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One of the most debilitating and defining hallmarks of ME/CFS and Long COVID is post-exertional malaise (PEM), a severe, disproportionate exacerbation of symptoms following even minor physical, cognitive, or emotional exertion

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However, several studies that have assessed the effects of one night's sleep deprivation on the HPA axis have shown that cortisol secretion is either not or minimally affected by sleep following prolonged wakefulness (65-67)