The pain can disrupt your sleep, but that’s not the only reason you’re tired.
The hallmark of the autoimmune disease ankylosing spondylitis is inflammation of the sacroiliac joint—the joint at the base of the spine that connects it to the pelvic bones. That said, there are a number of other symptoms and complications that can come with it.
“Ankylosing spondylitis … can affect some other body parts and systems because at the end of the day, it’s still an inflammatory disease of the body,” says Eliana Cardozo, DO, assistant professor of Rehabilitation Medicine at Icahn School of Medicine at Mount Sinai. Whenever the body is in a state of chronic inflammation, it can sustain damage over time that affects how the body functions and can potentially lead to complications of ankylosing spondylitis.
One of the lesser known symptoms of ankylosing spondylitis is fatigue. “The thought behind why that happens is really multifactorial,” says Dr. Cardozo. Causes of fatigue in ankylosing spondylitis include:
Inflammation: Fatigue is a common symptom in all autoimmune diseases because an active immune system requires increased energy.
Lifestyle: Dealing with the symptoms of ankylosing spondylitis may inhibit your ability to live a healthy lifestyle. For example, you might be less willing to exercise, and exercise can help improve energy levels.
Pain: Having chronic pain can itself lead to fatigue, and it can also disrupt your sleep or keep you up at night.
How to Combat Fatigue from AS
“Usually, I start off with speaking to patients about their sleep hygiene, meaning how many hours of sleep they’re getting a night,” says Dr. Cardozo. “If they’re not getting enough sleep, [I ask] why that is.”
Someone with fatigue from ankylosing spondylitis might be losing sleep because they are waking up in the middle of the night, they’re drinking coffee in the evening, or they’re bothered by back pain, to name a few examples.
Here are tips Dr. Cardozo gives to improve sleep hygiene and help fatigue:
1. Improve your sleep environment: Make sure you have a quiet and dark room with a slightly cooler temperature. Here are more tips for creating the perfect space for sleep.
2. Avoid technology before bedtime: That includes scrolling your smartphone and watching TV. These devices emit blue light that messes with sleep, so they can make it harder for you to fall asleep.
3. Be cautious with caffeine: Avoid caffeinated beverages like sodas, coffee, and energy drinks during the late afternoon and evening. They can stay in the body and affect your sleep for hours—much longer than you might expect.
4. Eat an anti-inflammatory diet: “We need to do more research in how diet affects certain conditions, [but] we know that more inflammatory diets with a lot of refined sugar and refined carbs can affect that,” says Dr. Cardozo.
An anti-inflammatory diet won’t “cure” your disease, but think of it this way: A diet high in inflammatory foods, such as red meat and refined carbs, can increase inflammation in the body, which could worsen your symptoms of ankylosing spondylitis. Thus, eating an anti-inflammatory diet can potentially reduce your symptoms by not adding to that inflammation.
“I try to counsel patients on having as healthy of a diet as possible, meaning as many whole, plant-based foods,” says Dr. Cardozo. In other words, incorporate whole grains, fresh fruits and veggies, lean proteins (such as beans), and healthy fats (such as avocado and nuts) as much as you can.
5. Stay active: “In ankylosing spondylitis, patients feel much more pain when they’re inactive. It’s called the ‘gelling phenomenon’, and they actually feel better when they’re more active and move around their joints,” says Dr. Cardozo. Learn more about the benefits of exercise for ankylosing spondylitis here.
If exercise is challenging, a physical therapist can be immensely helpful in finding an exercise regimen that works for each individual and their symptoms.
If you’ve made these changes and are still dealing with fatigue, talk to your doctor. You may have other underlying conditions that are affecting your energy levels. “Once all of those things are optimized, hopefully the patient would start to feel better and [see] improvements,” says Dr. Cardozo.
Dr. Cardozo is an assistant professor of Rehabilitation Medicine at Icahn School of Medicine at Mount Sinai.
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Ankylosing spondylitis, although it affects mostly
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the sacroiliac joints in the pelvis and the spine,
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it can affect some other body parts and systems,
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because at the end of the day,
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it's still an inflammatory disease of the body.
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Fatigue is a very common symptom.
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Around like 65 percent of patients report it.
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The thought behind why that happens is really multifactorial.
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So one is the inflammation itself.
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So inflammation of course can cause your body
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to feel fatigued and tired.
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Pain itself has been shown to cause fatigue,
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so having the disease under control and having pain
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under control and being as functional as possible
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is gonna help as well.
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Usually I start off with speaking to patients
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about their sleep hygiene, meaning how many hours
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of sleep they're getting a night.
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If they're not getting enough sleep, why that is.
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Is it, they're waking up in the middle of the night?
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They can't fall asleep?
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Then I get into more of the bread-and-butter sleep hygiene,
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which has a lot to do with your sleep environment,
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so making sure you have a quiet, dark room
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that's cool enough in temperature, and then also
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talking to patients about what they're doing either in bed,
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whether they're watching TV or looking at their phone,
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which we know can affect the sleep quality,
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and then lastly, I talk to them a bit more about their diet,
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if they're having caffeine during the day, until how late,
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things like that, which can all affect your sleep.
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While there isn't that much, and we need to do
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more research in how diet affects certain conditions,
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certainly in more inflammatory conditions,
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we know that more inflammatory diets
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with a lot of refined sugar and refined carbs can affect that,
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so I try to counsel patients on having as healthy of a diet
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as possible, meaning as many whole plant-based foods.
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Exercise is so important for any pain condition,
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but in ankylosing spondylitis, patients feel much more pain
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when they're inactive; it's called the gelling phenomenon,
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and they actually feel better when they're more active
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and move around their joints, so I frequently refer them
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to physical therapists so they can start an exercise regimen
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that won't increase their pain.
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Ankylosing spondylitis can be a difficult disorder
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and it really varies in spectrum, where some people
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are not affected as much as others.
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I would also say that it would be important
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that they're checked out for underlying conditions
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that we know increase fatigue, like anxiety and depression.
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Once all of those things are optimized,
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hopefully the patient would start to feel better
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and improvements in those different factors.
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Fatigue in spondylitis. Van Nuys, CA: Spondylitis Association of America. (Accessed on March 4, 2020 at https://www.spondylitis.org/Fatigue.)
Treatment of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults. Waltham, MA: UpToDate, 2020. (Accessed on March 4, 2020 at https://www.uptodate.com/contents/treatment-of-axial-spondyloarthritis-ankylosing-spondylitis-and-nonradiographic-axial-spondyloarthritis-in-adults.)