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This symptom group includes complaints such as nausea, diarrhea, cravings or, conversely, loss of appetite. Appetite can be affected by "Taste and smell" disturbances, or it can be independent.

Appetite and Digestion

Shortness of breath, dry cough, irritable cough
The active breathing cycle helps with&nbsp;dry cough and irritable cough. This exercise is also used for&nbsp;breath awareness&nbsp;and&nbsp;breath training. The active breathing cycle improves your lung ventilation and gently loosens the produced secretion so that you can cough it up. In addition, this exercise can reduce energy-sapping coughing attacks.
Repeat the three-step active breathing cycle&nbsp;several times a day for about 10 minutes. Suitable positions for this exercise are sitting and the side or prone position. The supine position is&nbsp;not&nbsp;suitable, as the lower lung areas are poorly ventilated in this position.
The active breathing cycle takes place in three phases:
<ul>
<li>Phase&nbsp;1: breathing control, perceive breathing</li>
<li>Phase 2: deep breathing</li>
<li>Phase 3: Huffing (or forced expiratory technique)</li>
</ul>
Please read the&nbsp;detailed information about the active breathing cycle&nbsp;(in German, EN version follows shortly).
You can find more information in a&nbsp;<a href="https://www.youtube.com/watch?v=qpzJmjtir08" target="_blank" rel="noopener" data-anchor="?v=qpzJmjtir08">video</a>&nbsp;that shows the active breathing cycle and in a&nbsp;<a href="https://www.youtube.com/watch?v=0Mer-1UeCOA" target="_blank" rel="noopener" data-anchor="?v=0Mer-1UeCOA">video</a>&nbsp;explaining "huffing" (in Dutch).
In a short video, the physio team of the B&uuml;rgerspital Solothurn shows and explains the&nbsp;<a href="https://www.youtube.com/watch?v=NVNhNvT-Bio" target="_blank" rel="noopener" data-anchor="?v=NVNhNvT-Bio">breathing exercise for breath awareness and breath deepening</a>. For more languages (incl. Spanish, Turkish, Serbian, Arabic, etc. click on&nbsp;<a href="https://www.solothurnerspitaeler.ch/uebungen-physiotherapie/" target="_blank" rel="noopener">"Atemtherapie (inkl. bei Covid-19)" and then scroll down until&nbsp; "Teil 3: Aktiver Zyklus Atemtechnik (ACBT)")</a>.

Active breathing cycle

Air hunger, fast breathing, exhaustion
Body positions that facilitate breathing help when you&nbsp;breathe faster than usual&nbsp;or if you&nbsp;feel hungry for air, but also if you find it&nbsp;difficult to breathe in deeply&nbsp;or if you&nbsp;feel exhausted.
In all postures that make breathing easier,&nbsp;leaning on the arms&nbsp;calms and lightens&nbsp;the breath. This happens for two reasons: first, the support reduces the weight of the shoulder girdle and, second, the auxiliary respiratory muscles can better help with inhalation.
The simultaneous implementation of the <a href="/en/vademecum/breathing/#pursed-lip-breathing" target="_self" data-anchor="#pursed-lip-breathing">pursed lip breathing</a> technique also supports the calming of the breath.
The following applies to all body positions that facilitate breathing:&nbsp;inhale slowly and deeply through your nose and slowly exhale using the pursed lips. Remain in the posture that relieves breathing until your breathing calms down.

The exercises can be done while sitting or standing.&nbsp;
Sitting:&nbsp;
<ul>
<li data-leveltext="" data-font="Symbol" data-listid="26" aria-setsize="-1" data-aria-posinset="1" data-aria-level="1">Coach seat&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="26" aria-setsize="-1" data-aria-posinset="2" data-aria-level="1">Sitting at the table&nbsp;</li>
</ul>
Standing:&nbsp;&nbsp;
<ul>
<li data-leveltext="" data-font="Symbol" data-listid="27" aria-setsize="-1" data-aria-posinset="1" data-aria-level="1">Goalkeeper position&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="27" aria-setsize="-1" data-aria-posinset="2" data-aria-level="1">Support against the wall&nbsp;</li>
<li data-leveltext="" data-font="Symbol" data-listid="27" aria-setsize="-1" data-aria-posinset="3" data-aria-level="1">Support on a railing or piece of furniture&nbsp;</li>
</ul>
&nbsp;
In the PDF you will find <a href="https://adm.altea-network.com/assets/2ea9476d-f697-4262-822f-52ec4d11a116?download" target="_blank" rel="noopener">illustrated instructions for the individual exercices</a>. (in German, the EN translation follows shortly) 
In a&nbsp;<a title="Positions to ease breathing video" href="https://www.youtube.com/watch?v=CGJYKzd7fUI" target="_blank" rel="noopener" data-anchor="?v=CGJYKzd7fUI">short video</a>,&nbsp;the&nbsp;physiotherapy team at the Solothurn Citizens Hospital&nbsp;<a class="Hyperlink SCXW174738013 BCX0" href="https://www.solothurnerspitaeler.ch/uebungen-physiotherapie/" target="_blank" rel="noopener">shows and explains the various exercises</a>&nbsp;to make breathing easier&nbsp;(page in German, videos in various languages).&nbsp;

Body positions to ease breathing

Shortness of breath, inner restlessness, stress
Targeted breathing exercises can help with&nbsp;inner restlessness&nbsp;or in&nbsp;stressful situations. They ensure better ventilation of the lungs and give you inner peace and well-being.
For breathing training, choose a&nbsp;well-ventilated room&nbsp;or, even better, go&nbsp;outside. Whenever possible, inhale slowly <a href="/en/vademecum/breathing/#exercise-to-unclog-the-nose" target="_self" data-anchor="#exercise-to-unclog-the-nose">through your nose</a> and let the breath flow out through your nose in a relaxed and automatic manner (or via <a href="/en/vademecum/breathing/#pursed-lip-breathing" target="_self">pursed lip breathing)</a>.
Please&nbsp;do not practice on a full stomach.
Initially, perform the exercises at rest&nbsp;for two weeks at least once a day. After this first training phase, you can integrate the breathing exercises into everyday life and use them at any time in stressful situations.
The 3 breathing exercises at a glance:
<ul>
<li>The&nbsp;three-stage breathing&nbsp;- creates a reservoir of fresh life energy in the body.</li>
<li>Opening the chest&nbsp;- gives you rest and relaxation.</li>
<li>The&nbsp;change of breath&nbsp;- is good for the lungs and circulation, and is also suitable for inflammation of the airways, coughing, accumulation of mucus and oppression in the chest area.</li>
</ul>
Here you can find a PDF with <a title="Altea VM Breathing Breatingexercise V2.0" href="https://adm.altea-network.com/assets/8fd834e5-df77-4124-b454-2c1761d874e8?download" target="_blank" rel="noopener">instructions and illustrations for the breathing training</a>.

