*YAWN* Why am I always so tired?!

Does your RA make you feel like this lady?  Are there days you are just so tired, and have no energy, you can't even pull yourself out of bed?  Lately, no matter how much rest I've been getting, I just have absolutely no energy.  I'm just so tired, and fatigued all the time.  It's becoming a real problem for me and I plan on bringing it up to my Rheumy, but in the meantime I decided to do a little research as to why this happens to us, and some tips and advice to possibly help me gain some energy back.

Fatigue is one of the most common symptoms of RA, and is usually the first sign of an upcoming flare.  It can interfere with your life, making everyday tasks almost impossible.  Fatigue makes it harder for you to concentrate, it can even make you feel hopeless.  Dealing with your 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.

The best thing to do is to pinpoint the cause of your fatigue, it 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.  Keeping a diary can help, note the times of day you are having a problem with it, after looking back you may be able to figure out what is causing it. 

Unfortunately, fatigue is just another side effect from our RA.  You have to adapt it to your life, don't look at it as a personal weakness, but find away to live with and cope with it.  RA 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. 

Here are some tips to help you cope and deal with your fatigue, making your life a little easier. Also note, I'm not a doctor, and any real problem with fatigue should be addressed with your doctor.  Although these may not be able to help all of you, but I hope most of you will come away with some advice you may not have known before.  

- Adjust your schedule (if you can) so you can start an hour or two later.  This gives you extra time to sleep, and extra time in the morning to get out of bed if you're feeling stiff.

- If you can, fit in a nap during the day, even if you use half your lunch break.  Sometimes a short 15-20 minute nap can go a long way, and help you last the rest of the day. You don't want to look like this lady at work!

- Avoiding heavy meals, lots of carbs and sugars cause crashes later on in the day.  Eating healthier and lighter can help big time.

- 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.

- A good nights sleep.  Getting the amount of 8-10 hours a night, and sleeping through the entire night can help loads.  If you have trouble, there are both prescription and over the counter sleep aids. 

Lastly, prioritize your daily activities.  There will be days where you feel more tired than others, and sometimes when you're asked to do something, you will have to say no.  Don't be afraid to say no, or ask for help when you need it.  You can't do everything at once, and forcing yourself to go to a party after work, is just going to hurt you in the long run.  Saying no to something, because you just don't have the energy, is not wrong, even if someone makes you feel it is.  Your body goes through a lot, adding stress and not getting enough rest is just going to make you more fatigued and lead to a flare-up.

I wish you all good luck, and a good night's rest!