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====Suspected ME/CFS==== *the person has had all of the persistent symptoms in the box below for a minimum of 6 weeks in adults ''(4 weeks in children and young people)'' '''and''' *the person's [[ability to engage in occupational, educational, social or personal activities is significantly reduced from pre‑illness levels]] '''and''' *[[symptoms are not explained by another condition]]. '''All''' the following symptoms are required for suspected ME/CFS: *Debilitating [[fatigue that is worsened by activity]], is not caused by excessive cognitive, physical, [[mental health|emotional]] or social exertion, and is not significantly relieved by rest. *[[Post-exertional malaise]] after activity in which the worsening of symptoms: **is often delayed in onset by hours or days **is disproportionate to the activity **has a prolonged recovery time that may last hours, days, weeks or longer. *[[Unrefreshing sleep]] or [[sleep dysfunction|sleep disturbance]] (or both), which may include: **feeling exhausted, feeling [[flu-like symptoms|flu-like]] and stiff on waking **[[sleep dysfunction|broken or shallow sleep]], altered sleep pattern or [[hypersomnia]] *[[cognitive dysfunction|Cognitive difficulties]] (sometimes described as 'brain fog'), which may include [[word-finding problems|problems finding words or numbers]], difficulty in speaking, slowed responsiveness, short-term [[memory problems]], and [[concentration problems|difficulty concentrating]] or multitasking.<ref name="MECFSguidelines2021" /> Definitions: *'''Activity'''<br /> Any effort that uses energy, which includes cognitive, emotional and social activity as well as physical activity. Different activities combine and interact to cause a cumulative impact for the person. *'''Fatigue'''<br />Fatigue in ME/CFS typically has the following components: ** feeling [[flu-like symptoms|flu-like]], especially in the early days of the illness ** restlessness or feeling 'wired but tired' ** low energy or a [[lack of stamina|lack of physical energy to start or finish activities]] of daily living and the sensation of being 'physically drained' ** cognitive fatigue that worsens existing difficulties ** [[muscle fatigability|rapid loss of muscle strength]] or [[lack of stamina|stamina]] after starting an activity, causing for example, sudden weakness, clumsiness, lack of coordination, and being unable to repeat physical effort consistently. *'''Post-exertional malaise''' The worsening of symptoms that can follow minimal cognitive, physical, emotional or social activity, or activity that could previously be tolerated. Symptoms can typically worsen 12 to 48 hours after activity and last for days or even weeks, sometimes leading to a relapse. Post-exertional malaise may also be referred to as post-exertional symptom exacerbation. *'''Unrefreshing sleep'''<br /> Unrefreshing sleep means sleep that is non-restorative. Even after a full night's sleep, people do not feel refreshed. People with ME/CFS often report waking up exhausted and feeling as if they have not slept at all, no matter how long they were asleep.<ref name="MECFSguidelines2021" />
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