‘Everyone gets tired’, I’m sure you’ve heard this annoying comment so many times. But chronic and long-term fatigue in ankylosing spondylitis isn’t like tiredness. It can really wear you down and leave you feeling absolutely drained. It can last for days or weeks at a time and no amount of sleep or rest will relieve it. Some people describe it as overwhelming. Unfortunately, fatigue is common among people with AS and there’s a big chance you will experience it at some point.


So, what causes fatigue in people with AS?


There are many possible reasons for fatigue in AS. The inflammatory process itself can be the culprit. 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 another common suspect in fatigue and can often be found alongside inflammation.

Some medications you take for AS can cause drowsiness and interfere with concentration, which may make fatigue worse. The worst culprits are medications containing opioids and nerve pain medications such as amitriptyline.

The pain and stiffness of AS can wear you down and can wake you up at night, adding to tiredness.

Don’t forget the emotional and mental aspect of living with AS. It can have a massive impact. Uncertainty about the future can lead to depression, which is associated not only with low mood but also with various physical symptoms, including fatigue.


How can you treat fatigue?


The good news is that medications which help to control inflammation 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.

You can also ask your GP to check if you are anaemic. If so, supplement can be prescribed to help. It could be worth including more food products containing iron into your diet. Pay extra attention to your iron intake if you’re vegan or vegetarian.

If you feel that life with AS is making you feel anxious and depressed, do talk to your GP. You may get anti-depressant medication prescribed that can make you feel better and more energetic. Try to share any worries you have with someone else. Whether you speak with a professional or just your friend and family it often helps to acknowledge negative feelings and thoughts.


What can you do to help yourself?


As usual exercise can be the perfect remedy. The right regime can improve your strength, flexibility, wellbeing, energy levels and sleep. Physical activity helps to energise you, but that means you should avoid working out in the evening, as it can keep you awake at night.

Keep in mind that resting is just as important as exercising. How much rest you need will obviously vary from one person to another but try to pause and relax for at least 10 minutes every hour. This little ‘you’ time may include anything from reading a book, watching a TV show, catching some sun in a park or having a warm bath. Pick things that you really enjoy and help you to clear your mind.

Some relaxation techniques like meditation, mindfulness or even gentle yoga can help the body recharge itself and may also improve your sleep.

Try to plan your day or even a week ahead. Don’t pack your schedule with dozens of activities. Instead address your top priorities and leave enough time for rest. Pacing your activities can help you to regain some control over your feelings of fatigue. Remember, your wellbeing is most important, other things can wait.

Getting a good night’s sleep can be really tricky with AS but there’s few things that can improve your sleep.

Try to get into a good bedtime routine: go to sleep and get up at the same time every day and stick to this as much as possible.

Isolate yourself from any noises and lights that can disturb your sleep. Make sure your bedroom is dark and quiet. You could use an eye-mask and earplugs to avoid being woken up.

If you are lying awake for more than 20-30 minutes, get up, go to a different room (or different part of the bedroom) and do something quiet and dull – like reading not-quite-exciting book or watching an Antiques Roadshow rerun. Then return to bed when you feel sleepy.

Avoid playing with your phone, computer games or watching anything action packed and exciting, you don’t want to further stimulate your senses. Try not to eat or drink much before going to sleep, but always eat proper energy-rich breakfast (sugary fruits are perfect!).

Try not to use your bed for anything else than sleep and sex. Performing any other activity in your bed can trick your brain into staying awake.

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