How to support someone with a chronic illness like ME/CFS, long COVID, POTS or fibromyalgia

Short answer

The support that helps sits between pushing her and overprotecting her. Believe her limits, even when she looks fine and her tests come back normal. Ask what she needs instead of guessing, help in ways that save her energy, and let her make her own decisions. Plan around delayed crashes, which can arrive 12 to 48 hours after effort (1). Talk openly with each other, including about how you feel, and look after yourself too, because you both need a pace you can keep.

If you have wondered whether she is exaggerating, you are not a bad person for wondering, and she is not imagining it. Energy-limiting conditions come with measurable changes in how the body regulates itself: in a study of 429 people with ME/CFS, blood flow to the brain dropped by about 26% during a tilt test, against 7% in healthy people (10). Routine blood tests are not built to catch that kind of problem. Being doubted is also part of what she lives with: in a survey of 4,835 people with POTS, 77% had a doctor suggest their symptoms were psychological before they got the right diagnosis (6). It is not her fault, and it is not a failure of willpower.

Printable version: download the 2-page quick guide for family, friends and caregivers (PDF). It fits on a fridge door and covers crashes, the energy budget, standing, brain fog, infections and what to say.

Note: this guide is for educational purposes only. It is not medical advice, diagnosis or treatment, and it does not replace a conversation with a doctor or another qualified health professional. Every person and every illness is different, so check what is right for her with her care team.

This page was written for the families of members of the Welltory Energy Lab, a community for women aged 35 to 65 living with energy-limiting conditions. It is written about "her", because that is who most of our readers love and look after. If she wants support from women with the same symptoms, she can join Energy Lab here; what the community is, who it is for and what it costs is explained on a separate page.

What is an energy-limiting condition?

ELC is an umbrella term for illnesses in which the main difficulty is that energy is very limited and runs out fast. It brings together people with different diagnoses and a similar experience: myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), long COVID, postural orthostatic tachycardia syndrome (POTS), fibromyalgia and related conditions. The shared feature is often post-exertional malaise (PEM), usually called a crash: a delayed, disproportionate worsening of symptoms after physical, mental or emotional effort (1, 3).

Her exhaustion goes far beyond ordinary tiredness or being out of shape. Many women say it feels like having the flu without the cough: heavy limbs, a foggy head, a body that feels poisoned. Sleep and rest don't fully bring her back.

What her body goes through

• Crashes that come late. Symptoms may worsen 12 to 48 hours after effort, though timing varies (1). Unlike regular tiredness, a crash can leave her foggy, in pain and barely able to get out of bed for days or even weeks. Our guide to post-exertional malaise explains why the crash arrives days after the effort.
• Everything costs energy. Exercise, yes, but also talking, screens, noise, bright light, stress, an argument, even lunch. It all comes out of the same small budget. Many women call the units "spoons" (the spoon theory). She gets far fewer each day than a healthy person does, so every spoon has to be placed with care.
• Standing is often harder than walking. In POTS, the body struggles to keep blood flowing up to the brain when she's upright. In adults with POTS, heart rate typically rises by at least 30 beats per minute within 10 minutes of standing, as part of the diagnostic criteria (2). In a line at the store or at the stove, she can feel close to fainting: pounding heart, lightheadedness, nausea, vision that blurs or narrows.
• Brain fog. Words go missing. Reading is hard, and so are decisions. Some compare it to the sedated feeling after surgery: she follows everything, but speech and focus come slowly.
• Pain, poor sleep and sensitivity to sound, light or temperature often come with it.

What she carries inside

• Loneliness and not being believed. She can look fine, so she often feels unheard and may start to question whether what she feels is real. It's hard for others to believe that someone who laughed at dinner yesterday can't get out of bed today. Doubt hurts most when it comes from the people closest to her, because they are the ones she relies on (3). Over time she may hide her symptoms or feel she has to justify her condition all the time. Friendships built around activities often fall away too, leaving a small core. Being disbelieved by doctors also leaves a mark. Medical gaslighting, when a doctor dismisses or doubts symptoms, is real, and over time it can damage trust in clinicians (5). In a UK survey of people with long COVID, 95% had experienced stigma at least sometimes (7).
• Grieving the life she had. Work, plans, the body she knew, sometimes the person she used to be. The grief is real, and hardly anyone acknowledges it, doctors and the people around her included.
• Feeling like a burden. She feels guilty about what others carry for her, and that guilt can push her to overdo it on a good day, which sets up the next crash.
• Worn out by trying everything. She has probably tried far more than you know: new diets, supplements, meditation, therapy, more rest, less rest. Many women end up as detectives of their own bodies, rebuilding their days by trial and error.