Breathing training

Shortness of breath, air hunger, fast breathing
Pursed lip breathing helps when it is&nbsp;difficult to&nbsp;breathe&nbsp;in&nbsp;deeply, as well as in case of&nbsp;shortness of breath, air hunger,&nbsp;or when&nbsp;breathing is faster than usual.
Pursed lip breathing brings relief in many ways: it calms the breathing and keeps the bronchi open longer, which improves exhalation.&nbsp;Breathing becomes slower, calm, and relaxed&nbsp;and deeply breathing in becomes easier. Air hunger is satisfied, and anxiety can be brought under control.
Performed regularly, the pursed&nbsp;lip breathing&nbsp;technique can have a preventive effect and reduce shortness of breath episodes.
&nbsp;
This is how it works:
<ul>
<li>Breathe in calmly, if possible, through your&nbsp;nose.</li>
<li>Pucker up your lips as if you were carefully blowing out a candle.</li>
<li>Let the air flow out evenly through the small gap between the loosely stacked lips. Make sure you&nbsp;breathe out at least two times longer than you breathe in.</li>
<li>Do not force&nbsp;your lungs to empty completely.</li>
<li>Repeat the technique as often as it feels good for you.</li>
</ul>
<span data-ccp-charstyle="jlqj4b" data-ccp-charstyle-defn="{&quot;ObjectId&quot;:&quot;bb3bba04-9fce-4676-b159-12b532d20b15|168&quot;,&quot;ClassId&quot;:1073872969,&quot;Properties&quot;:[134233614,&quot;true&quot;,201340122,&quot;1&quot;,469775450,&quot;jlqj4b&quot;,469778129,&quot;jlqj4b&quot;,469778324,&quot;Default Paragraph Font&quot;]}">Here you will find a <a title="Altea VM Breathing Pursed lip breathing v2.1" href="https://adm.altea-network.com/assets/de6bd75a-b483-480a-9fc7-3d61a3ad2696?download" target="_blank" rel="noopener">PDF on pursed lip breathing</a> with instructions and illustrations.&nbsp;
Here are some videos about pursed lip breathing :&nbsp;&nbsp;
<ul>
<li><a href="https://www.youtube.com/watch?v=CGJYKzd7fUI" target="_blank" rel="noopener" data-anchor="?v=CGJYKzd7fUI">SoH - Positions to Ease Breathing and the Pursed Lip Technique</a></li>
<li><a href="https://www.youtube.com/watch?v=A_54zno2fMU&amp;list=PLPbj_BS6skC9SmmtD_YRCDz4uo204-bDT&amp;index=6">Ligue Pulmonaire Suisse : Souffler avec les l&egrave;vres, &ccedil;a soulage. Sais-tu comment faire?</a>&nbsp;(in French)</li>
</ul>

Pursed Lip Breathing

Restlessness, palpitations, anxiety, panic, fast breathing
In case of&nbsp;restlessness, palpitations, anxiety or panic, slow diaphragmatic breathing calms the nervous system by activating the parasympathetic nervous system. This nerve of the autonomic nervous system is responsible for calmness and serenity.
In addition,&nbsp;diaphragmatic breathing supports the heart&nbsp;in its activity and relieves it by slowing down the pulse.
In a&nbsp;state of excitement and&nbsp;stress, we usually breath too much. Doing so, we lose too much of the important gas carbon dioxide. All the muscles tense up and we get stressed and breathless. If we practice moving the diaphragm slowly and evenly, we get an optimal oxygen supply.
Please read the PDF with <a title="Altea VM Breathing Diaphragmatic Breathing V2" href="https://adm.altea-network.com/assets/3b454a3c-ad24-43ce-8c27-d7fdd762e364?download" target="_blank" rel="noopener">detailed information and</a><a title="Altea VM Breathing Diaphragmatic breathing V2" href="https://www.altea-network.com/media/zf3bdjyo/altea_vm_breathing_diaphragmatic-breathing_v2.pdf" target="_blank" rel="noopener">&nbsp;excercices for the diaphragmatic breathing</a><a title="Altea VM Breathing Diaphragmatic breathing V2" href="https://www.altea-network.com/en/long-covid/vademecum/breathing/">.</a><a title="Altea VM Breathing Diaphragmatic breathing V2" href="https://www.altea-network.com/en/long-covid/vademecum/breathing/">&nbsp;</a>

Slow diaphragmatic breathing

Shortness of breath, mouth breathing
Do not&nbsp;do&nbsp;the exercise&nbsp;if you&nbsp;have an infectious disease&nbsp;(e.g., flu, fever, cold)! Please consult your doctor if there are any other side effects.
Nasal breathing is the only correct way of breathing according to&nbsp;<a href="https://buteykoclinic.com/" target="_blank" rel="noopener">Dr. Buteyko's theory</a>. By breathing through the nose, the air is humidified and warmed. This decongests and protects the lung tissue. The nose cleans and disinfects the air, and the airflow reaches more parts of the lungs.

To breathe through your nose, the nose should be free - that's why this exercise is helpful.
Always&nbsp;breathe&nbsp;through your nose&nbsp;during this exercise! Repeat each step&nbsp;six times.&nbsp;
<ol>
<li>Slowly move your head backward and forward.</li>
<li>Inhale while moving backward, exhale while moving forward.&nbsp;</li>
<li>After a normal breath: pinch your nose, swing your head back and forward 3 times. Then breathe in and out slowly through your nose.</li>
<li>After a normal breath: pinch your nose and blow gently into it, but do not let the air escape. Then breathe in and out slowly through your nose.</li>
</ol>
Please read the detailed information and exercise instructions. (To come shortly)
Here you can find two videos explaining the Buteyko Breathing Method:&nbsp;<a href="https://www.youtube.com/watch?v=tgmKIwUqhkg" target="_blank" rel="noopener" data-anchor="?v=tgmKIwUqhkg">video 1 (by Buteyko Clinic International)</a>&nbsp;&nbsp;and&nbsp;<a href="https://www.youtube.com/watch?v=gY9JhCjvAeI" target="_blank" rel="noopener" data-anchor="?v=gY9JhCjvAeI">video 2 (by Dr. Mandell)</a>. &nbsp;

Exercise to unclog the nose

<div class="text">
The Wim Hof breathing training helps with lack of energy and shortness of breath. It strengthens the immune system and helps to deal more efficiently with the inhaled oxygen.
In addition, the alternation between activation and relaxation stimulates the entire nervous system - especially and sustainably the parasympathetic nervous system, that part of the vegetative nervous system that is responsible for rest and digestion. This in turn has a positive impact on our emotional state while supporting our immune system in maintaining or regaining a healthy balance.
As the name suggests, breathing training according to Wim Hof is training and therefore only shows an effect if it is used regularly.
</div>

<div class="col-12 col-md-4 offset-md-1">
<div class="text">
Please read Wim Hof's detailed exercise instructions and tips on breathing training in our <a href="https://adm.altea-network.com/assets/3b01e454-fe97-48f5-aa88-1479789ffee7?download" target="_blank" rel="noopener">Guidebook</a>.
Youtube breathing sessions led by Wim Hof:
<ul>
<li>In English for beginners: <a href="https://youtu.be/0BNejY1e9ik" target="_blank" rel="noopener">https://youtu.be/0BNejY1e9ik</a></li>
<li>In German for beginners:&nbsp;<a href="https://youtu.be/BckqffhrF1M" target="_blank" rel="noopener">https://youtu.be/BckqffhrF1M</a></li>
<li>Also popular: <a href="https://youtu.be/0q8SU_QyoIM" target="_blank" rel="noopener">https://youtu.be/0q8SU_QyoIM</a></li>
</ul>
</div>
</div>

Breath training according to Wim Hof

Since COVID-19 attacks the airways, shortness of breath and dyspnoea can occur during the acute infection, but also afterwards. Fear and feelings of suffocation or the limitation of physical performance can seriously affect everyday life.

Breathing

Since COVID-19 attacks the airways, shortness of breath and dyspnoea can occur during the acute infection, but also afterwards for people who are affected by Long COVID. Fear and feelings of suffocation or the limitation of physical performance can seriously affect everyday life.

Treatment of Long COVID symptoms: Breathing exercises | Altea

These exercises can help in case of Shortness of breath

Unter Palpitationen versteht man das Gef&uuml;hl von Herzrasen oder schnellem, flatterndem, pochendem Herzklopfen. H&auml;ufig entsteht dabei der Eindruck, dass das Herz unregelm&auml;ssig, zu stark oder zu schnell schl&auml;gt. Obwohl Palpitationen be&auml;ngstigend erscheinen k&ouml;nnen, sind die Ursachen h&auml;ufig unbedenklich.
Palpitationen treten h&auml;ufig im Zusammenhang mit Long COVID auf. Im <a href="https://adm.altea-network.com/assets/a4e6e48d-3d3f-45d1-a476-00f0f9904459?download" target="_blank" rel="noopener">Ratgeber zu Palpitationen</a> wird genauer auf die Ursachen von Palpitationen bei Long COVID und Tipps zum Selbstmanagement eingegangen.&nbsp;
&nbsp;

Um Palpitationen zu vermeiden, k&ouml;nnen die folgenden Massnahmen helfen:
<ul>
<li>Ausl&ouml;ser identifizieren</li>
<li>Stress reduzieren</li>
<li>Stimulanzien vermeiden</li>
<li>Ausreichend hydriert bleiben</li>
<li>Regelm&auml;ssige Bewegung (falls m&ouml;glich)</li>
<li>Gesunde Ern&auml;hrung</li>
<li>Guter Schlaf</li>
<li>Falls sie regelm&auml;ssig Medikamenten einnehmen, diese wie verschrieben anwenden und etwaige Nebenwirkungen mit einer &Auml;rztin besprechen</li>
<li>Ein gesundes Gewicht halten</li>
<li>Den Gesundheitszustand durch regelm&auml;ssige Untersuchungen &uuml;berwachen</li>
</ul>

Palpitationen

Above all, this group of symptoms includes sudden, strong palpitations, which can occur without prior exertion, for example when falling asleep. A high heart rate and circulatory problems have also been observed.

