How to Beat Fatigue - Sleep and Pain
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For many people with arthritis, fatigue often is triggered by insomnia and poor sleep. Getting into a comfortable sleeping position is a challenge when joints are swollen and sore. Getting six or seven hours of deep sleep makes you feel better than spending eight or nine hours tossing, turning and waking up repeatedly.
People with sleep apnea may wake hundreds of times per night gasping for air. Weakened muscles or excess tissue in the throat can block the airway and lower the amount of oxygen in the blood. Sensing the low oxygen level, the body arouses itself. Waking up briefly to allow the airway to open interrupts normal, restorative sleep.
Researchers in Australia recently studied symptoms related to “acute sickness behavior,” consisting of fatigue along with increased sleep, inability to concentrate, poor memory, fever and decreased appetite. The researchers interviewed 69 people with infections. Then they measured the amount of cytokines in the patients’ blood samples and cell cultures. Results showed that fatigue consistently correlated with levels of interleukin-1 (IL-1) and IL-6, both of which are cytokines connected with inflammatory forms of arthritis. The higher the levels, the more unwell the study participants felt.
Anemia
Anemia affects up to two-thirds of RA patients and is most common in those with severe joint disease. If anemia can be successfully treated, the joint pain, swelling and tenderness responds better to treatment, and improving those symptoms decreases fatigue and increases energy, according to studies focusing on anemia in people with RA.
Dr. Pischel believes one cause of fatigue is anemia of inflammation. This type of anemia occurs when chronic illnesses cause a drop in the longevity of red blood cells. With too few or too-small blood cells, a body has too little iron, which means less energy.
When performing normal daily physical activities, the muscles are taxed closer to their maximum capacity – similar to a healthy person working out intensely. Overtaxed muscles result in fatigue after even a short burst of activity.
Loss of Muscle Mass
The loss of muscle tissue means the loss of cells that produce energy. More than half of people with severe RA, according to one study, are affected by a condition called cachexia, in which muscle mass decreases and fatigue increases. Cachexia is linked with overactive immune system cytokines; in fact, tumor necrosis factor-alpha – the cytokine targeted by the biologic medications adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade) – is sometimes called ‘cachectin’ because of its connection with cachexia.
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