Fatigue.

Last updated Monday, January 03, 2005

About fatigue

What is fatigue?

Fatigue is the feeling of extreme tiredness or exhaustion, often involving muscle weakness, that can result in difficulty performing tasks. It has been compared to the tired and achy feeling one has when experiencing a bout with the flu.

Fatigue is a frequent and troubling symptom of many types of arthritis and other rheumatic diseases, such as lupus. It may be due to many causes, such as illness, depression, joint and muscle pain, stress, overextending yourself, poor sleep, anemia, or a lack of physical activity.

The symptoms of fatigue vary from person to person. They may last a long time or only a short time. They may strike at any time or may be predictable.

There are many things you can do to help decrease the effects of fatigue. Knowing how it affects you will help you manage it better.

Fatigue and arthritis

How does fatigue make you feel?

Fatigue affects everyone differently. For instance, it may make you feel:

• Very tired with no energy. All you want to do is sleep. Some people who experience fatigue associated with their arthritis or lupus say, "When I'm fatigued, everything is too great an effort. Everyday tasks become too much to do."
• Increased pain. Fatigue often comes along with pain. One person with arthritis said, "Pain itself is very fatiguing. When I'm tired, I can't cope as well with the pain."
• A loss of control. Sometimes fatigue may make you feel helpless. You may feel you have little control over life.
• A loss of concentration. Decisions become more difficult. It's as if your mind is tired, too.
• Irritable. It may be difficult to be pleasant or happy when you're constantly tired. This may put a strain on your relationships. One person with arthritis commented, "I'm grouchy when I'm fatigued and I just don't care."

Fatigue may be accompanied by pain, irritability, and/or loss of energy, concentration, or sense of control.

Factors causing fatigue

There are many causes of fatigue.

Some of the reasons people get fatigued are because of arthritis or another chronic condition, depression, anemia, thyroid problems, nutritional problems, lack of adequate sleep, or deconditioning. Treating these conditions often leads to a reduction or elimination of fatigue.

Causes differ from person to person. Fatigue may be caused by one factor or it may be caused by several factors.

Physical causes

Disease

Fatigue may occur with many types of arthritis and other rheumatic diseases, especially those that affect the whole body (muscles, skin, blood, organs, as well as joints). These include rheumatoid arthritis, which can cause joint pain and swelling; lupus, which can cause a skin rash, joint pain, and problems with other organs; and fibromyalgia, which can cause extreme muscle aches and pain.

The process of inflammation can cause pain and swelling and also may cause fatigue. If you experience a "flare," or period of worsening joint inflammation, you're likely to become more fatigued.

Pain

If you have joint pain, you may use body positions that are less painful to your joints. However, these positions can put extra stress on your joints and muscles. This can lead to fatigue.

The physical and emotional energy you use trying to deal with pain can make you feel fatigued. Pain also may lead to fatigue by causing you to lose sleep or preventing you from really sleeping well.

Anemia

Several types of arthritis may be associated with anemia. This is a problem in the blood. It is a decrease of a key ingredient in your body's energy cycle. Anemia makes you feel tired. It cannot be corrected just by taking iron pills.

Being less active

You may not feel like doing much if you're in pain, feeling depressed, or if every task is a major effort. When you feel this way, for example, you may do less work around your house or yard. But if you don't get enough physical activity, your muscles will get weaker and feel tired most of the time.

Other health problems

Health problems of the heart, lung, and thyroid also may make you feel very tired.

Emotional causes

Living with any type of arthritis day after day can be emotionally draining. The following types of emotional stress can lead to fatigue:

Depression

The stress of an illness may make you feel sad or blue. You don't feel like doing anything, going anywhere, or being with friends and family. These feelings can make you feel tired. Being tired all the time, in turn, can contribute to depression. It's a cycle that, at times, can be difficult to escape.

Overextending yourself

"Most of my fatigue comes from overdoing," some people say. "After all my years of living with arthritis, I still find it hard to pace myself. The fatigue is always there in varying degrees. Sometimes it is difficult to know when I've reached my limit. I don't always listen to the signals of pain and fatigue. When I feel good, I push myself too hard."