Is her illness real if her tests come back normal?

Yes. Normal tests don't mean she isn't sick. Routine blood tests check for organ damage, infection or anemia. They aren't built to catch problems with regulation: how the heart, blood vessels, immune system and nervous system respond to standing, effort or an infection. A 10-minute standing test with a heart-rate monitor can show what a blood draw can't (8). Both can be true at once: her heart isn't damaged, and something is wrong with how it behaves when she stands up. Many women have heard "your labs are normal" followed by "so it's probably stress or anxiety", and some doctors stop looking once the numbers come back fine (3, 6).

Here is what major medical bodies say about each condition.

Is chronic fatigue syndrome (ME/CFS) real?

Yes. In 2015, the US Institute of Medicine (now the National Academy of Medicine) reviewed the evidence and called ME/CFS "a legitimate, serious, and complex systemic disease", estimating that between 836,000 and 2.5 million Americans live with it (23). Its diagnostic criteria include post-exertional malaise and unrefreshing sleep. One of the clearest objective markers comes from repeating an exercise test a day later: people with ME/CFS do worse on the second day, while healthy people do about the same, or slightly better (11).

Is long COVID real?

Yes. In 2024, the US National Academies of Sciences, Engineering, and Medicine defined long COVID as "an infection-associated chronic condition" that lasts at least three months and affects one or more organ systems. The same report says long COVID "can be diagnosed on clinical grounds" and that "no biomarker currently available demonstrates conclusively" its presence (24). In other words, there is no single blood test, and that is expected. Studies have found that oxygen reaches the blood normally, but the muscles can't extract and use it well under load (12), and that immune activation can still be present 8 months after a mild infection (13).

Is POTS real?

Yes. POTS has formal diagnostic criteria set out by the Heart Rhythm Society and an international expert consensus: a sustained heart-rate rise of at least 30 beats per minute within 10 minutes of standing in adults, with symptoms, and without a drop in blood pressure (2, 25). It can be measured at the bedside with a stand test or on a tilt table; our guide on how POTS is diagnosed explains both. A 2026 study found signs of central sensitization, where the nervous system turns up incoming signals, in 86.6% of 305 people with POTS (14).

Is fibromyalgia real?

Yes. Fibromyalgia has published diagnostic criteria from rheumatology researchers, most recently revised in 2016 (26). A review in JAMA describes it as a condition in which the central nervous system amplifies pain, rather than a problem in the muscles or joints themselves (27). People sometimes search for "signs someone is faking fibromyalgia". The more useful question for a family member is what the pain is like for her today, and what would help. Pain that changes from day to day is typical of the condition, not a sign of faking.

Why she is not imagining it: what's going on in her body

Behind energy-limiting conditions are real, measurable changes in how the body regulates itself. Several mechanisms work at once, in different proportions in different people, which is why no two women's illnesses look quite the same (3). Researchers are still studying how these mechanisms vary across conditions and from person to person.

• The body's autopilot is miscalibrated. The autonomic nervous system quietly runs heart rate, blood pressure, digestion and temperature. In ELCs it often misjudges what the body needs, like a thermostat that thinks a warm room is cold (3, 9). Her heart races when she stands, vessels don't tighten when they should, and digestion and sleep get thrown off. One regulation problem, many different symptoms.
• Less blood reaches her brain when she's upright. In the study of 429 people with ME/CFS, blood flow to the brain dropped by about 26% on average during a tilt test, against 7% in healthy people, even when heart rate and blood pressure looked normal (10). This is the physical side of brain fog.
• Her body can't recover from effort the usual way. Doing something once is often possible for her. Recovering from it is the part her body can't manage (11, 12).
• The immune system doesn't fully stand down. After an infection, immune activation can keep running for months in some people (13). That can explain the flu-like feeling many women describe.
• The volume on signals is turned up. With central sensitization, the brain and spinal cord stop damping incoming signals, so light, noise, touch and pain can feel much louder (14). The change is measurable, and it has nothing to do with being oversensitive by nature.

Where care goes wrong: pushing vs overprotecting

Most mistakes come from love. They tend to land on one of two sides, and the support that works sits between them, on her terms.

The next two sections look at what each side means day to day. What to say comes after that.

How to help without pushing her past her limits

These habits come from wanting her to get better. For her body, they often do the opposite.