Cardiovascular System

Above all, this group of symptoms includes sudden, strong palpitations, which can occur without prior exertion, for example when falling asleep. A high heart rate and circulatory problems have also been observed in people affected by Long COVID.

Treatment of cardiovascular Long COVID Symptoms | Altea

These tips can help with cardiovascular problems

Besonders mit Konzentrationsschw&auml;che und begrenzter Energie ist es oft schwer das Beste aus einem einzelnen Arzttermin herauszuholen. Hier finden Sie eine Checkliste, die sie zu Hause in eigenem Tempo vorbereiten k&ouml;nnen. So ist an alles gedacht.
Der Ratgeber <a href="https://adm.altea-network.com/assets/a19dec64-3671-4f31-bdcf-551d4691ce65?download" target="_blank" rel="noopener">kann hier heruntergeladen werden</a> und besteht aus drei Teilen:
<ul>
<li>Eine Checkliste als Gesamt&uuml;bersicht.</li>
<li>7 Fragen zur Vorbereitung des Termins.</li>
<li>4 Fragen die Sie w&auml;hrend des Termins beantworten sollten.</li>
</ul>

Wie bereite ich mich auf einen Arztbesuch vor?

Patients often feel that they are not taken seriously, be it in the private, medical or professional sphere. Sometimes family and friends do not know how to talk to them. Good communication is therefore necessary to facilitate understanding between those affected and those around them.

Communication

Good communication can help improving the interaction between health care professionals and patients | Altea Long COVID Network

How can communication between HCPs and patients be improved?

A feeling of dizziness, possibly in combination with balance problems, is also described by those affected as a symptom of Long COVID. Dizziness can also manifest itself as a feeling of lightheadedness, as if you are about to pass out.

Dizziness

<div class="text">
Fatigue&nbsp;
&ldquo;Fatigue&rdquo; is a form of pathological exhaustion that is physical, mental, or psychological in nature. Fatigue is one of the most common of the many symptoms of Long COVID.
Pacing means doing less than your strength currently allows. Pacing is a gentle way of using your resources.
Pacing helps when it has become difficult to calculate your day-to-day energy levels and when you are exhausted and feel completely worn out or very tired. Pacing can also reduce setbacks in your healing process.&nbsp;
The art of pacing involves finding your own optimal balance between conserving energy and practicing any activity, as well as continually increasing your activity. The goal: to get out of the ups and downs between good and bad days and returning to a stable energy level and everyday routine.
&nbsp;
More information and application tips on Pacing:
<ul>
<li>Detailed information and application tips in our Vademecum <a title="Altea VM Fatigue - Pacing part 1 v2.0" href="https://adm.altea-network.com/assets/f102b619-198e-444a-93ec-9de7fb0f83cd?download" target="_blank" rel="noopener">Pacing part 1: recognizing the limits</a> and <a title="Altea VM Fatigue - Pacing part 2 v2.0" href="https://adm.altea-network.com/assets/d0d94f3e-5fb2-4fcb-801b-d2eafa3df600?download" target="_blank" rel="noopener">Pacing part 2: The 4P&rsquo;s rule</a>.</li>
<li>Long Covid Physio. <a href="https://youtu.be/KS-FiXWLs9U">Navigating Pacing. (Podcast)</a></li>
<li>#MEAction. <a href="http://www.meaction.net/stoprestpace/"> Rest. Pace. (Video)</a></li>
</ul>
</div>

<div class="col-12 col-md-6">
<div class="text">
Procedure:&nbsp;
<ol>
<li>Identify your current limits in the four activity areas: physical, mental/cognitive, social, and emotional.</li>
<li>Identify your individual warning sign in each of the four activity areas.</li>
<li>Accept your current limits.</li>
<li>Communicate your current limits and get help.</li>
</ol>
Adjust your daily activities and tasks using the 4P's rule:&nbsp;
<ol>
<li>Prioritize</li>
<li>Plan</li>
<li>Pause regularly</li>
<li>Stay positive</li>
</ol>
&nbsp;
&nbsp;
&nbsp;
&nbsp;
<ul>
<li>Medinger, Gez. <a href="https://youtu.be/gUPvNwvkOlA">The Why, When and How of Pacing | Long Covid&rsquo;s Most Important Lesson. (Video discussion with experts)</a></li>
<li>Royal College of Occupational Therapists. <a href="http://www.rcot.co.uk/conserving-energy">How to conserve your energy.</a></li>
</ul>
Note: for more videos and links see the same page in other languages.
</div>
</div>

Pacing

<div class="text">
Heart rate monitoring is suitable for people with Fatigue to avoid <a href="https://altea-network.com/en/vademecum/fatigue/#pem-post-exertional-malaise" target="_blank" rel="noopener">crashes/PEM</a>. It refers to the constant measurement of the heart rate with a heart rate monitor and is used for <a href="https://altea-network.com/en/vademecum/fatigue/" target="_blank" rel="noopener">Pacing</a>. 
It is often difficult to develop a feeling for the limit of resilience and not end up in a crash/PEM. For many people, subjective perception is not tangible enough. With a defined upper limit (maximum heart rate), pacing becomes tangible and easier to implement. 
Crashes/PEM are often triggered by an activity for which the body has to provide the energy mainly without oxygen. The threshold from aerobic (with oxygen) to anaerobic (without oxygen) energy supply is called the anaerobic threshold. Heart rate is an adequate parameter to monitor anaerobic threshold. 
<ul>
<li>The threshold is very individual and depends on many factors. It can be determined relatively accurately with a cardio-pulmonary stress test. </li>
<li>It is also possible to calculate a guide value. You can find two ways to do this in our &ldquo;Heart Rate Monitoring&rdquo; guide. </li>
</ul>
Please read the detailed information on heart rate monitoring in our <a href="https://adm.altea-network.com/assets/012bdf93-63e0-4ca3-82ec-5c12a9f05d6d?download" target="_blank" rel="noopener">Vademecum</a>&nbsp;(in German, translation will follow).
</div>

Heart rate monitoring 

<div class="text">
Post-Exertion Malaise (PEM) refers to the worsening of symptoms after physical, mental or emotional exertion, it is also referred to as "crash". PEM is a different symptom than a healthy person's "normal" fatigue after activity, excitement, or exertion. For many clinics, researchers, and affected people, PEM is considered the primary symptom of chronic fatigue syndrome (ME/CFS). Many people affected by Long COVID report similar "crashes" even after the smallest physical, cognitive, or emotional exertion.
Early detection of PEM is important and can reduce "crashes" and provide more safety during efforts in everyday life. Early detection also improves physical and mental well-being.
</div>

<div class="col-12 col-md-6">
<div class="text">
How to recognize and reduce PEM:
<ul>
<li>Recognize PEM as a consequence or side effect of overexertion.</li>
<li>Keep diary to identify patterns of overexertion.</li>
<li>Search discussion with a doctor or an expert.</li>
<li>The following methods may help: Pacing / Return to sport / Specific rehabilitation</li>
</ul>
Here you will find a <a title="Altea Ratgeber Pem Pdf V1" href="https://adm.altea-network.com/assets/bf205e20-0d63-4d2b-9576-4b2dd74f5057?download" target="_blank" rel="noopener">PDF with detailed information about PEM</a>&nbsp;(in German, translation will follow). Here you will find two short <a href="https://www.dialogues-mecfs.co.uk/films/post-exertional-malaise/" target="_blank" rel="noopener">videos about PEM</a>. Here you will find a <a href="https://www.youtube.com/watch?v=TGIo1v7KVJQ" target="_blank" rel="noopener" data-anchor="?v=TGIo1v7KVJQ">short introduction to PEM</a>.
</div>
</div>

Post Excertional Malaise (PEM), recognize and prevent "crashes"

"Fatigue" describes a great amount of exhaustion that does not go away even with a lot of sleep. Such an all-encompassing fatigue is also known from other viral diseases. It is important to avoid, if possible, that the exhaustion becomes chronic.

