Does anyone else experience most of their fatigue in the afternoon?

[geekbread]

My fatigue and brain fog is mostly in the afternoon, it starts around 11:30am and gets better around 5pm. The worst part of the day is 2-5pm for me.

I'm wondering if anyone else experiences the same? I searched around on the forum but couldn't find much about people having similar experiences of having a consistent tiredness window. Let me know if you have the same!

I'm wondering why I would just be tired for that period of time and feel (mostly) ok in the mornings and night? I wonder what changes in the body at that time. If this is common, has there been any research in this area?

A few things I've already checked

• I've gotten blood sugar checked, wearing a "patch" to monitor it for 2 weeks, that came back normal.
• My adrenals are mostly ok, they are slightly off, but not drastically so. I respond really well to an "Adrenal complex" supplement with licorice root, which I take daily. I also do well with electrolyte/sea salt drinks.
• As far as food, I've tried everything, paleo, keto, elimination, etc... nothing will change my fatigue window. I really don't think my fatigue is diet related, even though that theory is an easy go-to when you are talking about "afternoon fatigue".

 

[YippeeKi YOW !!]

@geekbread
Like you, I usually hit a major wall anywhere from the early to the late afternoon, and have tried to be more alert and do a little lie down just before it gets really bad.

Mornings are generally good unless I'm really sleep-deficient or in a symptom spike.

I'm wondering why I would just be tired for that period of time and feel (mostly) ok in the mornings and night? I wonder what changes in the body at that time.

Cortisol comes to mind.

How's your blood pressure, generally? I ask because licorice is known for raising blood pressure, which for many of us isn't necessarily a bad thing.

licorice root

Be careful with licorice root. Here's a fairly readable NCBI paper on the dangers, some of which may be somewhat exaggerated to make the author's point, and possibly to get attention.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498851/

I know it gets tiresome, it seems like everything from 'harmless' herbs to our bathwater causes potential disastrous problems. Bugger and humbug .

 

[Seven7]

If I am not on OI meds and trying to go “al natural” I have to sleep 12pm or I am miserable from 12pm to 2pm or all afternoon. If I take nap no matter how short, I will be ok rest of
Afternoon. That was one of the things that made my doctor think I could ahve MS apparently they get set blocks of time where they also feel worst ( like 2pm or something like that.)

 

[Wishful]

Yes. Typically, I'll be feeling not too bad, then I abruptly start feeling worse (fatigue, malaise, brainfog). If I check the time, it's around 2:30 PM. It's that consistent. Yes, that worsening fades within a few hours (harder to be precise about gradual fading). Some days the 2:30 effect doesn't show up; never quite sure why.

It's not mealtime related, and doesn't change with season or sleeping pattern. I assume it's tied to the circadian rhythm through one or more hormones. My guess is that it's some number of steps down from a particular hormone level: hormone x changes this, which changes that, which affects something else, and so on, so I don't expect major improvements from supplemental hormones.

 

[Rufous McKinney]

My cycle is

1) come to, feel awake. 5 minutes later, zombie coma.

2) after about 1.5 hours- I seem to now wake up

3) what energy exists is available midday, after trying to actually eat

4) all my energy dwindles until the "Yin Deficiency" has now won (thats what we call it here)...and with Yin, now thoroughly depleted, the inflammatory symptoms and pain and Sahara Desert throat...move in.

So that might be a 2 pm on a mediocre day, 5 or 6 on a good day. But never fear, it will appear.

Zombie Zombie (see the Cranberries)

 

[pieddours]

I have the same afternoon crash. It starts around 1pm and maxes out around 3pm. I generally recover a little in the evening.

I've always assumed its cortisol related as I know I have messed up cortisol levels. I suspect everyone has the same basic rhythm (hence afternoon siestas, etc) but it's magnified in the case of CFS/ME.

All I've found is not to fight it - i.e. try to lie down and rest at that time. Forcing myself to do stuff at that time is a great way to bring on PEM.

I tried licorice root many years ago and got some transient benefit from it. Unfortunately, medium term use led to a big increase in my "tired but wired" symptoms. In my case, I suspect my body is maintaining low blood pressure for a reason. Everything I did to raise my blood pressure (licorice, salt, etc) worked in the short term but led to longer term setbacks. Your mileage may vary, of course!