Instead of urging her to sleep more or walk more so she'll feel better, learn what pacing is and help her with it. Pacing means staying inside her energy limits: spreading effort across the day, resting before she's exhausted, and stopping before a crash instead of after one (1). You can help her plan her days around it. Pacing together lowers the load on both of you, and you don't need to monitor her energy. Our guide to pacing and the 50% rule explain the approaches.

Instead of looking for the cause of a crash only in what she did yesterday, look for patterns together. PEM can cause symptoms to worsen 12 to 48 hours after exertion, though the timing varies. A simple log makes the link visible: what she did, and how she felt over the following two days. If she keeps one, ask if you can go through it together. A notes app works, or she can tag crashes and other symptoms in the Welltory app (15). Our article on the activity and symptom diary shows what to write down.

Instead of motivating her with exercise ("movement heals", "it gets easier the more you do"), let her and her care team set the pace. For someone with PEM, doing more than her body can handle can trigger a crash, and repeated crashes may make her usual level of functioning worse. In 2021 the UK's NICE guideline stopped recommending exercise programs built on a fixed, gradual increase in activity for ME/CFS, and said energy management should take individual limits into account (1). A 5-minute walk that doesn't cause a crash beats a 30-minute workout that puts her in bed for three days. With POTS or fibromyalgia, carefully dosed exercise can be part of treatment, built up slowly with her care team, on her terms.

Instead of holding her to a plan she wants to cancel, ask and let the plan bend. "Do you have the energy for this today, or should we change the plan?" Don't take cancellations personally or keep score.

Instead of cheering her past her limits, respect them as you would any other medical need. Nobody thinks a wheelchair is a whim. Her "no", her rest and her mobility aids are the same kind of thing: tools that protect her body and make it possible for her to take part at all. NICE recommends aids such as a wheelchair for people with moderate or severe ME/CFS, so they can keep their independence (1).

Instead of catching up on everything during a good spell, notice adrenaline-driven energy and gently suggest a rest. For someone with PEM, two good days in a row can end in a crash, because the extra energy often gets spent the moment it shows up. Help her stop early, before she looks tired. If she has POTS, our piece on adrenaline dumps explains why the next day can be worse.

Instead of feeling hurt when she says no to sex or closeness, keep closeness in low-energy forms. A film watched lying down, reading aloud, touch with no expectations. Sex draws on the same energy budget: it's a physical load, a strain on heart rate and blood pressure when upright, and an emotional load. Above all, talk about it. Silence pulls people apart faster than an honest conversation about her limits (3).

Instead of underestimating infection risk, take it seriously. If you're ill, keep your distance or wear a mask. For her, an ordinary cold can mean a long setback. Treat the precautions she asks for as a medical need.

Instead of expecting her to keep being the "good mother" or the one who runs the home, lift parts of those roles off her, by agreement. Decide together which parts of parenting and housework someone else can take on.

How to care for her without taking over

There's more health advice around than ever: protein, steps, muscle loss, the "right" diet. Worrying is natural. But when worry turns into rules she didn't ask for, it can feel like control rather than care. Research on how loved ones try to steer each other's health habits suggests that pressure sometimes changes behavior, but it often leaves the person feeling hostile, guilty or sad (16).

• Keep her in every conversation about her. Don't discuss her health with others, including her doctor, without her knowing and agreeing. Bring your worries to her directly. And when a skeptical relative speaks up in front of her, don't take their side.
• Leave food, drink and sleep choices to her. Ask: "Is there anything you'd like me to cook or pick up?"
• Ask first, offer second. Instead of pressing a diet, supplement or new doctor on her, try "What has helped you before on a hard day?" or "Want me to look into this for you?" Then let her decide. You can also suggest sharing her daily data with her doctor: sleep, crashes, movement and heart rate variability (HRV).
• Take on the costly tasks she's ready to hand over. Cooking, phone calls, paperwork. Ask: "Do you want me to take this, or would you rather do it at your own pace?" What she keeps doing herself is her choice. Slow down and walk beside her, even if you could rush ahead to bring the car around.
• Plan with her, not for her. Look at two or three days at a time: "What will this cost you tomorrow and the day after?" Build in rest before and after events, and keep a Plan B, like takeout on the couch instead of dinner out. Changing the plan is a sign the plan is working.
• Don't keep hard things from her. Talk calmly and in small doses, and share your own feelings too. When partners hide worries to protect each other, the one who stays silent tends to feel more distress, while couples who tackle problems as a team tend to have better health and more satisfying relationships (17). Pick a calmer hour, and never try to sort things out in the middle of a crash.