Fatigue

"Fatigue" describes a great amount of exhaustion that does not go away even with a lot of sleep. Such an all-encompassing fatigue is also known from other viral diseases besides Long COVID. It is important to avoid, if possible, that the exhaustion becomes chronic.

Pacing Against Exhaustion and Chronic Fatigue Syndrome in Long COVID | Altea

Fatigue and exhaustion: these tips are important

Kidney and bladder problems include: urgency (overactive bladder, with sudden desire to void often difficult to defer), urge incontinence (urine leaks before the patient reaches the toilet), frequency (need to urinate eight or more times a day), nocturia (need to urinate two or more times a night).

Kidneys and Bladder

<div class="text">
Law
Imagine the following scenario: you registered with the IV/AI office over a year ago but have not received anything yet. You have since lost your job, and your sick pay will be running out soon.
What can you do?
To move forward, the following action is advisable:
<ul>
<li>Request, in writing, all of the invalidity insurance files relating to your case, including any files that are "in progress" according to the IV/AI office.</li>
<li>Study the files to check what has been done and where the case stands.</li>
<li>If the rate of progress does not seem reasonable given the nature of the case, send a registered letter to the IV/AI office with the following content:
<ul>
<li>Set a deadline of 30 days.</li>
<li>Insist that a written decision is issued by a specified date (e.g. regarding occupational measures, daily benefits, medical clarification, or pension).</li>
<li>Explain that you will lodge a complaint of legal delay if the deadline is not met.</li>
</ul>
</li>
</ul>
This usually works. If the specified deadline is not met, no plausible timescale is provided for the next steps and a prompt decision is not expected, then you should consider a complaint of legal delay.
</div>

<div class="col-12 col-md-4 offset-md-1">
<div class="text">
Detailed information and application tips in our Vademecum <a title="Altea VM Law - Invalidity Insurance v1.0" href="https://adm.altea-network.com/assets/7a62b244-cda5-4a28-a4b3-7afff23c7577?download" target="_self">Management of the invalidity insurance (IV/AI)</a>.
&nbsp;
Altea blog 
<a title="69. IV-Verz&ouml;gerung" href="https://altea-network.com/en/blog/69-recht-iv-verzoegerung" target="_self">Speeding up the AI/IV process: How to insist on quick processing</a>
<a title="15. Krankentaggeld" href="https://altea-network.com/en/blog/15-krankentaggeld" target="_self">Who&rsquo;ll cover my loss of earnings if my insurer says I&rsquo;m healthy?</a>
&nbsp;
Other links
<a href="http://www.ahv-iv.ch/en/Home" target="_blank" rel="noopener">Information Centre OASI/DI&nbsp;</a>
<a href="http://www.covid-langzeitfolgen.ch/" target="_blank" rel="noopener">Verband Covid Langzeitfolgen</a> (Covid Long-Term Consequences Association, German Website)
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</div>

Management of the invalidity insurance (IV/AI) 

Legal aspects are of primary importance when it comes to Long COVID: how to deal with insurance companies? How to receive daily sickness allowances? Are certificates of incapacity for work available? What role does a diagnosis play in these legal aspects?

Law | Altea Long COVID Network

Health insurance, IV/AI and other legal issues: here you find some answers!

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Shinrin Yoku helps with stress and shortness of breath
The Japanese term "Shinrin Yoku" means something like "taking a bath in the atmosphere of the forest" and is to be understood in a figurative sense: immersing yourself in the forest and its atmosphere with all your senses.
A stay in the forest has a positive effect on health and well-being - inhaling the essential oils (terpenes) of the trees has been shown to strengthen the immune system.
Then there is the good air and the peace and quiet in the forest.In Japan, Shinrin Yoku has long been recognized as a method for relaxation and stress management.
However, forest bathing is much more than &ldquo;just&rdquo; a walk in the forest.
Those who take a forest bath travel slowly and take frequent breaks to take in all the details on the ground or in the trees. The stay in the forest is characterized by mindfulness and lasts between two and three hours.
More information on Shinrin Yoku:
<ul>
<li><a title="8. Forest bathing" href="https://altea-network.com/en/blog/08-shinrin-yoku-waldbaden" target="_self">Blog &laquo; Forest Bathing &raquo;</a>&nbsp;</li>
<li><a href="http://www.lunge-zuerich.ch/kurse">Course of the LUNGE Z&Uuml;RICH Association</a></li>
<li><a href="https://www.hirzelconsulting.ch/waldbaden-shinrin-yoku">Forest Bathing with Christina Hirzel</a></li>
</ul>
</div>

 Immersing in Nature: Forest Bathing (Shinrin Yoku) 

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Stress, inner restlessness, concentration problems, sleep disorders
The simple breathing from Yoga helps especially before and in challenging situations as well as in acute and chronic stress, inner restlessness, difficulty concentrating or problems falling asleep. 
As the name suggests, parasympathetic breathing activates the parasympathetic part of our autonomic nervous system; this is responsible for our recovery and calming. Within a short time, this breathing technique leads to deep relaxation. It also improves the ability to concentrate and generally leads to more serenity and self-confidence. 
You can do this exercise lying down (ideally) or sitting, preferably in an undisturbed place. Always breathe out through your nose. 
<ol>
<li>Relax and watch your breath without affecting it. </li>
<li>Breathe in deeply, count to 3. </li>
<li>Breathe out slowly, count to 6. </li>
<li>Hold your breath, and count to 6.</li>
<li>Start all over again with the 3-6-6 breathing and continue to breathe carefully and with concentration in this rhythm for a few minutes. </li>
</ol>
Please read the detailed information and exercise guides on <a title="Altea Ratgeber Atmung Parasympathische Atmung V1" href="https://adm.altea-network.com/assets/7704eb1e-7b54-4248-b3d9-9fd4e5792cba?download" target="_self">Yogic Parasympathetic Breathing</a>. (in German, English version will follow).
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 Yogic parasympathetic breathing 

<div class="text">
Stress, insomnia, restlessness, attention disorders
Meditation helps with stress, insomnia, inner restlessness or attention disorders. Among other things, it increases mindfulness, increases well-being, improves sleep quality and strengthens the immune system. The central element in meditation is the conscious control of attention.
 In order to learn how to meditate, one should start with simple exercises of 5 to 10 minutes and gradually increase the duration of the meditations. It is recommended to meditate daily. Mindfulness meditation from Buddhism is a good place to start. It is about perceiving the &ldquo;here and now&rdquo; &ndash; feel your body, mind and emotions without evaluating them. 
It's normal for thoughts to come and go when you meditate, allow them and keep bringing your attention back to your body and breathing. 
The individual steps of mindfulness meditation as well as general information about meditation can be found in the <a title="Altea Ratgeber Psychischegesundheit Meditation V1" href="https://adm.altea-network.com/assets/28b65c8e-9dca-450f-9bbf-feb0b405a855?download" target="_self">Vademecum about meditation</a> (in German, soon available in English).
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Meditation

<div class="text">
Stress, Restlessness, Concentration issues
Alternating Yogic Breathing is also known as Nadi Shodana.
Before starting, please pay attention to these points: 
<ul>
<li style="text-align: left;">Do not alternate breathing on a full stomach. </li>
<li style="text-align: left;">Do not force anything - this breathing technique can have an extremely positive effect if you do not overdo it. </li>
</ul>
In order for you to focus and relax, breathing should be effortless and easy. Take at least five minutes to do this. 
Alternating breathing has a balancing and harmonizing effect on our whole being. It promotes inner peace and emotional balance. It also gives a clear mind and promotes the ability to concentrate. In addition, alternating breathing generally improves nasal breathing.
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From a yogic point of view, alternating breathing has an anxiolytic effect and can thus strengthen self-confidence. By harmonizing all bodily functions, alternating breathing has a generally calming effect and can also prevent colds and allergies by strengthening the immune system. 
You can read about the individual steps of alternating breathing in the detailed <a href="https://adm.altea-network.com/assets/2bde20a6-f8cb-4c44-97c3-0d332f0ee562?download" target="_blank" rel="noopener">Vademecum </a>(available in German, translation will follow). 
When you've completed a round, calmly start over and alternate breathing for at least five minutes. 
This <a href="https://www.youtube.com/watch?v=kW9MMqipu5E" target="_blank" rel="noopener">video </a>explains alternating breathing from a yogic point of view.
</div>
</div>