 

[Moof]

Yep, I get that too. Exactly that pattern: 11:30 am-ish to around 5:00 pm. My absolute best time is mid to late evening, sometimes going through into the early hours. Whilst I was still working freelance, most of my work was done between 7:00 pm and 1:00 am.

I think it's a circadian rhythm defect. Many people with ME report reversed sleep/wake cycles, especially during active flares.

 

[pattismith]

I also have the brain fog hit at lunchtime (starting between 11h30 and 3h00), so I think it is the classic circadian lunchtime sleepiness that produces this effect. However, it may be stronger for us for a specific reason I guess.

 

[Rufous McKinney]

I've always assumed its cortisol related as I know I have messed up cortisol levels.

At this point, I Think its: we have now run out of ATP. So whenever that hits, TADA: the yucks move in.

 

[maple]

I crash at 2pm. I could set my watch by it. I have to lay down on my back, no pillow, feet elevated. I sleep but actually it feels more like my brain is checking out. When I come back to, around 3, I feel better but still tired. If I do this in the afternoon I can sleep at night. If I fight this afternoon crash and push through it I cannot sleep at night.

 

[edawg81]

I sleep from 2 or 3 till about 7 or 8, then half awake for 4 hours. Good for another 4-5 hours but still partially bedridden, then crash hard from 6-9pm with feverishness and may develop a migraine. Then better till i can fall asleep. Rinse repeat. I dont have my daily crashes if i have had a severe migraine or have taken an nsaid (but i cant take them often).

 

[Wishful]

At this point, I Think its: we have now run out of ATP. So whenever that hits, TADA: the yucks move in.

I disagree that it's due to lower ATP. I think it's more likely an increase in neurotoxins or something else interfering with normal neural function. We'll have to wait for researchers to answer this question.

 

[Rufous McKinney]

an increase in neurotoxin

Which are supposed to be removed by the body, which requires energy...which we seem to have little of. The organs arent getting oxygenated....also.

I"ve been in continuous PEM for 2.5 months now. The idea it subsides seems abstract to me. "My PEM lasts 72 hours...." some say. Oh?

I somewhat doubt neurotoxins have built up here, between waking (around 10 am) and unravelling- around 2-3 pm. It makes sense: ran out of energy for the day. ANd every body process that requires energy now has little. Just breathing and heart pumping takes: all of it.

But what the heck do we know: we are just living, endlessly, with this confounding experience that goes on, an on, and on.

 

[borko2100]

I wake up around 10 am, feel fine for 1 to 1.5 hours, then sudden fatigue and sleepiness hits, then later in the day around 11 pm get energy again, right when i am supposed to sleep, which fucks up my sleep rhythm constantly.

 

[YippeeKi YOW !!]

@Wishful

I disagree that it's due to lower ATP. I think it's more likely an increase in neurotoxins or something else interfering with normal neural function. We'll have to wait for researchers to answer this question.

That's an awfully broad attribution.

I'd ask you to cite sources, but as your last sentence makes clear, we'll just have to wait.

 

[YippeeKi YOW !!]

@Rufous McKinney , @Wishful

At this point, I Think its: we have now run out of ATP. So whenever that hits, TADA: the yucks move in.

I tend to agree with you, Red. I think that there's some sort of hitch in our Krebs Cycle git-alongs. The Krebs Cycle, or the tricarboxylic acid cycle, sometimes called the Citric Acid Cycle (because citric acid is the first product in the long and complex chain of conversions) is at the center of cellular metabolism, playing a HUGE role in both the process of energy production and biosynthesis. It finishes the sugar-breaking job started in glycolysis and fuels the production of ATP in the process. So there's any number of areas where malfunctions can occur, and none that I can think of have anything to do with:

an increase in neurotoxins or something else interfering with normal neural function.

 

[Wishful]

Well, for me, I can still do strenuous physical activity even at peak symptoms, so my body hasn't run low on ATP. It could be low ATP is a specific part of the brain, but that seem like a less likely scenario to me.