Do you feel the same way? If you answer "Yes," this may be one cause of your fatigue. It's natural to want to keep up with your regular activities. But with your arthritis, this may not always be possible.

Trying to hide your illness from others

Some people don't want others to know they have arthritis. They push themselves to do the same things, at the same pace, that people without arthritis do. This usually results in having to "pay for it" later.

Environmental causes

Features of the environment (your surroundings) may add to your fatigue. Loud noises and warmer temperatures may be tiring. For the person with arthritis, uncomfortable furniture, lots of stairs, and long waits may be very tiring.

Identifying causes

Think back to the last time you were fatigued. In the following list, note the things you think add to your fatigue.

• arthritis flare
• depression
• pain
• anemia
• muscle weakness
• not enough exercise or activity
• emotional stress
• not eating properly
• not enough sleep
• lack of quality sleep
• overdoing daily tasks
• holidays

Analyze your fatigue

Because there are many causes of fatigue, you may need to use more than one method to manage it.

What adds to your fatigue? At what time of day does your fatigue start? What helps decrease your fatigue? Listen to your body's signals telling you it needs to rest. Learn to pace yourself so you won't become too tired.

Analyze your fatigue

Because there are many causes of fatigue, you may need to use more than one method to manage it.

What adds to your fatigue? At what time of day does your fatigue start? What helps decrease your fatigue? Listen to your body's signals telling you it needs to rest. Learn to pace yourself so you won't become too tired.

Be aware of body positions

• Change the way you do activities so that you don't put too much stress on your joints.
• Maintain good posture. Poor posture (slouching) can stress your muscles and lead to fatigue.

Balance rest and activity

• Learn your body's signs of getting tired. Take breaks during or between tasks, before you get too tired.
• Pace yourself during the day. Do a heavy task, then a light task, then another heavy task, and so on. Do the most difficult things when you're feeling your best. If you pace yourself, you probably can work more than if you work straight through until you're worn out.
• When your disease is more active, take longer and more frequent rest breaks.
• Pace yourself from day to day. Allow plenty of time to finish the things you start so you won't feel rushed. Don't try to do too much at one time.

Make your work easier

• Learn your body's signs of getting tired. Take breaks during or between tasks, before you get too tired.
• Pace yourself during the day. Do a heavy task, then a light task, then another heavy task, and so on. Do the most difficult things when you're feeling your best. If you pace yourself, you probably can work more than if you work straight through until you're worn out.
• When your disease is more active, take longer and more frequent rest breaks.
• Pace yourself from day to day. Allow plenty of time to finish the things you start so you won't feel rushed. Don't try to do too much at one time.

Make your work easier

• Plan ahead. Look at all the tasks you do both at home and at work during a normal day and week. Eliminate the ones that are not necessary. Delegate some of the others. Make a schedule for each day, the night before or in the morning. Think about what each task involves in terms of the amount of time it requires and how tiring it is. Make an action plan with this in mind. Schedule rest breaks before you begin.
• Combine chores and errands so you can get more done with less effort. Create shortcuts. For example, you can save time and energy by preparing several meals in advance. If you want to serve more complex meals, choose a day when you have more time and are feeling well.
• Sit when you work, if you can. If you can't, take short rest breaks as often as possible. Practice relaxation techniques at your desk.
• Use labor-saving devices, such as an electric garage door opener, a microwave oven, or a food processor.
• Use self-help devices, such as tools with enlarged handles, jar openers, or "reachers"--long-handled devices that help you reach high places. These reduce stress on your joints and can make difficult tasks easier.
• Organize work areas so you can get more done with less energy. Arrange your desk or work space using inexpensive storage bins. Remove unnecessary items from your briefcase to lighten the load between home and work. Keep equipment needed for a particular task together in one area. As a general rule, keep items you use most often nearest to your work area and less-used items further away. If you are writing a report, assemble all the information needed before you begin. If you are baking, store mixing bowls, sifter, measuring cups, and spoons in one place. If you are doing housework, keep cleaning supplies in several places: kitchen and bathroom, upstairs and downstairs.