Yogic alternate breathing

<div class="text">
<div class="J0lOec">Stress, Restlessness, Shortness of breath</div>
<div class="J0lOec">&nbsp;</div>
<div class="J0lOec">Walking meditation helps in case of acute and chronic stress, inner restlessness and shortness of breath. This "moving" exercise is particularly suitable for people who become fidgety and restless when sitting or lying down. </div>
<div class="J0lOec">&nbsp;</div>
<div class="J0lOec">In walking meditation, you direct your awareness to the exhalation by using the rhythm of your steps as an aid. </div>
<div class="J0lOec">&nbsp;</div>
<div class="J0lOec">Walking meditation has the following positive effects: </div>
<ul>
<li class="J0lOec">It reduces stress. </li>
<li class="J0lOec">It calms your breath. </li>
<li class="J0lOec">It increases pulmonary resilience, i.e. breathing becomes more efficient.</li>
<li class="J0lOec">In addition, the relaxed, rhythmic activity brings a general calming effect by activating the parasympathetic system. </li>
</ul>
Please read the detailed walking meditation practice instructions in our <a href="https://adm.altea-network.com/assets/c0a878b4-f579-4e43-babb-d4a05777c7f7?download" target="_blank" rel="noopener">Vademecum </a>(translation will come shortly).
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Walking meditation with emphatic exhalation 

In addition to various pre-existing physical conditions, our experiences, personality and psychosocial environment also play an important role in the progression of Long COVID. A wide range of highly distressing symptoms and the fact that sufferers are often not taken seriously by their environment can put a strain on the psyche. Chronic illnesses, which in many cases include Long COVID, are associated with a risk of secondary mental illness. Moreover, patients with a history of mental illness are at higher risk of long-term sequelae following acute SARS-CoV-2 infection. That is why it is imperative to integrate these personal and psychological components in the therapeutic process.

This means that in addition to the physical balance (with physiotherapy) and the cognitive balance (with occupational therapy), the psychological balance (with psychological or psychosomatic treatment) must always be addressed. Accepting this aspect and taking it seriously is very important for recovery.
For detailed information please read the Guidebook on <a href="https://adm.altea-network.com/assets/27841cb2-8df2-4ab8-ba2d-54a96bd61e5c?download" target="_blank" rel="noopener">Long COVID and psychosomatics</a>

Body and psyche belong together

Long COVID can affect mental health in all its forms. Symptoms include feeling out of balance, anxiety, panic attacks, and depression, and decreased resilience, such as when dealing with pain.

Mental Health

Long-term effects of coronavirus on mental health | Altea

Take care of your mental health!

In queste guide rivolte i medici di base sono riassunti i messaggi chiave delle raccomandazioni sulla gestione post-COVIDper i pazienti. La versione completa delle raccomandazioni &egrave; disponibile <a href="https://altea-network.com/it/guideline">qui</a>.
Le raccomandazioni su diagnosi e trattamento sono un elemento importante dell'assistenza medica e guidano la gestione efficace dei pazienti affetti da alcune malattie, tra cui il post-COVID (Long COVID). Nell'agosto 2023, l'UFSP ha pubblicato raccomandazioni uniformi per il trattamento dei pazienti affetti dalla patologia post-Covid-19 destinate ai medici di base in Svizzera. Queste linee guida garantiscono ai pazienti affetti dalla patologia post-Covid-19 una diagnosi tempestiva, un'assistenza ottimale e, se necessario, l&rsquo;indirizzamento ad un trattamento specializzato. Le raccomandazioni sono frutto di uno sforzo congiunto degli Ospedali Universitari di Ginevra e dell'Inselspital, nonch&eacute; di numerose societ&agrave;, piattaforme di pazienti e associazioni svizzere, con il contributo di numerosi esperti e pazienti a livello nazionale. Questo lavoro &egrave; stato commissionato dall'Ufficio federale della sanit&agrave; pubblica (UFSP) e sostenuto dalla Federazione dei medici svizzeri (FMH). Qui riassumiamo le informazioni importanti per i pazienti affetti dalla condizione post-Covid-19 e per i loro familiari. Questa sintesi per i pazienti &egrave; stata redatta dal team editoriale di Altea e rivista dall'UFSP.

What is Long COVID?
In 2021, the WHO issued a definition of post-Covid-19-condition, which is explained in more detail <a href="https://altea-network.com/en/what-is-long-covid">here</a>. On the Altea website, the term &ldquo;Long COVID&rdquo; is mainly used for this condition. Since the WHO definition coined the term post-Covid-19-condition to describe this condition, the term post-Covid-19-condition was used in the recommendations and hence, is also used in this summary. Briefly, post-Covid-19-condition is defined as signs, symptoms and conditions that occur within three months of an initial SARS-CoV-2 infection, last for at least two months and cannot be explained by an alternative diagnosis. Patients with post-Covid-19-condition can experience a wide range of symptoms, including fatigue, cognitive dysfunction, sleep disorders, shortness of breath, headaches, pain and digestive or psychiatric disorders. A separate <a href="https://altea-network.com/en/blog/106-who-definition-kinde">definition</a> was recently published for children.
&nbsp;
The summary of the recommendations for non-health care professionals is divided into two guidebooks. The <a href="https://adm.altea-network.com/assets/90cb4581-5145-416f-aa44-3c8ab3f37148?download" target="_blank" rel="noopener">first guidebook</a> comprises the symptom-based assessment of the post-Covid-19-condition. The <a href="https://adm.altea-network.com/assets/36c4b5e9-77d0-4d2c-beef-21c9de71070f?download" target="_blank" rel="noopener">second guidebook</a> focuses on treatment and reintegration options and provides some additional information on vaccination and Long COVID in children. Moreover, a summary of all symptoms and the recommended treatment is available <a href="https://adm.altea-network.com/assets/8bedcf49-cac1-4cf1-90f4-e35c5ca72336?download" target="_blank" rel="noopener">here</a>.

In these guidebooks the key messages for patients from the recommendations on post-COVID management for primary care physicians are summarized. The full version of the recommendation is available on here.

National recommendations

Summary of the post-COVID Recommendations for primary care physicians

Summary of the post-COVID Recommendations for primary care physicians

Helps with muscle pain and fatigue
Shiatsu is a very&nbsp;gentle massage technique, a passive therapy and therefore not a so-called self-management method. Shiatsu helps with pain, exhaustion/fatigue and chronic tiredness. With Shiatsu you can harmonize your physical and mental functions and find harmony between body and mind.
The Shiatsu treatment was developed in Japan under the influence of traditional Chinese medicine. It is based on the idea of ​​the&nbsp;life energy Ki&nbsp;(identical to Qi in Chinese), which can be disturbed in various ways. The imbalance of the Ki is compensated by therapeutic stimulation at precisely defined points, reflex zones or along the channels (meridians), by pressure with the thumbs (shi a tsu) or hands and by palpation (examination of the body by touching or using the sense of touch).
<ul>
<li>In this PDF you can <a href="https://adm.altea-network.com/assets/496af4b5-4035-44d4-8548-e17901cf2eca?download" target="_blank" rel="noopener">find more about Shiatsu</a> (in German, the translation will shortly follow).</li>
<li>Here you can find a video of the Swiss Shiatsu Association (in French, Italian, or German)
<ul>
<li>DE:&nbsp;<a href="https://vimeo.com/shiatsuschweiz">https://vimeo.com/shiatsuschweiz</a></li>
<li>FR:&nbsp;<a href="https://vimeo.com/365035566">https://vimeo.com/365035566</a></li>
<li>IT:&nbsp;<a href="https://vimeo.com/365035801">https://vimeo.com/365035801</a></li>
</ul>
</li>
<li><a href="https://shiatsuverband.ch/fr/le-shiatsu-dans-le-traitement-du-syndrome-post-covid/">Shiatsu in Long COVID Treatment</a>&nbsp;(Swiss Shiatsu Association) &ndash; Article in German and French</li>
</ul>

