Chronic fatigue syndrome can be divided into two categories: mental fatigue and physical fatigue. It’s a condition where patients often suffer for a lengthy period before they are accurately diagnosed. Fatigue itself can be caused by a wide range of issues, ranging from insomnia, heart disease-related dyspnoea (a shortness of breath) and uncontrolled diabetes to adrenal gland disorders, hyperthyroidism and clinical depression.
“Most outpatients who visit hospital experience fatigue,” says Dr Hassan Hariri, Head of Sleep Clinic and Pulmonologist, Rashid Hospital. “It could be a side effect of medication such as pain killers for back pain.
“There is a difference between acute fatigue and chronic fatigue. The reason for acute fatigue should be obvious from the patient’s clinical history such as an illness or new medication.
“Chronic fatigue syndrome could be described as a persistence of fatigue without any explanation.”
Diagnosis
To establish the difference between sleepiness and fatigue, Dubai Health Authority’s Sleep Clinic performs a Multiple Sleep Latency Test, a daytime test. The team ask patients to take a nap in four or five trials that are, for example, for 20 minutes two hours apart. They assess how quickly patients fall asleep. If they fall asleep in less than eight minutes, it means the patient is sleepy. In cases like this, they are usually prescribed medication to stimulate the brain cells, allowing them to be alert enough for the sleepiness to disappear. “We prescribe modafinil, which is a medication that replaces internal hormones in our brain cells, called hypocretin, which keeps you awake,” says Dr Hariri.
The reason for acute fatigue should be obvious from the patient’s clinical history such as an illness or new medication.
“If it takes eight minutes or more on average to fall asleep, it is not sleep disorder-related — it is fatigue.”
Ordinarily, people visit a GP when they suffer from fatigue. They would often be required to take lots of different tests such as blood sugar and thyroid tests to eliminate various causes. “For example, a GP will not usually carry out an echocardiogram test until the end of the process and this is when they discover that the fatigue is linked to poor heart performance,” says Dr Hariri. At the end of this process, if we cannot find any explanation, then a patient is diagnosed with chronic fatigue syndrome.
“Usually, the best way to treat chronic fatigue syndrome is with anti-depressant medication.” Dr Hariri believes sleep testing should be introduced far earlier in the patient journey as this could help diagnose the syndrome quickly. “Instead of spending money on tests, patients with chronic fatigue should be assessed as early as possible by a sleep physician. I have had many cases of teenagers who reported poor academic performance and fatigue. With the correct diagnosis from sleep testing, their lives were improved.”
