Edited by Frederick A. Matsen, III, M.D. and Basia Belza, Ph.D., R.N.
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
Fatigue is problematic, especially for those people with chronic conditions like arthritis. If fatigue is of new onset, is getting significantly worse, or interferes with activities of daily living, it would be valuable to see a health provider. There are many causes of fatigue and a physician or nurse practitioner will be able to help diagnose and treat the cause(s) of your fatigue.
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.
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
• 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
Getting a good night’s sleep restores your energy and helps you cope with pain. It also gives your joints a chance to rest. Only you know how much sleep your body needs. Get into the habit of listening to your body. For example, if you feel tired after lunch every day, take a rest break or brief nap. This “power nap” is becoming more accepted in the general business community. It could be all you need to restore your energy and lift your spirits.
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
Fatigue may be a sign of increased disease activity or inflammation. Make sure you follow the treatment plan you and your health care provider have designed. Don’t skip medications on days you feel good. This can backfire and lead to increased symptoms. Report any increasing fatigue or changes in general health to your health care provider so appropriate measures can be taken.
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.
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.
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.
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