Shiatsu

Progressive muscle relaxation (PMR) helps with&nbsp;pain,&nbsp;stress&nbsp;and&nbsp;sleep disturbances. Used regularly, PMR also serves as a preventive measure: exercise strengthens personal stress management skills and leads to relaxation and inner peace. At the same time, you train your&nbsp;body awareness. You learn to recognize tensions in everyday life and interpret them as an indication for the use of PMR.
The basic PMR technique: consciously tense certain muscle groups in sequence for 5 seconds and suddenly release them. After the contraction, consciously feel the relaxation for at least 30 seconds for each muscle group. With each muscle group, relaxation gradually spreads through the body.
Your own muscles are capable of learning. After about four weeks of regular exercise, you can relax in seconds.
Please find here a <a title="Altea 2.2 Ratgeber Schmerz PMR PDF V5 NR FINAL Dri (1)" href="https://adm.altea-network.com/assets/2b263640-9d27-4df7-9f76-e1dada9da159?download" target="_blank" rel="noopener">PDF</a> (in German, translation will be published soon) with detailed information about the PMR.
Here you find a <a href="https://www.youtube.com/watch?v=BiAA4YsHXTo" target="_blank" rel="noopener">video on "Progressive Muscle Relaxation"</a> from the Cantonal Hospital of St. Gallen (approx. 40 min./ in German).

Progressive Muscle Relaxation (PMR)

<div class="J0lOec">Muscle pain, Muscle tension</div>
<div class="J0lOec">&nbsp;</div>
<div class="J0lOec">Stretching can relieve pain in case of acute or persistent muscle pain and muscle tension.&nbsp;Stretching exercices&nbsp;stretch shortened muscles and improve not only the muscular ability to relax, but also the <a title="Psychische Gesundheit" href="https://altea-network.com/en/vademecum/mental-health/" target="_self">mental one</a>.&nbsp;This has a positive effect on regeneration.</div>
<div class="J0lOec">&nbsp;</div>
<div class="J0lOec">A distinction is made between&nbsp;dynamic and static stretching.&nbsp;Static stretching is recommended in pain therapy.</div>
<div class="J0lOec">&nbsp;</div>
<div class="J0lOec">To perform static stretching, slowly enter the stretch position, hold it for 10 to 60 seconds, and then slowly release.&nbsp;You should feel a slight stretch pain during the stretch.</div>
<div class="J0lOec">&nbsp;</div>
<div class="J0lOec">Continue to breathe calmly and evenly during the stretch, your breath should be fine and quiet.&nbsp;Stretching can have a positive effect on breathing and give it space and width.</div>
<div class="J0lOec">&nbsp;</div>
<div class="J0lOec">You can stretch several times a day.</div>
<div class="J0lOec">&nbsp;</div>
<div class="J0lOec">Here is a <a title="Altea 2.2 RG Stretching PDF V6 CM FINAL Dri" href="https://adm.altea-network.com/assets/d833ae8c-6c5a-403a-8977-46cd4c1b99a7?download" target="_self">PDF on stretching with illustrated exercise</a> instructions (translation will follow).</div>

Stretching

This is one of the most common group of symptoms. These include muscle, limb and joint pain, stomach and chest pain, cramps and stiffness, or headaches and migraine attacks. Pain and tightness can also occur in the area of the lungs.

Pain

This is one of the most common group of Long COVID symptoms. These include muscle, limb and joint pain, stomach and chest pain, cramps and stiffness, or headaches and migraine attacks. Pain and tightness can also occur in the area of the lungs.

Treatment of Long COVID symptoms: muscle and limb pain | Altea

What to do about pain? These techniques help

Long COVID can affect sexuality. Symptoms include decreased desire and increased pain. Erectile dysfunction has been reported in men. Changes in menstruation and premenstrual syndrome have been reported in women.

Sexual and Reproductive Health

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Rashes, redness, nodules, wheals, pustules, itching
Infectious diseases such as measles, rubella or chickenpox often trigger a rash that covers a large area of ​​the body: the so-called exanthema.
Little is still known and researched on that skin changes can also occur in the context of COVID-19. These can be unspecific itchy rashes with redness and nodules, itchy wheals and pustules as in allergies or blisters as in chickenpox.
However, rashes do not necessarily have to indicate a COVID-19 infection; they can also be the result of an intolerance or an allergic reaction.
In most cases, the changes heal on their own after about a week without leaving any permanent damage such as discoloration or scars.
</div>

<div class="col-12 col-md-6">
<div class="text">
These tips will help relieve itching:
<ul>
<li>Do not take hot showers and baths</li>
<li>Moisturizing care (e.g., aloe vera gel or Polidocanol-based lotion) to be used daily, 1-2 times a day</li>
<li>Store care products in the refrigerator</li>
<li>Bath with moisturizing additives, max. 15 min. (E.g., St. John's wort oil, has anti-inflammatory, antibacterial and analgesic effects)</li>
<li>Dab areas of skin several times a day with a mixture of apple cider vinegar and water (1: 1)</li>
<li>Do not scratch, better rub or pinch (bacteria under the nails can lead to further infections)</li>
<li>If the rash worsens, short-term cortisone-based creams will help</li>
<li>For advice on which products to use, contact your dermatologist.</li>
</ul>
</div>
</div>

What to do against the itching

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Hair loss, alopecia, telogen effluvium
Every day, we lose around 100 strands of hair. This is completely normal and no cause for concern, since every hair shed is replaced by a new one. We only talk about abnormal hair loss (alopecia) when a person loses more than 100 hairs a day for an extended period of time.
When it comes to COVID-19, hair loss can be triggered by two things:
<ul>
<li>Cases of heavy hair loss resulting in significant bald patches could point to an autoimmune disorder known as alopecia areata.</li>
<li>The second cause can be infection-related stress, where hair loss is more or less consistent across the whole scalp. In this case, we may be dealing with telogen effluvium (TE). The good news is that TE is usually temporary.</li>
</ul>
Attention: Only a doctor can diagnose pathological hair loss. If you suffer from unusual hair loss, please consult a dermatologist.
Please read the <a title="Altea VM Skinhair Hairloss V2 0" href="https://adm.altea-network.com/assets/f0151cb9-2a83-4bd2-9a9a-8dcf89663123?download" target="_blank" rel="noopener">detailed information on the causes and treatments of hair loss</a> related to COVID-19.
</div>

 Treatment for hair loss 

<div class="text">
Herpes Zoster (Shingles) &ndash; Antiviral therapy, antiseptic and desiccant therapies
Patients who develop herpes zoster (shingles) have had chickenpox in their childhood or adolescence. The varicella zoster virus (VZV) penetrated the body, triggered the disease and then remained in the spinal ganglia. If the defense against the virus falls below a critical limit, infectious virus particles are transported in the affected nerves into the skin, where they lead to the classic vesicular zoster symptoms that can affect all parts of the body.
Possible triggers for a renewed infection are sun, stress, viral infections, malignancies, or immunosuppressive therapy.
The typical zoster pain is described as burning or stabbing and often begins a few days before the skin symptoms appear. At the beginning there are unspecific symptoms such as slightly increased temperature, tingling, burning, and shooting pains. The typical zoster rash occurs a few days after the first symptoms. Usually, the rash lasts a few weeks and often requires treatment (analgesics, anti-inflammatory drugs).
</div>

<div class="col-12 col-md-6">
<div class="text">
If the course is simple, the following therapies are recommended:
<ul>
<li>Wet compresses</li>
<li>Local antiseptic and drying therapies</li>
<li>If necessary, creams with antibiotic additives</li>
</ul>
Normally, shingles blisters dry out within two weeks, forming a scab, leaving no scars. Once the blisters are dry, emollient ointments such as Dexpanthenol can be helpful.
A medical examination is recommended in all cases, because if medications are needed, they should be taken as soon as the first symptoms appear.
</div>
</div>

Herpes Zoster (Shingles)

Various dermatological complaints have been observed: These include, for example, rashes, pustules on the cheeks, hives (severe redness / wheals on the skin with itching), changes in the tongue ("COVID tongue") or hair loss.