What to say to someone with a chronic illness (and what not to say)

The heart of it: empathy and validation

Validation means telling her that what she feels, and how she reacts, makes sense. You can do that without agreeing with every conclusion or promising it'll all be fine. Research on couples living with chronic pain links partners' empathy and validation to better relationships (19). A simple structure for any hard conversation:

1. Make space. Put the phone down, sit at her level, don't interrupt. "I want to hear you. How are you right now?"
2. Reflect what you heard and name the feeling, as a guess. "Sounds like after that appointment you're confused and angry, because so much is still unclear. Is that right?"
3. Say it makes sense. "If I'd gone months without clear answers, I'd find it hard to stay calm too."
4. Ask before advising. "Do you want me just to be here, help you think it through, or look something up?"
5. Offer something concrete. "I could come to the next appointment, or help you write your questions down. Which would help more?"

The short version: "I hear that… It sounds like you feel… That makes sense, because… How can I help?"

How to help someone with POTS, ME/CFS, long COVID or fibromyalgia

Most of this guide applies across energy-limiting conditions. A few things are specific to each one.

How to help someone with POTS. Make it easier to sit or lie down: a chair at the kitchen counter, a shower stool, seated plans, a folding stool in a long line. Heat, long showers, standing still and big meals can make symptoms worse, so plan outings with shade and places to sit. If she uses compression garments or needs extra fluids and salt on her doctor's advice, treat that as part of her care, not a quirk. See POTS symptoms for the full picture.

How to help someone with ME/CFS. The central rule is to protect her from crashes, because PEM is the defining feature (23). That means fewer, shorter visits, quiet rooms, help with the invisible work of planning, and no pressure to "build up" activity. More on the condition in our ME/CFS guide.

How to help someone with long COVID. Many people with long COVID were healthy and active before, so families often expect a quick bounce-back. Recovery, if it comes, tends to be uneven and slow. Watch for PEM, which many people with long COVID have, and take new infections seriously (24). Our long COVID explainer covers symptoms and timelines.

How to help someone with fibromyalgia. Pain can move and change intensity from day to day, so ask about today rather than assuming from yesterday (27). Lower the sensory load, offer practical help with physical tasks, and support gentle movement only as she and her care team decide. See our fibromyalgia guide.

If you live with her: everyday support and a crash plan

You see the good hours and the bad ones, and the way your home runs shapes her energy every day.

• Take over the planning as well as the tasks. Remembering what to buy, booking appointments, keeping track of who's coming when: that invisible work drains her too. Ask which parts she'd like to hand over.
• Agree on a quick energy signal. A number from 0 to 10, the spoons she has left, or a traffic light: green, amber, red. One word or one emoji in a text tells you how she is, without her having to explain.
• Make it easier to sit or lie down. A chair at the counter, a shower stool, a quiet room after a visit.
• Agree on a crash plan while she's well. Decide who handles meals, kids, pets and errands so she doesn't have to direct you while she's down.
• Talk about good days ahead of time. On a good day she may have a little more energy, but she still needs to pace herself. Agree on this in advance, so a bad day afterward isn't seen as a setback or a sign that the good day wasn't real (3).

How to help during a PEM crash

• Cut the sensory load. Dim the lights, lower the noise, keep screens off or turned down. Hold off visitors.
• Cut the thinking load. Keep talking short and simple. Skip questions, choices and decisions; if you must ask, make it a yes or no. Handle calls and messages for her.
• Bring water and easy food. Something she can eat without cooking or choosing.
• Don't try to get her moving. This is the delayed reaction to effort, and nobody did anything wrong.
• Expect it to last. A crash that is over after one day is a good outcome. It can take days, sometimes weeks. If her step count was low and she still crashed, our piece on crashing with zero steps explains why.

If you don't live with her: staying close from a distance

For a friend, relative or colleague: you usually see her in short windows, and often in the good ones. You can be the friend who doesn't fade.

• Remember you see the best hour. If she looks fine at dinner, that's one good hour of her day. A crash can come one or two days later, at home.
• Make it small and easy. Keep it short, seated, at her place, somewhere quiet, or over video. Say up front that it's fine to cancel with no explanation.
• Keep inviting her, even after cancellations. An invitation shows her she's still part of your life, even if she can't come this time.
• Offer something specific. "Can I bring dinner on Thursday?" works better than "Let me know if you need anything."
• Make it a gift. She may feel she owes you for every bit of help. Say it plainly: "You don't owe me anything for this."
• Send messages that don't need a reply. "Just wanted you to know I'm thinking of you, no need to reply."
• Keep sharing your life. Don't hide your news to spare her feelings. Being left out of ordinary life hurts more than hearing about it.

