930e1">35% of nonhospitalized patients who had mild COVID-19 cases</a> did not return to baseline health 14 to 21 days after their symptoms started. And this wasn’t just in older people or people with underlying health conditions. Twenty percent of previously healthy 18-to-34-year-olds <a href="http://dx.doi.org/10.15585/mmwr.mm6930e1">had ongoing symptoms</a>. Overall, research shows as many as <a href="https://doi.org/10.7326/M20-5926">one-third of individuals</a> who had COVID-19 and weren’t hospitalized will still be <a href="https://doi.org/10.1093/ofid/ofab060">experiencing symptoms up to three months later</a>. </p>
<p>To put these numbers in context, only 10% of people who get the flu are <a href="https://doi.org/10.1093/cid/civ952">still sick after 14 days</a>. </p>
<h2>Long-term symptoms, long-term effects</h2>
<p>The medical community still does not know just how long these symptoms will persist or why they occur.</p>
<p>According to recent research that has yet to be peer-reviewed, many long-haulers <a href="https://doi.org/10.1101/2020.12.24.20248802">cannot return to work or do normal activities</a> because of brain fog, pain or debilitating fatigue. Before my patient got sick, he would bike up a mountain in our Colorado town almost every day. It took him four months to recover to the point where he could climb it again. </p>
<p>SARS-CoV-2 hurts people in more ways than the medical community originally recognized. At Colorado State University, my colleagues and I are studying long-haulers and exploring whether immune system imbalances play a part in their disease process. Our team and many others are diligently working to identify long-haulers, to better understand why symptoms persist and, importantly, to figure out how the medical community can help.</p><img src="https://counter.theconversation.com/content/154331/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephanie LaVergne does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>‘Long COVID’ – in which people have symptoms lasting more than a few weeks – is turning out to be very common. People hospitalized for COVID-19 are at highest risk, but they aren’t alone.Stephanie LaVergne, Research Scientist, Colorado State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1484772020-10-23T14:26:19Z2020-10-23T14:26:19ZDaylight saving time: five tips to help you better adjust to the clock change<figure><img src="https://images.theconversation.com/files/365201/original/file-20201023-17-x2zcxr.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C7348%2C4891&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Time changes interrupt our internal "body clock". </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sweet-dreams-work-station-sleepy-tired-735692446">Roman Samborskyi/ Shutterstock</a></span></figcaption></figure><p>Daylight saving time was first implemented <a href="https://www.nationalgeographic.co.uk/2018/03/strange-100-year-history-daylight-saving-time#:%7E:text=In%201895%2C%20George%20Hudson%2C%20an,bug%20hunting%20in%20the%20summer.">during the first world war</a> to take advantage of longer daylight hours and save energy. While this made a difference when we heavily relied on coal power, today the <a href="https://www.frontiersin.org/articles/10.3389/fphys.2019.00944/full">benefits are disputed</a>. In fact, emerging research suggests that moving the clocks twice a year has negative impacts, particularly on our health. </p>
<p>During the first days after the clocks change, many people <a href="https://www.sciencedirect.com/science/article/pii/S1087079212001141?casa_token=MRNAdjOSzfQAAAAA:km-RiLylYSmvcVt8B-R40oj8_HTkO4TY1DTPsE7Corq2XKNYg9GdvzSlUKCEdkWJl_cErHTa">suffer from symptoms</a> such as irritability, less sleep, daytime fatigue, and decreased immune function. More worryingly, <a href="https://pubmed.ncbi.nlm.nih.gov/29461606/">heart attacks</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/27938913/">strokes</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/19702372/">workplace injuries are higher</a> during the first weeks after a clock change compared with other weeks. There’s also a 6% increase in <a href="https://www.sciencedirect.com/science/article/abs/pii/S0960982219316781">fatal car crashes</a> the week we “spring forward”. </p>
<p>The reason time changes affect us so much is because of our body’s internal biological “clock”. This clock controls our basic physiological functions, such as when we feel hungry, and when we feel tired. This rhythm is known as our circadian rhythm, and is roughly 24 hours long. </p>
<p>The body can’t do everything at once, so every function in the body has a specific time when it works best. For example, even before we wake up in the morning, our internal clock prepares our body for waking. It shuts down the <a href="https://www.yourhormones.info/glands/pineal-gland/">pineal gland’s</a> production of the sleep hormone <a href="https://www.yourhormones.info/hormones/melatonin/">melatonin</a> and starts releasing <a href="https://www.yourhormones.info/hormones/cortisol/">cortisol</a>, a hormone that regulates metabolism. </p>
<p>Our breathing also becomes faster, our blood pressure rises, our heart beats quicker, and our body temperature increases slightly. All of this is governed by our internal biological clock.</p>
<p>Our master clock is located in a part of the brain called the <a href="https://www.yourhormones.info/glands/hypothalamus/">hypothalamus</a>. While all tissues and organs in the body have their own clock (known as a peripheral clocks), the brain’s master clock synchronises the peripheral clocks, making sure all tissues work together in harmony <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710582/">at the right time of the day</a>. But twice a year, this rhythm is disrupted when the time changes, meaning the master clock and all the peripheral clocks become out of sync. </p>
<figure class="align-center ">