Skin and hair

Dermatological complaints, itching and rash in Long COVID | Altea

Here we speak about Dermatological issues

Sleeping troubles
Sleep hygiene refers to all&nbsp;habits and circumstances&nbsp;that are conducive to healthy sleep. Consistently following a few simple rules often results in a significant&nbsp;improvement in sleep quality.
Sleep hygiene helps with&nbsp;problems falling asleep, i.e. if you need more than 30 minutes to fall asleep after going to bed, or with&nbsp;problems sleeping through the night, i.e. if you wake up regularly at night and then lie awake for a long time.
Healthy sleep&nbsp;strengthens the immune system and general well-being. The rules of sleep hygiene will help you to have a restful sleep and thus reduce your daytime tiredness and increase your mental and physical performance during the day.

Pay attention to the following four things:
<ol>
<li>Do not eat&nbsp;large meals&nbsp;3 hours before bedtime.</li>
<li>Stop drinking&nbsp;coffee or other beverages containing caffeine and tea&nbsp;4 to 8 hours before bedtime.</li>
<li>Stop drinking&nbsp;alcohol&nbsp;3 hours before bedtime.</li>
<li>Don't&nbsp;smoke&nbsp;after 7pm (or better yet, quit smoking altogether).</li>
</ol>
Please read the detailed information and application tips &nbsp;in our guide to Sleep Hygiene &ndash; Behavioral Factors.

Sleep Hygiene – Behavioral Factors

Sleeping troubles
The following tips may help if you have&nbsp;trouble falling asleep&nbsp;or&nbsp;staying asleep through the night:
<ul>
<li>Try to have&nbsp;regular times&nbsp;for&nbsp;getting up and going to bed.</li>
<li>Avoid excessive physical exertion&nbsp;after 6 p.m.</li>
<li>Create a&nbsp;transition period&nbsp;between daily life and bedtime (reference value: 2 hours).</li>
<li>Establish a&nbsp;bedtime ritual, that is, a series of regular actions performed in the same order.</li>
<li>Make your&nbsp;environment comfortable and conducive to sleep&nbsp;(temperature, light, noise).</li>
<li>Don't look at your watch&nbsp;at night,&nbsp;turn off your cell phone.</li>
<li>Do not spend more time in bed than you slept on average per night (reference value: 7-8 hours).</li>
<li>If you wake up at night,&nbsp;do not expose yourself to strong light.</li>
<li>Don't pressure yourself with the idea that you'll only be rested if you've slept through the night.</li>
<li>Keep a&nbsp;sleep diary.</li>
</ul>
Detailed information, application tips and a list of useful Websites, videos and other sources (e.g. sleep diaries) can be found in our Vademecum on <a title="Altea VM Sleep Hygiene Environmental Factors v2" href="https://adm.altea-network.com/assets/2cc0a063-0ec1-47e4-9944-e00a6268247d?download" target="_blank" rel="noopener">Sleep Hygiene - Environmental Factors</a> (in German, the English version will follow shortly).

Sleep Hygiene – Environmental Factors

Sleep disorders
Melatonin is a&nbsp;hormone naturally produced in the brain&nbsp;in response to darkness. It signals the body that it is&nbsp;time to sleep&nbsp;and thus regulates the sleep-wake cycles.
Taking melatonin can help&nbsp;regulate the sleep, and thus manage sleep disorders and improve sleep quality. Then the treatment&nbsp;should be gradually discontinued. Melatonin intake should be complemented by the&nbsp;sleep hygiene measures.
Before&nbsp;starting to take melatonin, it is important that a&nbsp;doctor assesses the sleep disorder(s). Indeed, while it is safe for medical use, it is important to understand what are exactly the troubles: falling asleep, sleeping through the night, or maybe there are other causes that provoke insomnia?

Melatonin intake

Due to Long COVID, both issues with falling asleep and staying asleep can occur. Those who lie awake before falling asleep or in the middle of the night are more likely to be physically and mentally tired during the day. This can also unbalance the sleeping / waking rhythm.

Sleep

Problems falling asleep and staying asleep through Long COVID | Altea

Difficulty falling asleep and sleeping through the night? Check these tips!

<div class="text">
Taste and Smell Loss
COVID-19 can cause a loss of taste and smell. Approximately 80% of patients are affected. It has been shown that the SARS-CoV-2 virus enters the central nervous system through the mucous membranes of the olfactory and gustatory systems and can damage or destroy sensory cells.
Due to the damage or destruction of these cells, only an incomplete olfactory impression reaches the brain. This can lead to olfactory or gustatory confusion, so that affected persons can no longer recognize the smell or taste of coffee, for example. This can also impact appetite.
Fortunately, the sensory cells can renew themselves, and the course of olfactory and taste disorders with COVID-19 is generally considered favorable by experts.
</div>

<div class="col-12 col-md-6">
<div class="text">
A simple smell training can significantly improve olfactory perception.
<ul>
<li>Step 1: smell regularly, for example in the morning and in the evening, for 10 to 15 seconds, each time four intensive scents.</li>
<li>Step 2: consciously perceive the smell and visualize it at the same time.</li>
</ul>
Advice:
<ul>
<li>The best fragrances to start with are clove, rose, lemon and eucalyptus.</li>
<li>Change the 4 training scents after 12 weeks.</li>
<li>Familiar scents, such as your favourite perfume or the smell of coffee, are also useful for training.</li>
</ul>
Please read further information and instructions in the <a title="Altea VM taste and smell - smell training v2.0" href="https://adm.altea-network.com/assets/ae229b5f-2ca6-426e-ab23-e605a81d5065?download" target="_blank" rel="noopener">Vademecum about smell training</a>.&nbsp;
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Smell training

COVID-19 can cause a change or loss of taste and/or smell. For example, foods may appear tasteless or have a different taste or smell. This disorder can resolve itself or persist over time.

Taste and Smell

Treatment of Long COVID symptome: Taste and Smell | Altea

Loss of the sense of taste and smell: these tips are important

Attention disorder, concentration difficulties, word-finding impairment and memory loss issues / &ldquo;Brain Fog&rdquo;
Many people report decreased concentration, impaired memory, or word-finding problems after COVID-19 infection. In that case, these complaints are part of Long COVID.
In Long COVID, it is common that the above difficulties occur at the same time as <a title="Fatigue" href="https://altea-network.com/en/vademecum/fatigue/" target="_self">Fatigue</a>, a common phenomenon of Long COVID. In detail, this means that cognitive complaints are particularly severe during periods of pronounced fatigue. Patients often describe Fatigue as a &ldquo;Brain Fog&rdquo; - a rapid and premature mental exhaustion.

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The good news is that in most cases the symptoms improve significantly or even disappear completely over time.
What helps against disorders of thinking and perception?
<ul>
<li>Energy management</li>
<li>Neuropsychological/ergotherapeutic brain power training</li>
<li>Regular sleep and healthy daily structure</li>
<li>Mental health</li>
</ul>
Here you will find a PDF with <a title="Altea VM Thinking and perception- Energy management v2.0" href="https://adm.altea-network.com/assets/8ae5ae05-1650-4bd7-b19d-b4d2a7b133b1?download" target="_blank" rel="noopener">detailed information about the energy management / brain power training</a>.
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Energy management, brain performance training

Difficulty concentrating and being unusually forgetful are possible cognitive symptoms of Long COVID. This also includes slowness in thinking or difficulty in expressing yourself. Impairment of the eyes has also been described.

