Persistent Fatigue Leaves Arthritis Patients Unrefreshed

Question: Persistent Fatigue Leaves Arthritis Patients Unrefreshed

Arthritis patients can sleep 8 or 10 hours every night and still wake up unrefreshed. What is the reason for the persistent level of fatigue? Is there anything which would help or improve fatigue?

Answer: It's a fact -- some patients do not feel refreshed in the morning despite adequate amounts of sleep. There are several reasons that explain why that happens.

Sleep Apnea

Sleep apnea is a common cause. While most physicians will consider the diagnosis of sleep apnea in an overweight male, the problem is often not considered in thin patients or females. Yet, the latter group may actually have severe sleep apnea due to a small airway, large tongue, or receding jaw. Consider a diagnosis of sleep apnea if you snore loudly and fall asleep when still (such reading or watching television). To detect sleep apnea, an overnight sleep study at a sleep center would be recommended.

Diminished Stage 3 or 4 Sleep

Other patients may have diminished stage 3 or 4 sleep (also called delta, deep, or restorative sleep) causing patients to feel unrefreshed in the morning and fatigued. Aerobic exercise, 30 minutes per day, 4 to 5 days per week may help these patients. The exercise should be completed 3 to 4 hours before bedtime, otherwise the exercise itself could cause insomnia.

In addition, medications such as Elavil and Flexeril at bedtime may help initiate sleep by relieving pain.


Depression may be associated with increased sleep and fatigue. If you are feeling down or are not getting pleasure out of life, talk with your doctor about the possibility of depression.

If needed, antidepressants such as Prozac, Zoloft, Cymbalta, and Effexor may improve your mood and your energy.

Your Partner's Sleep Habits

The sleep habits of your partner may play a role in your fatigue. Do you go to sleep and wake up at different times? Does your partner's evening or morning activity affect your ability to stay or fall asleep? Does his loud snoring or noise keep you up? If the latter is the case, suggest that he see he doctor to be evaluated for sleep apnea. Even if he does not have sleep apnea, an oral appliance may diminish his snoring and allow you to sleep well. Weight loss, better sleep positioning, and surgery are other ways to solve or lessen snoring.

Chronic Pain

Patients with chronic pain may find sleeping uncomfortable, whether the pain is located in the spine or there is arthritis of other joints (such as knees or hips). As a result, they may awaken during the night, or toss and turn. In either case, they are unable to achieve good sleep and feel unrefreshed when they get up.

Many of these patients may need to take some sort of pain medication in the evening to allow them to rest better.

Answers provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is author of Arthritis Without Pain - The Miracle Of TNF Blockers. The book is useful for anyone on one of the biologic drugs (Enbrel, Remicade, Humira) or considering the biologic drugs. Read my review of the book and also visit Dr. Zashin's website.

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