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Coping With Fatigue
Fatigue is one of the most common symptoms of rheumatoid arthritis, and it is sometimes the first sign of inflammation. Fatigue can make it harder to concentrate or deal with pain – it can even make people feel helpless. Like pain, fatigue is a signal that something is wrong. Coping with fatigue can help you feel better.
Fatigue may be caused by inflammation, overdoing routine activities, medication side effects, stress, depression or a combination. Poor sleep and nutrition, and absence of regular exercise also may also contribute.
Feeling tired all the time can lead to stress and depression. And, if you become physically run down, your immune system will be less able to fight infection and illness. By setting priorities, making smart choices and conserving your strength, you will still be able to do most of what is important to you.
Pinpoint causes of your fatigue
Your fatigue may be caused by physical, emotional and environmental factors. Environmental factors such as high noise levels, temperature variations, and even daily hassles such as dealing with traffic and waiting in line can make you feel tired.
Keep a fatigue diary
Keeping a fatigue diary can help you discover the causes of your fatigue. Note the times of the day or week when you feel fatigue and what seems to trigger it. Sometimes you may see an obvious solution to the problem. For instance, you may blame overactivity when you feel tired, but by reviewing your diary you may see that your fatigue is a sign of increased disease activity.
Ask your doctor
Rheumatoid arthritis fatigue due to inflammation is often more easily corrected than fatigue that results from stress. The inflammatory cytokines (protein molecules) that are released in RA are the same chemicals that are released if you have a severe cold or flu. Your doctor can treat this type of fatigue by prescribing higher doses of your drugs or another drug to control the body’s inflammatory process. Once inflammation is under control, fatigue usually lessens.
It is also important to consider other potential sources of fatigue that your doctor can reverse. An example is anemia, which occurs when the body has too few red blood cells to transport oxygen effectively. One type of anemia, also called “the anemia of chronic disease,” is often seen in people with RA. Effective treatment of arthritis usually resolves this type of anemia. Another cause of anemia is blood loss from stomach ulcers, which may require iron replacement and other treatments.
Another consideration is the medications themselves. Fatigue is a side effect of many medications, most frequently drugs for other conditions such as hypertension (high blood pressure) or depression. Ask your doctor if any medications you are taking cause fatigue, and whether any adjustments can be made to improve the situation.
Fibromyalgia is also common in people with rheumatoid arthritis, and may cause fatigue. If you have a second chronic condition, your fatigue level may be even higher. If you and your doctor address these additional problems, your level of energy should increase.
How to cope
The most effective approach you can take when dealing with your fatigue is to be aware that fatigue is a part of RA, and that you might have to adapt your schedule. Don’t look at your fatigue as a sign of personal weakness or try to deny it. It is simply one more symptom of your arthritis that you can learn to handle.
Here are some fatigue tips that are worth trying.
Many people with RA adjust their daily schedules, starting their days an hour or two later. This makes it easier to deal with morning stiffness and may also enable you to sleep longer. Ultimately, the result is less fatigue and a more productive day. Other people may rest or nap in the afternoon, which then allows them to continue their daily activities without exhaustion at the end of the day.
Avoid eating heavy meals; instead, opt for a light lunch, perhaps with a healthy morning and afternoon snack thrown in.
Rest is crucial. But doing too little can often lead to deconditioning – which makes you feel more fatigued. Moderate exercise keeps your muscles and joints in condition, and has the added benefit of helping you sleep better at night.
Get a good night’s sleep
A lack of restful sleep is a problem shared by many Americans – and caused by a variety of factors: stress; depression; caffeine, alcohol or drugs; not allowing enough time for sleep; and pain. When you have RA, pain may keep you from falling asleep easily, or it may awaken you during the night. Research has shown that some people with RA experience light, easily disrupted sleep with many mid-sleep awakenings. This contributes to fatigue.
There are several stages of sleep. During the night, your brain moves between these stages in cycles, and the types of electrical brain waves generated vary from stage to stage. To feel rested, your brain requires what is called “delta sleep,” named after the brain waves that occur in the third and fourth stages of sleep. REM (short for rapid eye movement) sleep is also important. It’s the stage of sleep when dreaming occurs, and without it, you will feel tired. (See "Insomnia? Getting a Good Night's Sleep" for more information)
Prioritize your time and energy
There may be times when you feel more fatigued than others, and you will have to deal with limitations to your energy. Think of your energy as a resource that you have to conserve for your most important activities. This may involve saying no to lower-priority activities that take up too much of your energy.
Of course, saying no isn't always easy, but it helps you stay focused on the priorities in your life, such as earning a living or spending time with your children. When you’re feeling fatigued, opting out of an activity may allow you to get the rest you need. Saying no to one activity may allow you to say yes to something more important to you.
Ask for help
Successful managers know that they cannot do everything themselves. Borrowing from their techniques, you can learn to delegate tasks that will help you manage your activities. Asking for help may be difficult at first. Because the effects of RA are not always visible, you may be afraid that co-workers and acquaintances will perceive you as lazy.
You may feel embarrassed to ask for help, especially if you’ve always viewed yourself as a high achiever. The following fatigue tips can make it easier to request help.
• Ask for specific help. For example, if you ask someone to take you shopping for one hour every other Tuesday morning, you are letting them know precisely what you need. Also, you show that you understand his or her time is valuable.
• Develop a pool of helpers. Spreading out the tasks keeps the burden from falling on any one person. Keep a list of friends and family and the tasks they’re willing to help with.
• Consider bartering or trading services. If you dislike asking for help, perhaps you can provide a service in return. For instance, offer to watch your friend’s children one afternoon a week at your house, if she will run some errands for you.