Thinking and perception

Treatment of Long COVID symptoms: Thinking and perception | Altea

Thinking and perceptions disorders are also part of Long COVID

Tinnitus (ringing in the ears)
Hearing loss has been observed in the context of SARS-CoV-2 virus infection, which can lead to tinnitus. Possible ways in which the virus could damage the inner ear or auditory nerve are also described in literature, as are isolated cases of tinnitus that have occurred in a possible association with the Covid vaccination.
This hearing disorder results in signals from a certain sound spectrum that are no longer transmitted to the auditory cortex of the brain for processing. Tinnitus develops due to central sensory compensation, which begins as overactivity of the auditory cortex. If there is a subsequent interconnection between the auditory cortex and other areas of the brain responsible for stress, emotion, attention, consciousness, memory, or sleep, this intrinsic activity in the auditory cortex may be perceived as &ldquo;ringing in the ears&rdquo;.
The good news: In most cases, even in the context of a COVID-19 infection, the tinnitus improves over time or even disappears completely.
In the <a title="Altea VM ENT Tinnitus V1" href="https://adm.altea-network.com/assets/2d313908-f7cc-4a40-8da2-abc2b7592941?download" target="_blank" rel="noopener">Vademecum Tinnitus after COVID-19</a> you will find further information, therapy options and links.&nbsp;

 Treatment options for tinnitus 

This group includes cold symptoms such as a sore throat, cough, earache, headache or fever. Tinnitus has also been reported. The dry cough that is characteristic of COVID-19 can in some cases become permanent.

Throat, nose, ears

This group includes cold symptoms such as a sore throat, cough, earache, headache or fever. Tinnitus has also been reported. The dry cough that is characteristic of COVID-19 can in some cases become permanent for people suffering from Long COVID.

Treatment of Long COVID symptoms: Throat, nose, ears

Tipps against problems with the throat, nose and ears

If you needed oxygen during the infection, or you currently need it, and/or if you had heart problems or circulation issues, including thromboses, you must discuss the resumption of regular exercise with your doctor.&nbsp;
People affected by Long COVID report a&nbsp;feeling of weakness: physically with&nbsp;reduced performance&nbsp;(muscle weakness) and mentally with&nbsp;apathy and listlessness. Some can hardly walk, others have to force and overcome themselves enormously to do any activity. On the other hand,&nbsp;regular physical activity&nbsp;is important in the short, medium and long term for physical and mental health and well-being.
Thus&nbsp;dosage is always decisive&nbsp;for the success of the training: intensity&nbsp;and&nbsp;recovery&nbsp;time&nbsp;are considered as guideline values. The art is to find the&nbsp;balance&nbsp;between optimally dosed, regular physical activity and restful, restorative periods. This is the only way to increase performance and improve quality of life step by step.

When resuming training, it is important to consider the following four points:
<ol>
<li>Clarify and define individual limits</li>
<li>Be consistent with rest breaks</li>
<li>Adapt training time to everyday life</li>
<li>Document your progress</li>
</ol>
You can find detailed information and instructions as well as further links in the Vademecum "<a title="Altea Ratgeber Fatigue Zur&uuml;ck Zum Sport V1" href="https://adm.altea-network.com/assets/9ea6716b-d2c7-4ffa-ad21-dcc8676c5856?download" target="_self">Back to sport</a>".
We have summarised the most important points on a&nbsp;printable poster.&nbsp;Download the&nbsp;five-phase graphic: <a title="Altea VM Back To Sport 5 Phases EN" href="https://adm.altea-network.com/assets/9ea6716b-d2c7-4ffa-ad21-dcc8676c5856?download" target="_blank" rel="noopener">english version</a>

Back to sport/physical activity

The Borg scale is a simple&nbsp;method for independently determining the intensity of exertion and training.&nbsp;It helps you if you are unsure about how much physical exertion you can or should do. And it is a compass if you do not want to or cannot orientate yourself (exclusively) on your pulse rate during training.&nbsp;The Borg scale gives you confidence in the dosage of physical exertion or activity.
It is very easy to use: look at the scale from 0 to 10 during exertion or training and assess your subjective feeling of exertion spontaneously and honestly: 0 corresponds to rest, 10 corresponds to maximum exertion for you. Take into account muscular, respiratory and mental exertion equally.
Here you can find a <a title="Altea Ratgeber Fatigue Borg V1" href="https://adm.altea-network.com/assets/1728d5ff-21dd-4a45-83f7-26c561ffe8ab?download" target="_blank" rel="noopener">PDF</a> with information and a representation of the Borg scale.

Training control using the Borg scale

People affected by Long COVID report feeling weak: physically with reduced performance (muscle weakness) and mentally with apathy and listlessness. Some can hardly walk, others have to force themselves enormously to perform every activity.

Weakness

Long COVID Treatment: Decreased performance and listlessness | Altea

Tips against reduced performance, muscle weakness and listlessness

Returning to work
Accompanying COVID patients in the workplace is a challenge even for experienced employers since recovery varies and there is still little experience in dealing with the topic. The measures that can be used to support the return to work are correspondingly diverse and individual. However, it has been shown that practicing a profession is usually successful if certain factors are considered.
In collaboration with the REHA Bellikon &ndash;&nbsp;<a href="https://www.rehabellikon.ch/centre-of-expertise-for-occupational-integration/" target="_blank" rel="noopener">Centre of expertise for occupational integration</a>,&nbsp;<a href="https://long-covid-info.ch/" target="_blank" rel="noopener">Long COVID Schweiz</a>&nbsp;and&nbsp;<a href="https://www.sulserpartner.ch/" target="_blank" rel="noopener">Sulser &amp; Partner AG</a>&nbsp;(case management and professional reintegration) we have developed some tips to support employers.

Three general tips for supporting employees with Long COVID:
<ol>
<li>Less is more: Plan the return to work together with the affected person. Design individual and flexible working models. Distribute more demanding tasks over different days.</li>
<li>Maintain relationships: Structure conversations clearly and create a benevolent, appreciative atmosphere.</li>
<li>Relieve yourself with professional help:&nbsp;Due to the complex health conditions of those affected and the necessary coordination with social insurance, it is worth delegating support to professional coaching or case management.</li>
</ol>
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Here you find three PDFs with detailed information and tips on this topic:
<ul>
<li><a title="Altea VM Work Employers Tips RKB Kbe EN v2" href="https://adm.altea-network.com/assets/7b27b7c6-34d9-4eff-b4a7-60856ec73d03?download" target="_blank" rel="noopener">Three tips to support employees with Long COVID</a> (REHA Bellikon)</li>
<li><a title="Altea VM Work Employers Part1 V1" href="https://adm.altea-network.com/assets/c94b2f01-572f-4829-996d-bec8ad1404fa?download" target="_blank" rel="noopener">Back to work &ndash; Part 1</a>: Understanding employees suffering from Long COVID (Long Covid Schweiz and Sulser &amp; Partner AG)</li>
<li><a title="Altea VM Work Employers Part2 V1" href="https://adm.altea-network.com/assets/a59bf8b0-5078-4acc-8f08-85c38debdc9b?download" target="_blank" rel="noopener">Back to work &ndash; Part 2</a>: Practical advice for employers when employees with Long COVID return to work (Long Covid Schweiz and Sulser &amp; Partner AG)</li>
</ul>

Tips for employers

Returning to work
Every COVID infection is different and dealing with the disease is very individual. Therefore, the way back to work is very different depending on the symptoms and performance and depending on the job. Progress in performance is not always visible. However, you can make your return to work early and successful, especially if you allow yourself enough time and get helpful support.
Please read the <a title="Altea VM Work Patients RKB Kbe EN v2" href="https://adm.altea-network.com/assets/25fb569c-d61b-424e-9727-2b141445fe47?download" target="_self">tips for LC affected people</a>, by REHA Bellikon,&nbsp;<a href="https://www.rehabellikon.ch/centre-of-expertise-for-occupational-integration/">Centre of expertise for occupational integration</a>.

Three general tips for those affected:
<ol>
<li>Don't go beyond your limits: If you put too much strain on yourself or too soon, so-called "<a href="http://altea-network.com/en/vademecum/fatigue/#pem-post-exertional-malaise" target="_blank" rel="noopener">crashes</a>" occur that require long recovery times and prevent the stabilization of initial successes. Therefore, work closely together with specialists from therapy and integration or from your company to gradually build up your ability to work.</li>
<li>Take breaks: Listen to your body and take breaks outside of normal hours if you need them.</li>
<li>Let yourself be accompanied professionally: Let yourself be accompanied on your way back to work by a professional job coach or case manager, who will be made available to you by the health insurance company or the IV.</li>
</ol>

Tips for affected people

Going back to work can be very different depending on the symptoms and occupation and can be a challenge for both employees and employers.

Work

For people affected by Long COVID going back to work can be very different depending on the symptoms and occupation and can be a challenge for both employees and employers.

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