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Tiredness/fatigue in adults - Management
What treatments should I consider for an adult with tiredness?

  • Treat the underlying cause, if this is known.
  • In women of child-bearing age with serum ferritin of 50 micrograms/L or less but without anaemia:
    • Identify the cause and consider offering iron supplementation (80 mg/day elemental iron) for at least 4 weeks (off-label indication, based on limited evidence).
  • For all people with persistent unexplained fatigue, including those with suspected chronic fatigue syndrome (CFS)/myalgic encephalomyelitis or encephalopathy (ME):
    • Try to establish a supportive therapeutic relationship.
    • Try to offer an understandable explanation for tiredness/fatigue that:
      • Absolves the person from blame but also offers ways for the person to take, or at least share, responsibility for managing the symptom.
      • Is linked clearly to the person's specific concerns.
      • Provides links between psychosocial and physical factors.
    • Try to broaden the person's perception of tiredness/fatigue so that psychosocial causes and solutions are validated and considered along with biomedical causes.
    • Identify and address modifiable psychological, social, and general health factors, including stress, work, personal relationships, pain, and alcohol.
  • For people meeting criteria for CFS/ME who have not yet been assessed by specialist CFS/ME services:
    • Offer advice on sleep management.
      • Provide general advice on sleep hygiene — see the section on Good sleep hygiene in the CKS topic on Insomnia.
      • Discourage excessive sleep and daytime sleeping or naps.
    • In relation to activity, rest, and relaxation, advise:
      • Limiting the length of rest periods to 30 minutes at a time.
      • Introducing low level physical and cognitive activities (depending on the severity of symptoms).
      • Avoiding unsupervised, or unstructured, vigorous exercise.
      • Using relaxation techniques.
    • Advise a well-balanced diet.
    • Manage nausea by giving advice on eating little and often, snacking on dry starchy foods, and sipping fluids.
      • Use anti-emetic drugs only if nausea is severe.
  • For people with persistent unexplained fatigue (lasting 4 months or longer) who do not meet criteria for CFS/ME:
    • There is insufficient evidence to make any additional, clear recommendations, but the following treatment strategies may be considered:
      • Advise a balance between activity (including exercise) and rest.
      • Offer advice on sleep management — see the CKS topic on Insomnia.
      • Consider offering referral for counselling or cognitive behavioural therapy, if services are available and the person is motivated and psychologically minded.
      • Consider referring to specialist CFS/ME services for a structured, multidisciplinary approach to management, to access specialist interventions such as cognitive behavioural therapy and supervised graded exercise therapy, or for a consultant opinion for occupational reasons or disability benefits.

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