Managing fatigue

What is fatigue?

Fatigue is an extreme, sometimes overwhelming, physical and mental tiredness, that doesn’t significantly improve with rest or sleep.

It’s a common problem associated with arthritis and can make other symptoms, such as pain and joint stiffness feel more severe and limiting.

It can affect your motivation and your ability to concentrate, this is sometimes described as having brain fog. Some people find it affects their emotional wellbeing making them feel irritable or depressed.

People with fatigue often say it’s similar to having the flu, with symptoms such as:

  • their body and limbs feeling heavy and difficult to move
  • exhaustion
  • feeling their energy has drained away.

Fatigue is unpredictable. It can start suddenly at any time of the day. Some days you may feel exhausted from the moment you wake up, even if you think you slept well.

It can last an hour, a day, or several days. Some people may find it lasts longer.

It can make you feel as though you haven’t the strength or energy to achieve even simple everyday tasks.

People with fatigue often feel they have to miss out on things they enjoy doing, to save energy for jobs or tasks. However, missing out on the things that lift your mood can make fatigue worse.

Fatigue is more extreme than simple tiredness. However, there are ways you can manage it and reduce its impact on your life.

What causes fatigue?

Fatigue is your body’s reaction to a build-up of stressful events, experiences, health issues or feelings.

Usually there isn’t a single reason for fatigue, it tends to be caused by a combination of factors.

The causes can be different for everyone. It could be the result of:

  • inflammation, which can cause swelling, redness, heat and pain as the body tries to heal an infection or injury by sending more blood and fluid to the area
  • anaemia, where a lack of red blood cells, which deliver oxygen around your body, can lead to weaker muscles and lower energy levels. It can be caused by iron deficiency. Anaemia can be linked to conditions such as rheumatoid arthritis, lupus and ankylosing spondylitis. It can be a side effect of some arthritis treatments.
  • some treatments, such as some drugs to stop seizures, anti-depressants and anxiety medications, opioid-based painkillers, some muscle relaxants, antibiotics, and long-term use of oral steroids. Drug treatments can affect people in different ways, talk to your doctor or pharmacist if you have any concerns.
  • long-term conditions, such as inflammatory arthritis or autoimmune conditions
  • pain
  • muscle weakness caused by pain and inactivity
  • overdoing it with boom and bust behaviour. This is when you carry on with your tasks, ignoring your pain or tiredness, until you physically and mentally cannot continue.
  • poor quality sleep
  • stress and anxiety
  • missing meals, poor diet or not drinking enough water and other healthy non-alcoholic drinks means your body has less energy to rely on.

Fatigue and arthritis

Arthritis is commonly associated with pain and stiffness. It can affect your general health, sleep, weight, emotional wellbeing and the amount of activity you feel able to do.

Many people with arthritis say fatigue is one of their biggest challenges.

Fatigue can be linked to many types of arthritis and related conditions. It’s commonly a symptom of autoimmune conditions, such as rheumatoid arthritis, reactive arthritis and lupus. In autoimmune conditions the immune system mistakenly attacks the body’s own healthy tissues.

It’s also strongly linked to conditions that can cause long-term pain, such as fibromyalgia, polymyalgia rheumatica and complex regional pain syndrome.

People with osteoarthritis have also reported having fatigue.

Talking to your doctor about fatigue

There are several things that can reduce the impact of fatigue. Firstly, it helps if you can work out what could be causing it.

There aren’t any specific tests for fatigue. However, you can help your doctor’s diagnosis by writing down how you feel, what could be causing it and how it’s affecting your life. They may also be able to provide you with a self-assessment questionnaire to fill out.

Depending on your symptoms your doctor may recommend you have blood tests to check your fatigue hasn’t been caused by another condition. If it has been, treating this condition may improve your fatigue.

There aren’t any specific drug treatments for fatigue. However, your doctor, physiotherapist, occupational therapist or rheumatology team, should be able to help you recognise the signs and learn to manage them.

How can I help myself?

There are a number of things you can do to help manage your fatigue.

Planning your time wisely to spread your energy over the course of a day or week can help. It’s also important to factor some gentle exercise into your day and to have a healthy diet.

There’s a strong link between getting enough good quality sleep and fatigue. And there are several positive steps you can take to improve your chances of sleeping well.

Stress and worry can make your fatigue feel worse, so it’s a good idea to spot anything that is causing you stress and try to deal with them in good time.

The four Ps

The four Ps are problem solving, planning, prioritising and pacing. The aim is to think of the four Ps at the beginning of each day or week to help you manage your energy levels. It can take a while to master this way of thinking, but it’s worth being patient with it because it can make a difference.

Problem solving:

It’s easier to manage your energy if you can work out what problems might be adding to your fatigue and thinking of ways around them.

For example, if cleaning your house is becoming an overwhelming task and using up so much energy that you find it difficult to do anything else, how could you make it easier?

Would it help to get a cleaner? Sometimes we all have to pay someone to help get a job done. If it means you have more energy to do other things, such as paid work, the benefits should be greater than the cost.

If you find it tough doing a weekly shop at a supermarket, could you do online shopping?

Often small changes can alter the amount of energy you use and the way you feel about yourself.

Planning:

Try to plan the things you want to achieve in your day or week. If you have a big job that will need a lot of energy, try breaking it into achievable tasks that can be spread through your day or week. Plan to do bigger tasks at a time of the day when you tend to have more energy. Plan lighter activities and rest breaks around them.

It’s also important to plan activities you enjoy into your day, it’s not just about getting tasks and chores done. Taking part in activities you enjoy can improve your mood and energy levels.

Try to stick to your daily plan, but don’t beat yourself up if you can’t do everything. Your healthcare team should be able to help you set and review realistic goals.

Prioritising:

While you’re planning your day or week put your activities into an order of importance. Ask yourself:

  • Does this need to be done today?
  • Does it need to be done at all?
  • Do I have to do it, or can I ask someone else?
  • Can I get someone to help me with parts of the task?

Pacing:

Pacing is about not using up all your energy in one go. We’ve already talked about breaking activities into smaller tasks, particularly ones that you’ll need a lot of energy for. You could then spread out these pieces of activity over the course of a day, a week or longer.

For example, instead of doing all your cleaning in one go and then feeling wiped out later that day and the next day, could you spread it out over a week or a fortnight, and do it room by room? This could make it more manageable and less overwhelming.

As you get better at using the four Ps to manage your time you should see a noticeable difference in your energy levels and the amount you feel you’ve achieved.

Research and new developments

Versus Arthritis-funded research has found talking therapies can help reduce the impact fatigue has on people with arthritis. Our researchers are currently testing whether these therapies can be provided as a treatment by rheumatology teams.

Versus Arthritis is also funding a review of the interventions that can be offered to help combat fatigue in people with rheumatoid arthritis. Most new drug treatments for inflammation in arthritis are now also tested to see if they reduce fatigue.