for me at least (I have me/cfs type long covid, possibly also pots) it's also
- generalized burning/sore pain that's hard to identify, when the fatigue is really bad (especially if I haven't slept)
- severe insomnia (up to four days without sleep is pretty normal for me; I usually get four to six hours of sleep). somehow being fatigued makes it harder for me to sleep, which is pretty evil.
- cognitive symptoms: auditory hallucinations usually repeating a sound I heard recently, internal monologue repeating words or phrases involuntarily for hours making it almost impossible to think, internal monologue getting louder on certain words. other stuff I don't even know how to begin to explain. for some reason being more fatigued makes this all worse.
- brain fog. brain fog is too mild-sounding a term for what it is, though. it's being trapped in a brain that's going haywire and being aware of what's happening but not able to think about it properly because my train of thought is incoherent. it's being too tired to think, too tired to be conscious, too tired to be alive.
- worsened sensory issues because processing the sensory overload is exhausting and the fatigue makes all pain more noticeable and worse
- typing is tiring. holding my phone at the right angle is tiring. having to press any extra buttons (like capitalizing words) is extra effort mentally and physically.
- changing the tone of how I communicate in different situations is taxing. when it's bad I switch to formal grammar/vocabulary because I'm too exhausted to remember what slang or more casual grammar to use. if it's really bad I don't use grammar; anything I write like this would be incomprehensible to anyone else (this is when I'm too fatigued to get out of bed but can't sleep, so it's relegated to my notes app). I don't really talk to anyone when I'm fatigued enough for this to be an issue though, anyway, because at that point I'm way past too exhausted for social interaction (that used to be most of the time but this part of it has gotten a little better recently, but it's still pretty often)
- relatedly, conversation is exhausting. having to process the other person's responses and what I'm expected to respond with and what I want to say at once is exhausting (I'm also neurodivergent so it was a struggle before but the fatigue and brain fog this causes now is a whole other beast). when it's at the worst I can't really remember anything besides the most literal information I need to communicate, so I end up sounding rude because I can't process polite social cues. it makes it very difficult/impossible to express what I'm struggling with and why I can't communicate properly (this has also gotten a little better for me recently but is definitely still an issue)
- at it's worst, I'll be so exhausted that I know the position I'm resting (trying to rest) in is uncomfortable, but I can't really process that I should... move and do something about that, and getting into a more comfortable position is exhausting and painful (and then I just get uncomfortable again, rinse and repeat). so I'll just kind of be uncomfortable for... hours? it's hard to even tell how much time is passing
- even on my "good" days I'm more tired than I would've been after staying up two or three nights in a row pre-illness
- irregular, fast heartbeat (which is then extra sensory input and makes me more fatigued)
- I get too exhausted to think properly after about 15 minutes of intentional focus on any new information. sometimes up to half an hour on better days, and very rarely I'll have a good couple hours (like, maybe five times in the past year). so anything that requires sustained focus is really difficult. I can't read or study anything for long without it giving me physical symptoms (sometimes I get so tired I get nauseous), and worse, brain fog.
- a lot more but this is all I can think of right now
I really really wish people understood that fatigue is different to being tired because it's not even comparable. it's like comparing a stab wound to a papercut.
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