Supporting a partner with a chronic illness: you matter too

Living next to a long, unpredictable illness is hard on you too. In a study of 1,418 people with ME/CFS and their family members, most of them partners, families reported a major impact on their own lives: worry, frustration and sadness, plus changes to holidays, plans, sex life and money (20). Feeling tired, sad, frustrated or helpless is normal. It doesn't make you a bad partner, parent, friend or caregiver.

What many family members feel is closer to compassion fatigue: the strain of caring about someone who is suffering, again and again, with no clear end. It's a normal cost of empathy (21). You may be grieving too: she's here, but parts of the life you shared and the future you imagined have changed.

• Don't be her only support. Share the load with family, friends or paid help, so no single person runs on empty.
• Get support of your own. A caregivers' group, a friend who listens, or a therapist. Acceptance and commitment therapy (ACT) for family caregivers has good evidence for easing distress (22). This is support for you, separate from any treatment for her.
• Notice resentment early. It's a signal that your reserves are low.
• Be honest, gently, about what you can sustain. A calm conversation now is better than months of quiet effort.
• Plan time for yourself before you run empty.

Understanding doesn't arrive in one conversation. For most families it comes slowly, as they watch the same pattern repeat. That's normal.

Living with a chronic illness in the family: the questions people ask next

Is chronic illness a common reason relationships struggle?

Long-term illness changes roles, plans, money, sex and how much time a couple has for each other, and families of people with ME/CFS describe a major impact on their own lives (20). What seems to protect relationships is tackling the illness as a team: research on couples facing chronic physical illness links shared, open coping with better relationship satisfaction and health (17). Talking about your own limits early, and getting outside support, gives a relationship more room than quiet endurance does.

What if I'm dating someone with a chronic illness?

Ask how her energy works and what a good date looks like for her: seated, short, at home, or at a quieter time of day. Expect cancellations and don't treat them as a verdict on you. Learn what a crash is, so a bad day after a good date isn't a mystery. Above all, believe what she tells you about her body, because being doubted by the people closest to her is one of the heaviest parts of living with an energy-limiting condition (3).

How do I explain her illness to a skeptical relative?

Keep it short and concrete: "She has a medical condition where effort causes a delayed crash, sometimes a day or two later. Normal blood tests don't rule it out." You can point to the 2015 Institute of Medicine report calling ME/CFS a serious systemic disease (23) or the 2024 National Academies definition of long COVID (24). Have the conversation without her in the room only if she has agreed to it, and stand up for her in front of others.

Should I go to her doctor's appointments?

Only if she wants you there. If she does, you can help most by taking notes, keeping track of questions, and helping her bring a dated record of crashes, sleep and activity. Let her lead, and don't speak for her unless she asks you to. An appointment often costs her a lot of energy, so plan rest before and after it.

How do I deal with my own guilt and resentment?

Both are common, and neither makes you a bad person. Resentment is usually a sign that you are carrying too much alone. Share the load with others, get support for yourself, and tell her honestly and gently what you can and can't sustain. Compassion fatigue is a recognized cost of caring for someone over a long time (21), and ACT has good evidence for easing caregiver distress (22).

Will she get better?

It depends on the condition and the person, and nobody can promise a timeline. Some people improve, some stay stable, some fluctuate. Repeated crashes may lower a person's usual level of functioning, which is why pacing matters (1). What families can control is the environment: fewer avoidable crashes, less doubt, and a shared plan for hard days.

When to seek care: for her, and for you

You are not her doctor, and you don't need to be. But some situations call for professional help, quickly.

• If something feels like an emergency, call 911. Don't wait to work out whether it's "just her condition". If she talks about wanting to die or harming herself, call or text 988, the Suicide & Crisis Lifeline in the US.
• Encourage her to contact her doctor about new or rapidly worsening symptoms, a crash that is much longer or deeper than her usual pattern, or changes after starting a new medication.
• Bring a record, not a reconstruction. A dated log of crashes, what came in the two days before, sleep and resting heart rate makes an appointment more useful than "it happens a lot."
• For yourself, talk to your own doctor or a therapist if you notice persistent low mood, poor sleep, irritability or a sense that you can't keep going. Getting support for yourself helps you keep supporting her.