From what I've read, an increase in neurotoxic kynurenines could cause the symptoms. The increase in symptoms from extra tryptophan or IFN-g (increases IDO) feels similar to that from ME or PEM, so increased neurotoxic kynurenines seems like a reasonable hypothesis.

 

[YippeeKi YOW !!]

@Wishful

Well, for me, I can still do strenuous physical activity even at peak symptoms,

As you stated, that's for you. Others of us aren;t that lucky.

Are you sure you have ME? That kind of strenuous activity would be the unreachable star for me, and for others who've posted in these threads.

The increase in symptoms from extra tryptophan or IFN-g (increases IDO) feels similar to that from ME or PEM, so increased neurotoxic kynurenines seems like a reasonable hypothesis.

I'm not saying it isn't. I'm just saying that for me, and apparently for @Rufous McKinney, it feels more like ATP deficiencies and possible Krebs Cycle issues.

 

[Wishful]

it feels more like ATP deficiencies and possible Krebs Cycle issues.

The problem is that 'feels like' can be misleading. LSD can make people 'feel like' they are flying, but an independent observer sees them staying flat on the ground. Thus it seems reasonable to assume that some form of brain alteration can make people feel that they are low in ATP, even if they aren't. I did a quick check to see if there were any credible papers finding ATP levels low enough in ME patients to account for the physical symptoms, but didn't find any (just Myhill's, which was discredited). Furthermore, even if low ATP was the cause for some patients, that wouldn't prove that it wasn't just a secondary symptom for some PWME.

Yes, I fit the criteria for ME. The PEM is very definite. There are other people on this forum who also have clear ME symptoms but can still do strenuous weightlifting, running or whatever. I take that as strong evidence that ATP production (at least in muscles) isn't a core part of ME. Thus I have to consider alternative explanations for 'feeling low in energy'. Alterations in some process in the brain that controls what we 'feel' seems to work as a hypothesis.

Viral infections can make us 'feel low in energy', but again, I can't find any credible papers clearly stating that this is actually due to low ATP. People fighting infections might have lowered ATP, but that isn't necessarily the cause of the perceived fatigue. The neural alterations that are part of sickness behaviour could account for it.

I suppose this question could be settled by an experiment. Hook up some muscle tissue to an electrical stimulator (avoids brain issues) and measure work output. I'm not sure whether it's better to test with live legs or with samples of tissue (fed with blood from someone with severe ME, or a control), but either way it tests the work capacity of the muscles directly, rather than by indirect methods such as used by Dr. Myhill. Using tissue would also allow swapping the blood supplies, to see if 'something in the blood' directly affects muscle work capacity.

 

[borko2100]

https://www.sciencealert.com/alzhei...he-neurons-that-keep-us-awake-study-shows/amp

Oh and his colleagues have a different theory. Rather than stemming from a lack of sleep from the night before, they suggest that excessive daytime sleepiness is caused by direct degeneration of wake-promoting neurons.

Looking at brain tissue, the team found a significant tau buildup in three wakefulness-promoting brain centres, including the locus coeruleus (LC), the lateral hypothalamic area (LHA), and the tuberomammillary nucleus (TMN). Remarkably, this complex system had lost as many as 75 percent of its neurons.

Among the many fatalities was a type of neuron in the LHA that produces a neuropeptide called orexin. This neuron plays a crucial role in wakefulness; when it is deleted in mouse models, the animals show similar patterns to human narcolepsy - a chronic sleep disorder characterised by daytime drowsiness.

In the brains of patients with AD, UCSF researchers found orexin practically annihilated. In fact, the abundance of these orexin-producing neurons had decreased by more than 71 percent.

"To put this into another perspective, patients with narcolepsy .. have been reported to show 85-95 [percent] reduction in the number of orexinergic neurons, almost comparable to what we see in patients with AD," the authors write.

Something similar might be happening to CFS sufferers who need naps during the day.

If indeed orexin is reduced in those patients and this can be proven clinically, then this is also quite a good argument for disability and proof that something is physically wrong.

I've also heard of several people who were diagnosed with narcolepsy. Maybe the narcolepsy was caused by CFS?