Ugh fatigue.

This has been one of the most frustrating symptoms associated with my Systemic Sjogren’s.  In fact 96% of those of us with Systemic Sjogren’s report this as a significant symptom.

For anyone that has not experienced fatigue- it is not your run-of-the-mill “I am tired”…

This is Part 1 of a 2 part series on Fighting Fatigue. In this part, we will talk about what fatigue is and isn’t and what medically can cause it. In part 2 we will talk about what we can do about it!

So what exactly is fatigue? What causes it?

Fatigue is something that is much more than just being tired. It is sleeping for 10-12 hours only to wake up just as exhausted the next morning.  I describe it as feeling like you are walking through quicksand or thick mud.

It is just a really challenging symptom that can be very prevalent and persistent in particular with Sjogren's Syndrome, but also with other conditions. In particular, we see fatigue a lot with chronic fatigue syndrome also can accompany fibromyalgia, and other autoimmune conditions such as rheumatoid arthritis, lupus Hashimoto's thyroiditis, and can be a part of mental health conditions too, such as depression and anxiety. My patients dealing with immune deficiency also report significant fatigue.

I like giving you a look behind the curtain into how the doctor’s brain might be thinking about your symptoms to help you understand where we may be coming from.

Let's start off by talking about some of the medical conditions that as a physician, your primary care doctor, or other people on your care team may be thinking about when you tell them that you are dealing with fatigue.

Sleep

One thing I want to focus on when I'm talking with my patients in the office is finding out what their sleep is like.

In particular, I will ask how much they are sleeping, how the quality of their sleep seems to be what their bedtime routine and morning wakeup routine look like.

It's really helpful if you have someone who may be a bed partner or in the home when you're sleeping, to have them keep an eye and especially an ear out for your sleeping because one of the main causes of fatigue that we see is sleep apnea. This is when our breathing is affected while we sleep and our body is not getting enough oxygen to function adequately, overnight. Typically, this can be due to structural issues, but sometimes can be due to neurologic issues as well. This would be a really important health condition to be evaluated for if there is a concern for sleep apnea. Apnea over the long-term can lead to increased stress on the heart and the lungs causing high blood pressure in the lungs, which is very problematic.

One of the other things I will talk to patients about while we're talking about sleep is what their consumption of electronics looks like, especially in the evening hours and overnight.

In part, this is a little bit of projection, because I know that I have a tendency to take a look at my phone or my Kindle overnight, especially lately, I have a 6-month-old who is still nursing overnight.  It is very tempting to scroll, check my email, and do those sorts of things in the middle of the night.

But in doing so, we are exposing our eyes, even with our phone settings, limited to wavelengths of light that are not beneficial to getting real restful sleep.

So do as I say not as I always do.

Thyroid Function

The other medical conditions that your primary care doctor or other people in your care team may be thinking about when you talk about fatigue are your thyroid function.

The thyroid is a butterfly-shaped gland that sits at the base of your neck and the top of your chest. It is the main component of our body that functions with metabolism. It's also an organ that very commonly can be the target of autoimmune inflammation or viral inflammation as well.

When the thyroid gland is inflamed, it can either release too much of the hormone that it creates or over time, it can secrete less of the hormone. And in these circumstances, we can have variations in our ability to lose or keep on weight, and also changes in our digestion and our energy levels as well.

Vitamin D Deficiency

Another common condition that can result or contribute to fatigue is vitamin D deficiency.

If I have a patient who talks to me about fatigue that they've had difficulty improving, with focusing on sleep and nutrition and other things, I very well may suggest we check a vitamin D level, and a blood count because of anemia or low red blood cell count can also contribute to fatigue. So these are some of the medical conditions I think about.

Depression & Anxiety

Additionally, I also will ask patients about their moods. Depression and anxiety are also huge contributors to fatigue.

I will phrase it in one way to our autoimmune community, many times if we are under an immense amount of stress or worry, that stress and worry will steal extra spoons away from us.

It is harder to make more spoons or more energy when we are using up that mental energy. Especially ruminating in our thoughts.

I have certainly been very challenged by this over the course of my Sjogren's diagnosis but also preceding this as a very go-getter type person.

Ever since I was little, I've always had multiple things going on my mind is always racing, always thinking about that next thing, how am I going to do this better, so on and so forth, and that expends a lot of energy. Criticizing myself.

We may not be literally running around, but our brain is continually going and our brain is a huge energy expenditure that we use and we need to fuel in our everyday life.

So if you have untreated depression or anxiety, high functioning or not, can contribute to fatigue.

Medications

Many times, medications can also contribute to fatigue. I am guilty as charged. Many of the medications used to treat allergies can contribute to fatigue.

Antihistamines or allergy medications are a huge contributor for many people in causing brain fog and fatigue and sleepiness.

If you are on any medications regularly and dealing with fatigue, I would encourage you to speak with your care team or maybe make an appointment with the pharmacist where you fill your medications in order to see if there are particular medications you're on that may be contributing to fatigue.

If I have a patient who's having issues with fatigue, we may change the type or timing of medications.

For instance, certain medications and certain antihistamines are less likely to cause fatigue? For instance, fexofenadine or Allegra are much less likely to cause fatigue than diphenhydramine or Benadryl.

We also sometimes may change when they're taking the medication. For instance, if I have a patient who's taking an antihistamine in the morning, it's causing sleepiness.

We may say, "Okay, let's try it in the evening at bedtime and see if that is a better fit."

You should always as always talk with your own care team to work through some of these trials or think about these situations together as a team because these are just generalities and for educational purposes only. You need to work with your own care team in order to develop a personalized approach that's going to work for you and your unique circumstances.

Chronic Pain

The other aspect that contributes to fatigue can be chronic pain. 75% of those with Systemic Sjogren’s deal with chronic pain and certain other chronic conditions are commonly associated with pain including rheumatoid arthritis and diabetes.

Chronic pain is incredibly challenging. We know that it wears on us and have dealt with chronic pain in my low back for many years. I know that also played into my mood symptoms as well.

Chronic pain can be challenging to treat and typically requires a multi-pronged approach that may include medications, mindfulness techniques, and prescriptive movement (such as physical therapy, yoga, or similar).

If you found this helpful, consider sharing it with a friend who is looking for naturally-minded, scientifically-grounded, and sustainable approaches to anti-inflammatory living. While you are here, make sure you have subscribed to our newsletter so you don’t miss any of the new blog or podcast announcements.

Remember you are only a few habits away from being that thriving woman you want to be so start applying them today.

Stay tuned for part 2 next week we will dig into specific strategies we can take day by day to improve our energy.

Join Jen & I at the Mid-Year Resolution Retreat starting July 2nd!