<img alt="Our body is controlled by internal 'clocks' which regulate all our body's functions." src="https://images.theconversation.com/files/365202/original/file-20201023-13-267gl2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/365202/original/file-20201023-13-267gl2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/365202/original/file-20201023-13-267gl2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/365202/original/file-20201023-13-267gl2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/365202/original/file-20201023-13-267gl2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/365202/original/file-20201023-13-267gl2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/365202/original/file-20201023-13-267gl2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Our internal body clocks control all our body’s functions.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/circadian-rhythms-controlled-by-clocks-biological-1320423206">kanyanat wongsa/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Since our rhythm is not precisely 24 hours, it resets daily using rhythmic cues from the environment. The most consistent environmental cue is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751071/">light</a>. Light naturally controls these circadian rhythms, and every morning our master clock is fine-tuned to the outside world. </p>
<p>The master clock then tells the peripheral clocks in organs and tissues the time via hormone secretion and nerve cell activity. When we artificially and abruptly change our daily rhythms, the master clock <a href="https://link.springer.com/chapter/10.1007/978-81-322-3688-7_16">shifts faster than the peripheral clocks</a> and this is why we feel unwell. Our peripheral clocks are still working on the old time and we are experiencing jetlag. </p>
<p>It may take several days or weeks for our body to adjust to the time change and for our tissues and organs to work in harmony again. And, depending on whether you are a natural morning person or a night owl, the spring and autumn clock change <a href="https://www.sciencedirect.com/science/article/pii/S0960982207020866">might affect you differently</a>. </p>
<p>Night owls tend to find it more difficult to adjust to the spring clock change, whereas morning larks tend to be more affected by the autumn clock change. Some people are even entirely unable to <a href="https://pubmed.ncbi.nlm.nih.gov/24156521/">adjust to the time change</a>.</p>
<p>While any disruption to our circadian rhythm can affect our wellbeing, there are still things we can do to help our body better adjust to the new time: </p>
<ol>
<li><p><strong>Keep your sleeping pattern regular before and after the clocks change.</strong> It’s particularly important to keep the time you wake up in the morning regular. This is because the body releases <a href="https://www.yourhormones.info/hormones/cortisol/">cortisol</a> in the morning to make you more alert. Throughout the day you will become increasingly tired as cortisol levels decrease and this will limit the time change’s <a href="https://www.sleepfoundation.org/circadian-rhythm/can-you-change-your-circadian-rhythm">impact on your sleep</a>.</p></li>
<li><p><strong>Gradually transition your body to the new time by changing your sleep schedule slowly over a week or so.</strong> Changing your bedtime 10-15 min earlier or later each day helps your body to gently adjust to the new schedule and eases the jetlag. </p></li>
<li><p><strong>Get some morning sunlight.</strong> Morning light helps your body adjust quicker and synchronises your <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751071/">body clock faster</a> – whereas evening light delays your clock. Morning light will also increase your <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751071/">mood and alertness</a> during the day and helps you sleep better at night. </p></li>
<li><p><strong>Avoid bright light in the evening.</strong> This includes blue light from mobile phones, tablets, and other electronics. Blue light can <a href="https://pubmed.ncbi.nlm.nih.gov/33022281/">delay the release</a> of the sleep hormone <a href="https://www.yourhormones.info/hormones/melatonin/">melatonin</a>, and reset the internal clock to an even later schedule. A dark environment is best at bedtime.</p></li>
</ol>
<p>5) <strong>Keep your eating pattern regular.</strong> Other environmental cues, such as <a href="https://www.sciencedirect.com/science/article/pii/S0960982217306231">food</a>, can also synchronise your body clock. Research shows light exposure and food at the correct time, can help your master and peripheral clocks <a href="https://theconversation.com/changing-your-meal-times-could-help-you-beat-jet-lag-and-shift-work-79061">shift at the same speed</a>. Keep mealtimes consistent and avoid late-night meals.</p>
<p>Following a Europe-wide consultation, in March 2019 the European Parliament voted in favour of <a href="https://ec.europa.eu/transport/themes/summertime_en">removing daylight saving time</a> – so this might be one of the last times many European readers have to worry about adjusting their internal clocks after a time change. While member states will decide whether to adopt standard time (from autumn to spring) or daylight saving time (from spring to autumn) permanently, <a href="https://journals.sagepub.com/doi/10.1177/0748730419854197">scientists</a> are in favour of keeping to standard time, as this is when the sun’s light <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6784249/">most closely matches</a> when we go to work, school, and socialise.</p><img src="https://counter.theconversation.com/content/148477/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gisela Helfer receives funding from the Academy of Medical Sciences, the Wellcome Trust, the Government of Business, Energy and Industrial Strategy and the British Heart Foundation and Diabetes UK.
</span></em></p>Time changes make many people feel tired, irritable, and unable to sleep.Gisela Helfer, Senior Lecturer in Physiology and Metabolism, University of BradfordLicensed as Creative Commons – attribution, no derivatives.