Get enough sleep

Exercise

Follow an exercise program designed by your doctor or physical therapist. The right type and right amount of exercise helps keep your muscles strong, bones healthy, and joints usable. A good exercise program also helps you keep or restore joint flexibility. Exercise can improve your sense of well-being and may result in overall increased energy.

Keep in mind that when you first start exercising, your heart will beat faster, you'll breathe faster, and your muscles may feel tense. You may feel more tired at night, but awake feeling refreshed in the morning. These are normal reactions to exercise that mean your body is adapting and getting into shape. You'll know you've done too much if you have joint or muscle pain that continues for more than two hours after exercising or if your pain or fatigue is worse the next day. Next time, decrease the number of times you do each exercise, or do them more gently. If this doesn't help, ask your physical therapist about changing the exercise.

Follow your treatment plan

Ask for help

Ask for help when you need it! Family, friends, and co-workers would rather help you than have you overextend yourself, trigger a flare, and be confined to bed. Below are some people who can help you manage your fatigue.

Your health care providers

These include your doctor and nurse. They also may include an occupational therapist, a physical therapist, a social worker, and a psychologist. Show your fatigue management plan to members of the team. They may be able to refer you to other resources.

Support groups

Sharing your feelings with a group can help you cope with arthritis. Support groups can help you feel understood and can give you new ideas to help cope with problems. People who attend groups often comment, "It's nice to know I'm not alone. Listening to others and helping them helps me feel better." Groups may be run by professionals, or they may be self-help groups led by people with arthritis. Some groups focus on specific topics. Others focus on the special concerns of the group members. Contact your local Arthritis Foundation chapter or ask your health care provider about local groups for people with arthritis. Sometimes you can better help yourself with the help of others like you.

Counselors

Any major change in your life, such as an illness or continual problems such as fatigue or pain, may make you feel depressed, angry, helpless, or even hopeless. Some people feel so bad that they cannot sleep or eat. If you cannot get yourself going, therapy or counseling may help you get through these problems.

Some people are afraid to admit they need help. They believe others will think they are crazy if they talk to someone about their problems. It's smart to get help when you're forced to live with a difficult problem such as chronic pain and fatigue. If you are having symptoms of depression--poor sleep, change in appetite, crying, sad thoughts--be sure to talk with your health care provider.

Coping methods

Fatigue can affect all parts of your life, but there are many things you can do to cope with it.

You can better cope with fatigue by pacing yourself, listening to your body's signals, asking for assistance, making back-up plans, and working in partnership with your health care providers. If the first methods you try do not work, try other methods. The most effective way to manage fatigue may be to use a combination of these methods:

• Follow the treatment plan you and your health care provider agree upon. Share details with your family so they can better understand how you're doing.
• Prepare for the ups and downs of arthritis. Plan other activities, schedules, or time for extra rest if you're feeling tired.
• Practice ways to save your energy.
• Use your fatigue as a signal. This will help control it.
• Remember that depression, pain, and fatigue are closely connected. Solving one of these problems can help you reduce the effects of the others.
• Pace your daily tasks. Break down long-term goals into small, manageable steps that can be finished in a short time.
• If you keep a journal, write about all aspects of your fatigue, rate your fatigue on a daily basis from (0) no fatigue to (10) severe fatigue, and monitor if the fatigue changes over time.
• Set a goal of doing one thing a day that may require a bit of activity. Try walking around the block once, doing the TV Sit and Be Fit program, clean one drawer out in your desk, etc. It is likely that you will feel better when you get one thing accomplished and you will be challenged to do it again the next day.
• Ask for help from family, friends, and co-workers.
• Work in partnership with health care providers. You can do this by:
  • learning all you can about your arthritis
  • following through with treatment
  • reporting your progress and setbacks to your health care team
  • becoming a self-manager
  • keeping a positive attitude

Asking questions

Credits

Some of this material may also be available in an Arthritis Foundation brochure. Contact the Washington/Alaska Chapter Helpline: (800) 542-0295. If dialing from outside of WA and AK, contact the National Helpline: (800) 283-7800.

Adapted from the pamphlet originally prepared for the Arthritis Foundation. Edited by Frederick A. Matsen III M.D. and Basia Belza, Ph.D., RN. This material is protected by copyright.