Some people experience overwhelming fatigue after COVID-19. They find they are unable to return to previous levels of energy and health in the weeks following the infection.

Some degree of fatigue or weakness is quite common after a viral infection. This is known as post-viral fatigue.

Often it is short-lived and people return to normal after a few weeks but for some a full return to health can take months.

Using our current knowledge of post-viral fatigue and other similar viral infections such as SARS, there are some general principles around managing fatigue that can help in supporting your natural recovery process.

The initial fatigue phase

If you have or had COVID-19 it’s likely that you will experience fatigue as a symptom. This is the body’s normal response to dealing with an infection.

For most people the infection and initial fatigue will be mild to moderate with recovery occurring over a week or two.

During this initial phase it is important to…

Sleep

You may find that you need to sleep much more and/or have disturbed sleep. This is normal during an infection and while recovering with long Covid, so sleep as much as you feel you need.

If you can, keep a routine for your sleep/wake schedule. Try to go to bed and wake up at the same time each day. Avoid napping in the day, unless it’s part of your fatigue management, particularly after 3pm.

Reduce time on electronic devices, such as a smartphone, before bedtime and avoid using these in the bedroom as it stimulates the mind and causes light exposure.

Don’t go to bed full, hungry or thirsty. Avoid stimulants that contain caffeine eight hours before bedtime, as well as nicotine and alcohol.

Make sure the bedroom is cool, dark and quiet before bed. Avoid clock watching by making sure clocks are not visible.

Sleep restriction can help by only staying in bed for the time you can usually sleep (so long as it is more than a couple of hours). If you cannot get to sleep, try getting up and doing something else for a while.

In the morning get out into natural light as soon as is practical, preferably around the same time every day. Natural light supports your physical and psychological wellbeing as it helps your body produce vitamin D, can improve focus and sleep, as well as making you feel happier.

Engage in daytime exercise and/or activity and in the evening relaxation activities like reading, yoga, meditation, controlled breathing, listening to music, meditation and breathing exercises – these can all help.

Speak to your healthcare professional or GP if the problems continue or if you are having very vivid or distressing nightmares, enacting your dreams, lashing out, injuring yourself or partner, or waking to find damage around you as this could indicate a sleep disorder or other mental health problem.

You may also find the advice at thesleepcharity.org.uk helpful.

Rest

This allows your body to focus on dealing with the infection. It can mean period of rest during the day, doing very little, physically or mentally. Even low-level activity such as watching TV or reading, may need to be paced or minimised, depending on your level of illness.

Eat and hydrate

Eat and drink little and often if you can. If drinking is easier than eating, sip on nourishing or milky drinks during the day.

Move

If you feel well enough, move at regular intervals throughout the day to keep your body and circulation moving. This could be simple stretches either in your bed or chair if you are unable to walk around.

Pause your work or education

Allow yourself to fully recover from the initial infection before returning to your previous activity levels.

The fatigue recovery phase

When people start to feel better after an infection, it is often tempting to return to previous levels of work, leisure and social activities. However, trying to do too much, too soon, can often be counter-productive. It is easy to get caught up in a ‘boom and bust’ cycle of activity that can prolong your recovery.

Boom and bust cycle

If fatigue and other symptoms are persisting, it’s important to remember to allow yourself time to recuperate by finding the right balance of rest, relaxation and activity for your own individual circumstances.

While you might feel ready to go back to work or pick up your life where it was left prior to COVID-19, it’s important to listen to your body and gradually build a physical and emotional recovery plan that can help you get back to your life and stay on track, without experiencing too many setbacks.

The most important aspect of managing post-infection fatigue is giving yourself time for recuperation, or convalescence as it has been known. This requires a combination of rest, relaxation and gentle activity. In practice it involves:

Activity management

Balancing periods of low-level gentle activity with periods of rest. You could start with some light activity or tasks followed by longer periods of rest. Mix up the physical and mental activities throughout the day.

Setting limits

Finding the right balance of activity management is very individual to you and the stage that you are at with your recovery. Once you’ve worked out what is a suitable level and duration to do an activity for, try to set the limit before you start something and do not exceed this, for example unload the top layer of the dishwasher only or check through emails for five minutes.

Routine

Try to resume a pattern of sleep, mealtimes and activity. Avoid doing too much on a good day which might exacerbate the fatigue and other symptoms. Having a basic routine that has some flexibility can be helpful for when you are ready to start increasing activity. A regular routine can also help you sleep better.

Rest and relaxation

Find the time to engage in activities that you enjoy, value, and help calm your mind.

This could include connecting with friends and family, hobbies and interests and simply setting aside some ‘you time’. Building these into your recovery gradually could begin with something small, such as chatting to a friend, walking round the garden, making a snack, reading a book or watching your favourite TV show.

You can find tips and ideas on how to balance rest and activities as part of your recovery at www.rcot.co.uk/conserving-energy

Also, certain relaxation exercises can calm the mind, reduce stress hormones in the blood, relax muscles, help manage fatigue and pain and elevate your overall sense of wellbeing. Using them regularly can lead to long-term changes in the body to better counteract the harmful effects of stress.

There are some useful links and smartphone apps available. Visit www.mind.org.uk/information-support/tips-for-everyday-living/relaxation/relaxation-tips and www.nhs.uk/apps-library

Sleep

We encourage resuming a routine for sleep, however, sleeping for longer can often be an important requirement for ongoing healing. You may find a short day-time nap of 30 to 45 minutes, not too late in the afternoon, is helpful.

You may also find the advice at thesleepcharity.org.uk helpful.

Eat and hydrate

Eat and drink little and often if you can. If drinking is easier than eating, sip on nourishing or milky drinks during the day.

Work or education

It might be advisable to avoid going back to work too soon once the initial viral symptoms of fever or cough have subsided and to give yourself time to recover. You may find a phased or gradual return helpful, for example, starting with just mornings every other day and slowly building up over the next few weeks. You may be able to get support from occupational health or a fitnote from your GP.

Exercise

Depending on the stage of your recovery, some exercise may be helpful. This might be some gentle stretches, yoga or a short walk. For people who usually do a lot of exercise, it is important to only do a small fraction of what you would normally do and at a gentle pace. Resume slowly and gradually increase over time as your illness improves.

Post infection

You may be starting to feel better after a few weeks and over time you may feel able to increase your activity gradually. Resist pushing through the fatigue and maintain some degree of routine, rest and activity.

In most cases people do eventually recover from post-viral fatigue after a period of convalescence, but it can take many months sometimes.

If your health is not improving or if you continue to experience persistent symptoms after a few months which interfere with your ability to carry out normal everyday activities, it is advisable to speak to your GP. They can check to find out if there are any other causes for the fatigue.

Go to leaflet…

• Long Covid
• Managing your breathing
• Managing your cough and clearing your chest
• Tiredness and fatigue
• Emotional impact
• Communication and changes to your voice
• Food and diet
• Quit smoking
• Getting active

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