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How Welltory helps — and what it cannot do

The limits first. Welltory is a general wellness product, not a medical device. It does not diagnose, predict, monitor, prevent or treat ME/CFS, long COVID, POTS, fibromyalgia or post-exertional malaise, and it cannot warn either of you that a crash is coming. What it can do is give her a physiological record next to the one she keeps herself, and give you both something concrete to look at together instead of guessing (15).

1. She tags what happened; a supported watch or ring records the rest the same way every day. If she uses an Apple Watch or Oura, the Today screen (iOS) flags stress stretches and asks "What happened?". She can tap a suggested tag, type a few words, or just talk: "crash", "PEM", "long shower", "family dinner", "argument", "upright 3 hrs", "short night", "heat". With a supported wearable, resting heart rate, heart rate variability, sleep, stress minutes and Battery are recorded the same way every day (with the phone camera alone, she takes spot HRV readings herself), so a bad day is compared with her own ordinary days rather than a population average. Stress minutes and Battery need iOS with an Apple Watch or Oura.

2. Look at the one to three days before a crash, not the day of it. If she wants to, sit down with her and go through that window together: what she did, how she slept, what her resting heart rate and stress minutes looked like. Looking at that window together can make the delayed link easier to see. If the data looks fine and she feels awful, believe her body.

3. My Patterns, over weeks, shows what tagged events have in common. My Patterns (iOS, Apple Watch or Oura) starts showing patterns at around seven tagged events in a month: which tags tend to come with stressful stretches, rarer tags her body reacts to strongly, and day-of-week trends. Anything it surfaces is an association, not a cause.

4. A record for her doctor. The Journal keeps her measurements, tags and notes together, and the web app exports a CSV (Dashboard → choose a chart → Export). Walking into an appointment with eleven dated crashes over three months is a different conversation from "she's always tired."

5. Your role is support, not surveillance. The data is hers. Look at it when she invites you to, and let her decide what it means and what to change.

Where she can learn this with other people. Welltory runs Energy Lab, a paid, moderated community for women living with energy-limiting conditions. Members learn to read their own data together and share pacing strategies with peers who have the same symptoms. It is education and peer support, not medical care, and it does not replace her own clinician. This guide was originally written for Energy Lab members to pass on to the people closest to them. Read how Energy Lab works, who it is for and what it costs, or join Energy Lab.

A note from her

I want to help you understand what's happening with me. I'm not asking for sympathy. I want us to plan our life together in a way that works.

I have a limited energy budget, and it's smaller than it looks from the outside. When I say no to something, or ask for rest, I'm not pulling away from you. I'm protecting the energy that lets me take part in our life at all.

Feeling well in a moment doesn't mean I've recovered. Good days and bad days often follow what happened one or two days before.

Please talk to me, not about me. I don't need to be a hero, and I'm not fragile. I just want to be myself with you.

I don't need you to understand everything. I need you to trust me when I tell you what I can and can't do right now.

Adapted from the sample letter in Understanding PEM, Chapter 12 (3). Feel free to copy it, change it and send it to the people you love.

Want to go deeper? Read the free book by Welltory co-founder Jane Smorodnikova, Understanding PEM: What the Research Says in 2026. It explains in plain language what happens in the body with PEM, POTS and related conditions, and what helps. Or download the 2-page printable quick guide to keep on hand.

How we made it

This article is adapted from "What's happening to her: a guide for family and friends", written by Mariia Podobed for members of the Welltory Energy Lab community, and from its two-page printable version. We restructured it for readers arriving from search and AI assistants, added sections on whether each condition is real, condition-specific tips and common follow-up questions, and checked every source.

Made with AI tools, then edited and fact-checked by the Welltory team. See our Editorial & AI policy.

Sources were chosen in this order: national guidelines and consensus statements (NICE, the Heart Rhythm Society, the US National Academies), peer-reviewed studies and reviews, and the book Understanding PEM for plain-language explanations. Some findings on couples, caregivers and validation (sources 16, 17, 19, 21 and 22) come from research on other long-term conditions or on healthy couples. We include them because the mechanisms are general, and research specific to energy-limiting conditions is still scarce.

We did not include a chart drawn from Welltory data. This is a guide to relationships and care, and our data doesn't measure them.

Jane Smorodnikova, co-founder of Welltory, built the methodology behind how we read physiological data.

Written by Mariia Podobed.

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