Psoriatic Fatigue: Why do I feel so tired?

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What is fatigue?

It is normal to feel tired after exertion, insufficient sleep or at the end of the day; this tiredness is usually relieved by rest or sleep. With fatigue, the symptoms often go beyond normal tiredness and can include decreased or lack of energy with accompanying physical or mental exhaustion. These symptoms usually persist even after a good night’s sleep.

In the UK, 10-20% of the population report being tired for a month or longer, with 1.5% feeling a need to see their GP. The symptoms often include difficulty sleeping; muscle or joint pain; headaches; painful lymph nodes; sore throat; cognitive dysfunction; symptoms made worse by physical or mental exertion; flu-like symptoms; dizziness; nausea; or palpitations.

Why do I feel tired all the time?

People with psoriasis or psoriatic arthritis often feel tired all the time. Some people who develop this symptom think there must be something psychologically wrong with them. There isn’t; fatigue is a common and recognised symptom of the conditions. It is also acknowledged that doctors underestimate fatigue as a component of psoriasis and in particular of psoriatic arthritis. People often feel frustrated about the lack of support and understanding they get when presenting with a debilitating and invisible symptom.

It appears that fatigue is more severe in people with psoriatic arthritis than those who have psoriasis alone, with studies suggesting that three out of every ten people with psoriatic arthritis have symptoms of fatigue. Fatigue may be an early symptom or sign of inflammatory activity in people who may have psoriasis and or psoriatic arthritis; both are classed as long-term inflammatory conditions. Inflammation is linked with the release of powerful chemicals. These include:

  • inflammatory proteins which increase the stickiness of blood platelets
  • proteins which bind to antibodies and circulate as immune complexes
  • immune system chemicals that help immune cells communicate with each other, such as interleukins, especially interleukin 1.

What causes fatigue?

As described above, inflammation appears to be part of the process of feeling fatigued, but researchers do not know exactly what the link is, or how increased levels of inflammatory substances in the body influence fatigue.

Myths and misconceptions

There are many myths and misconceptions about fatigue. People are sometimes wrongly viewed as being “lazy” by their work colleagues and sometimes by their own family members.

The reason that the person affected by fatigue is unable to carry out basic everyday tasks is the inflammatory process taking place in their body. People often think that caffeine will help wake them up. As caffeine is a stimulant, the effects are short-lived; people often feel more tired once the initial effect wears off. Caffeine is typically found in coffee, tea, cola and energy drinks. Caffeine is also a diuretic, causing dehydration, which will also have a negative effect. In some instances people may resort to the use of alcohol, under the misapprehension that it will relieve the symptoms. However, alcohol is likely to make people drowsier, depressed and can affect sleep, which will also contribute to fatigue.

What can I do?

If you feel tired all the time, tell your doctor, as it is important to rule out any other causes of fatigue. Sometimes you may need to have your medication changed or take tests so that your GP can fully understand what is happening.

With or without medical intervention, there are a number of lifestyle changes that may help you feel generally less exhausted.

Dietary advice

  • Eat a diet providing at least five servings of fresh fruit or vegetables a day
  • Reduce the animal fats in your diet and avoid fatty foods as much as possible
  • Eat fresh, home-made foods rather than prepackaged convenience foods
  • Increase your intake of B-group vitamins, needed for the production of energy in the body. These are found in brown rice, wholegrain bread and cereals, oatmeal and oat flakes, pulses, green leafy vegetables, oily fish and poultry
  • Aim to eat more oily fish, virgin olive oil or rapeseed oil, nuts and seeds
  • If you are unable to increase your intake of fish, consider taking an omega-3 fish oil supplement
  • Cut back on saturated spreads and vegetable oils and products which contain them, such as shopbought biscuits and cakes
  • Consider taking a vitamin and mineral supplement supplying around 100% of the recommended daily amount for as many nutrients as possible.

see  Psoriatic Lifestyle and Nutrition

Behavioural changes

  • Avoid things that interfere with sleep, such as caffeine, nicotine, excessive alcohol and eating rich, heavy food late at night
  • Avoid excess stress
  • Aim to lose excess weight.

Put yourself first

  • Take some time to rest during the day
  • Keep a balance between the demands on you and your energy
  • Learn to say no, if possible
  • Tell people when you are tired
  • Avoid using unnecessary energy.

Physical activity

Some people find it difficult to get motivated and take part in some form of physical activity. As everyone has different activity levels, pain thresholds and body weight, you should start by finding activities which keep you mobile and strengthen your muscles, but which do not cause you any pain. Try to think of a physical activity that you enjoy which you can easily fit into your daily routine. If you enjoy walking, try to go for a walk a few times a week and increase the walking time by a minute or so per session. After a few weeks you will have learnt how far you can comfortably manage without experiencing pain. Other activities you may find beneficial are cycling, gentle gym exercises or more complementary therapies such as yoga or pilates. See Physiotherapy and Exercise: Psoriatic Arthritis for more detail

Balancing energy

  • Try to keep back some energy for something you l ike to do; it will give you satisfaction and a morale boost
  • Use pain relief regularly and as directed , as constant pain will make you fatigued
  • Take regular, gentle exercise
  • Take a rest before the children arrive home from school or if you are having visitors, as this will help you to spend more time with them
  • Spread chores out over a few days rather than trying to complete them on the same day
  • Stop any activity before you are too tired. Rest and then start again
  • Plan your activities so that you can take time out to rest before and after
  • Find time to relax by learning mindfulness or other similar relaxation techniques
  • If you have been concentrating on a particular activity, you may find it helpful to follow it with some physical activity, change of scene and rest
  • Sit down and use labour-saving devices when you can, as these will preserve your energy.
  • Be kind and gentle to yourself.

Keeping a diary

People find it difficult to understand why they feel fatigued; often there appears to be no obvious cause. You may find it useful to record the times and days you feel fatigued and for how long it lasts. Log the actions from the previous few days which might influence your energy levels, such as work, sleep, events, occasions, and even your food and drink. This may help you to understand the patterns and adjust your lifestyle and activities to reduce the incidence of fatigue. You will then be able to plan your life more effectively. It may also be useful to share this information with your healthcare provider, as they may be able to help you understand the causes.

Show and tell

Because not everyone fully understands the effects of fatigue, psoriasis or psoriatic arthritis, show family and friends a copy of this and other PAPAA information leaflets. You may find they can offer support and adjust activities and events to suit your needs.

If you are employed, it may be helpful to talk to your human resources department or your line manager, as they may be able to adjust your working environment. Under the Equality Act 2010, employers must make reasonable adjustments to make sure workers with disabilities, physical or mental health conditions are not substantially disadvantaged when doing their jobs. This applies to all workers, including trainees, apprentices, contract workers and business partners.

Conclusion

A number of published scientific studies suggest that fatigue is an integral part of psoriasis and psoriatic arthritis, although there appears to be little link between levels of fatigue and disease severity. Overall, it is often dismissed by doctors as trivial, but people find that it can be very debilitating and affect their ability to function or carry out daily tasks, including work and studies.

This article is adapted from the Psoriatic Fatigue leaflet

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