How can I help myself?
There are many things you can do to reduce the impact of fatigue. Start by working out the possible causes then talk to your healthcare team so they can look at different ways to help you manage it.
If you think your medications may be causing your fatigue, talk with your doctor about reviewing your treatment. They can also check for signs of other conditions that may be causing fatigue, such as inflammation levels or anaemia (low iron).
If you have signs of active inflammation, your doctor may alter your RA medications to improve your symptoms, which will help to ease fatigue. However, it’s unusual to make major changes to RA medications to control fatigue unless there’s significant evidence of inflammation as well.
No specific medications can treat arthritis-related fatigue, but there are many ways that you can reduce the impact of fatigue on your life without medication. Changing behaviours like this does work, but most of us need support to do it, so discuss this information with your GP or rheumatology team, who should be able to help you work through it (particularly your occupational therapist, rheumatology nurse or physiotherapist).
Try combining some of the following tips on self-management.
The four Ps
When people feel fatigued, they often spend their energy on work and chores and give up things that they enjoy. Use the four ‘P’s’ to help you to conserve your energy, work out what’s important to you and give you time for things you want to do:
Often it’s not what you do, it’s the way that you do it that makes a difference. Look at your daily routine. Start to notice if you spend all morning doing the same type of repetitive tasks or if your working position causes you pain or discomfort. Perhaps your body complains when you do certain tasks or you get very tired by the afternoon.
If a task causes you a problem, ask yourself how you can do it differently.
Make a plan of the things you want to achieve during the day or over the week. Plan how and when you’re going to do certain tasks and spread them out wherever possible over a number of days.
Make sure that demanding jobs are spaced out during each day or week.
If you list the tasks you need to do, you can put them in order of importance and decide what tasks you can remove, delay or hand over. Ask yourself the following:
- Does this need to be done today?
- Does it need to be done at all?
- Do I have to do it, or can someone else?
- Can I get someone to help me with parts of the task?
Break tasks down into smaller achievable parts and spread them throughout the day or week, and take short, regular rest breaks. Change your position and activity regularly.
Don’t use exhaustion as a guide for when to stop – change your task or rest before you start to feel tired.
You may have found that fatigue has stopped you doing things you really want to, so it’s worth spending some time thinking about what things would make you feel good (for example socialising with friends or getting back into a hobby).
Setting yourself small, weekly goals can help you build up to what you really want to do as you start managing your fatigue. You’re much more likely to meet small, specific goals than vague ones or ones that aim too high. Your occupational therapist or rheumatology nurse may be able to help you set and review goals.
Monitor your energy output and fatigue
It can be difficult to assess how much energy you use on different tasks during the day, so it may be useful to monitor it and create a visual picture to help you see links with your fatigue. Create a chart to record your activities, when you do them, how long they take, and the energy levels you use.
Mark the activity as red when it’s a high-energy task. High energy is whatever you consider it to be – it could be physical (washing up, gardening), mental (office work) or emotional (family meetings).
Colour the activity yellow if it’s low energy. This is when you’re doing something which isn’t using a lot of energy.
Use green for rest time, for example when you’re reading or watching TV. During this time, you’ll have a chance for recovery and won’t be using much energy.
Use blue for sleep.
When your fatigue is very noticeable (for example, you had to stop what you were doing, sit down or go to bed to rest), put a cross through the activity.
At the end of a week, look back at your diary and ask yourself these questions:
- Were there episodes when you were exhausted?
- Were these related to high-energy activities (boom and bust)?
- Were there long blocks of high-energy activity with no breaks?
- Was your sleep disturbed?
- Were you sleeping during the day?
- Was there enough time for enjoyment and recovery?
Use the information to give you a better idea of when you need to pace yourself and to help you to prioritise your time. Try planning the next few weeks and review your progress as you go. Your rheumatology nurse specialist or occupational therapist may be able to give you charts and work through the process with you.
Download our activity chart (PDF, 513 KB) to help get you started.
Talk to family and friends about fatigue
For many people, fatigue is a major symptom of their arthritis – it’s just as common and as troublesome as pain. But because it’s an invisible symptom, many people with fatigue often don’t talk about it because they think that others won’t understand.
This can make you feel angry or frustrated over the impact fatigue has on your life. The lack of help and understanding from others can make your fatigue worse.
Family and friends can help you manage your fatigue, but they won’t know about it unless you tell them. Sharing the effects of fatigue with others helps them understand why you don’t always feel able to join in with activities or have to take more time to rest. Ask them to go to the myRA website to help them understand what fatigue is, how it can affect you and how seriously your healthcare team take it.
It can also be useful to explain fatigue to your work colleagues. This will help them to understand that you sometimes need to take more time over tasks. It might help with decisions on working patterns or adjustments to equipment to make your fatigue more manageable. Speak to an occupational therapist if you need more information.
Learn to say no
It can be hard to say no when people invite you out or ask you to do something for them, even if you know that it’ll leave you feeling exhausted. People with fatigue tend to keep agreeing to things because they feel they should or they think their own needs aren’t as important. Explain about your fatigue and what it would mean for you to say yes.
