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Last updated:12th December 2016

AS and fatigue

Fatigue is a major symptom of AS 

Everyone gets tired or even exhausted at times, but after a few good nights rest or a break away they usually feel refreshed.

Chronic or long term fatigue in AS is not like tiredness. Some people describe it as overwhelming. You may feel that:

  • It's a different type of tiredness from what you have experienced before
  • After sleeping you don't feel refreshed
  • It's not due to exhaustion or loss of motivation

Here's what some people with AS have to say about how fatigue from AS affects them:

It feels as if lead weights are tied to my eyelashes.

Most days I seem to hit a wall in the early afternoon. If I am at work I plod on slightly less productively than at other times but if I am at home I generally shut down and sleep for a few hours.

I don't spend as much time as I used to socialising with friends and family. I used to be very active and go out in the evenings but now I have early nights instead. My husband describes how I have become as zombie like as I am not very sociable in the evenings because I am so tired.

A whole range of different factors can contribute to fatigue:

The underlying inflammatory process in AS can lead to fatigue. Researchers have found that chemicals called cytokines are found in inflamed tissue. These are similar to the type of chemicals released during viral illnesses such as colds and flu, and can cause extreme fatigue.

Anaemia is often found alongside inflammation. Do get this checked out with your GP.

Pain, especially long term pain, wears you down and can wake you up at night, adding to tiredness

Sleep disturbance due to pain and stiffness in the night

Certain drugs used to treat arthritis can cause drowsiness and interfere with concentration, which may make fatigue worse. Medications containing codeine or other opioids and medications such as amitriptyline are most likely to cause these side effects

Weakness of the muscles can occur. This can contribute to fatigue since more effort will be required to perform certain activities

Any long term condition can cause distress and uncertainty about the future. This can lead to depression, which is associated not only with a low mood but also with various physical symptoms, one of which is fatigue

Treatments to help fatigue

Medications which help to control inflammation in AS, resulting in reduced pain and stiffness, should also help to reduce the fatigue you are feeling. If you are on pain medications which cause drowsiness and loss of concentration then do speak to your GP or rheumatology team about possible alternatives to these.

Ask your GP to check if you are anaemic. If you are anaemic your GP can prescribe an iron supplement to restore the iron that is missing from your body. Your GP can also advise you on how to include more iron in your diet. The GP may wish to run tests to see why you are anaemic and short of iron.

If you do feel that living with AS is leaving you feeling anxious and depressed do go and talk to your GP about how you are feeling. You may feel better and more energetic on anti depressant medication. Do try to share any worries you have with someone else. It often helps to acknowledge negative feelings and thoughts.

How can I help myself?

The right exercise regime can improve strength, flexibility, wellbeing, energy levels and sleep. Ideally you should get advice from a specialist rheumatology physiotherapist. Don't forget NASS branches meet weekly for hydrotherapy and / or gym based physiotherapy.

It's important to remember that taking enough rest periods is just as important as taking exercise. How much rest you need and how often you need to take a rest will vary from one person to another but resting for 10 minutes every hour is often recommended. Rest times could include reading a book or magazine, watching a favourite TV programme or having a warm bath.

Relaxation techniques can help the body recharge itself and may also improve sleep.

Pace yourself. People with AS can find that pacing activities can help them regain some control over their feelings of fatigue. Try to prioritise so that you are doing the most important things first and leave more difficult jobs for when you are feeling at your best. Ideally try to plan ahead so you develop a weekly schedule which sets a pace you can live with, allows you to address your top priorities and leaves you time for rest.

Clare Clark, is an occupational therapist in Wales and she has worked with NASS to develop this short video on the importance of prioritising. ,


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