06/08/07
 How to Beat Fatigue - Part 2

As such, patients have a hard time telling their doctors what may have
led to the fatigue. In Hewlett's study, the few RA patients who felt
comfortable discussing fatigue with their doctors still reported
inadequate care for it, perhaps due to the emphasis on more measurable
physical problems, even though fatigue is just as much a problem for
them as pain. Or perhaps due to the fact that pain usually is eased
with medication, whereas a fix for fatigue typically isn't that
straightforward. In often-rushed appointments, doctors may be able to
only confirm fatigue's existence, but Hewlett says this offers little
help to patients.

Grant agrees. She knows the "Oh, dear, here we go again" look from
doctors when she brings up her fatigue. "Doctors don't want to hear how
tired patients feel. I think it makes them feel uncomfortable because
they can't `fix' it," she says.

       *Untangling Causes*

Finding the cause of fatigue means ruling out the many possible
culprits. Dr. Pischel explains that fatigue has many contributing
factors. "Not only is joint inflammation a major factor, but also
chronic pain, hormonal changes, anemia, poor sleep, depression and
stress." But 1 in 5 people with RA also has fibromyalgia, and the
majority of those with fibromyalgia also experience chronic fatigue.
Some people with inflammatory diseases also have celiac disease,
cardiovascular problems or lung problems associated with the
inflammation, and all of those conditions make the body's systems
work harder than normal and may lead to fatigue. Figuring out the
trigger is like having to unravel dozens of tangled strings of
lights to find the few burned-out bulbs.

Sleep problems are usually the first line of investigation. But even
if insomnia or restless sleep is present, the search is not over.
Maybe 2 or more factors are at work causing the fatigue.

       *Sleep and Pain*

For many people with arthritis, fatigue often is triggered by insomnia
and unrefreshing sleep due to unrelieved pain. Getting into a sleeping
position that is comfortable enough to allow solid slumber is a
challenge when joints are swollen and sore. And with sleep, quality
tends to be more important than quantity. Getting 6 or 7 hours of
deep, restorative sleep makes you feel better than spending 8 or 9
hours in bed tossing, turning and waking up repeatedly.

People with obstructive sleep apnea may wake briefly hundreds of times
per night as they gasp 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.

Studies show that disrupted sleep or too little sleep may heighten pain.

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