Saying no doesn’t have to mean you don’t take on any of the activity at all. Could you use the pacing strategies and only take on part of the request? For example, you could agree to go shopping but only for half a day. Discussing your own health needs isn’t being aggressive, it’s simply helping people understand your situation and being confident about how much you can reasonably do.
Learning to say no is an important step towards self-managing your fatigue and will help you in achieving daily goals. Most people will understand if you explain that you want to do something in a different way so you can save your energy for the good things in life.
Join a self-help group
Aside from talking to friends and family about their fatigue, many people find that joining a self-help group is useful. You can talk about how you’re getting on with your fatigue, and you can learn from other people’s experiences. Hearing from someone in a similar situation as yourself can be really helpful in enabling you to become more confident in your decisions.
There may be local self-help groups for RA, so ask your rheumatology team. Some organisations run self-management courses for people with arthritis, and some of these may address fatigue.
Increase your physical activity
RA can reduce physical activity because of the impacts of joint pain, muscle weakness and fatigue. Although doing too much can increase fatigue, a lack of exercise reduces fitness levels and contributes to muscle weakness, and it therefore can be a cause as well as a result of fatigue.
The good news is that fitness can be improved with the right sort of exercise. Start slowly, perhaps just a 5–10 minute walk, then gradually increase the amount of exercise or activity. Generally, the best way to develop your fitness is little and often. As you get fitter you’ll feel an increase in well-being, strength and energy.
Your physiotherapist may be able to help with a fitness programme or advice on exercises, or refer you to a gym or a health walks programme run by local authorities. Your doctor might suggest timing pain-relieving medications before you exercise to help prevent discomfort and allow you to continue with your activity.
You can also gradually increase your daily activities, for example housework and gardening. An occupational therapist can work with you to set specific goals and help you tailor a graded activity programme to reach these goals.
Read more about exercise.
Deal with stress or anxiety to help fatigue
At times, all of us have things going on in our lives that we find stressful. It can help to tackle stress as soon as possible.
Think about practical ways to reduce stress
Are there practical things you can do to reduce stress? For example, if you have a big task that’s bothering you, can you break it down and tackle a small bit each day? If it’s something you’ve been worrying about, can you take a deep breath and find the energy to do it? Sometimes our fears make things seem worse than they really are.
Reduce your physical reaction to stress
Reduce your physical reaction to stress through relaxation so that you feel more able to cope with things you find stressful. Take time for yourself – read a book or have a bath, for example.
Use relaxation techniques
Using relaxation techniques may also help to ease your stress. There are many relaxation, meditation or mindfulness apps, CDs and downloads available, or your occupational therapist or rheumatology nurse may be able to offer you some.
These techniques vary and can last from 5–45 minutes. They can be very effective if you practise them regularly. Your occupational therapist may also be able to advise about other relaxation techniques.
Find support for low mood to help fatigue
You may find that your fatigue makes you feel low or even depressed. It often helps to talk about negative feelings and thoughts, so it could be useful to speak to your GP or rheumatology team, or your friends and family. Support groups are also available – talk to your rheumatology team about organisations in your area.
There are several kinds of support for low mood, such as talking therapies (available as individual or group session, in person or over the internet) or a short course of drug treatment, some of which not only help with low mood but may also ease pain and improve sleep.
The first step is finding out what help or self-help might suit you best, so talk with your GP.
For more information on depression visit beyondblue.
Get a good night's sleep
Because poor sleep can cause fatigue, it’s important that you get a good night's rest. Try the following tips to improve your sleep:
- Aim to wind down in the hour before you go to bed – a warm bath might help you relax and reduce discomfort from tired muscles.
- Make a note early in the evening of things you’ve achieved during the day and what you need to do the following day. This can help prevent you worrying about things in the night. It may also be useful to keep a pen and notepad next to the bed so you can jot things down if you think you may not remember them in the morning.
- Reduce the amount of caffeine you drink (from tea, coffee or cola) and avoid alcohol after early evening.
- If you have pain, take a simple painkiller like paracetamol before you go to bed. Try to organise it so that you could take another dose if the pain wakes you in the night. Ask your doctor about treatment options if pain is affecting your sleep, or speak to a hand therapist about wearing splints to support your joints in the night.
- Look at your sleep environment – is the room too hot, light or noisy? Are your mattress, pillow and blankets comfortable?
- Try to remove as many disturbances as possible (such as a ticking clock or your mobile phone) to help you to settle down to sleep more easily. Removing clocks and phones from the bedroom can also reduce the temptation of checking the time or your messages if you wake up during the night.
There’s no recommended number of hours sleep – some people need 8–9 hours and others only 5–6 hours. Sleeping too much can also cause fatigue. Keep an activity chart to see if you have a regular sleep pattern.
Late nights followed by late mornings, or taking a nap in the day, can upset the body’s natural day/night hormonal and sleep patterns. Try to develop a regular bedtime and waking time and avoid lie-ins. It may take several weeks to get into this routine, but it’ll help as it restores the body’s natural sleep cycle.
Download a sample activity chart (PDF, 128 KB) to monitor your sleep pattern.
For more tips, read our information on sleep.
Eat a healthy diet
Eating a well-balanced diet will help to provide all the nutrients you need for general well-being and energy. Try to eat regular meals to keep your energy levels up.
Read more about healthy eating.