Managing Fatigue with Axial Spondyloarthritis (Axial SpA): Tracking Sleep and Energy Levels

Fatigue is one of the most common and debilitating symptoms experienced by individuals with axial spondyloarthritis (Axial SpA). Axial SpA is a type of inflammatory arthritis that primarily affects the spine, causing pain, stiffness, and reduced mobility. However, beyond these physical symptoms, many patients also report profound fatigue that can greatly affect their quality of life.

In this blog, we will explore the relationship between Axial SpA and fatigue, and discuss the importance of tracking sleep and energy levels as part of managing this condition.

Understanding Fatigue in Axial SpA

Fatigue in Axial SpA is multifactorial and can result from the chronic inflammation that underpins the disease. The immune system, in its overactive state, releases inflammatory chemicals called cytokines, which can cause a persistent feeling of exhaustion. Moreover, pain and stiffness – especially during the night – can severely disrupt sleep, leading to sleep deprivation and heightened fatigue during the day.

For many people with Axial SpA, the fatigue can be as disruptive, if not more so, than the pain and stiffness. It can affect concentration, mood, and the ability to carry out daily activities. However, recognising and tracking fatigue can help individuals better understand the factors contributing to it and identify patterns that might offer some control over its management.

The Importance of Sleep in Managing Axial SpA Fatigue

Sleep is crucial in managing fatigue in general, but it becomes even more vital for individuals with Axial SpA. Quality sleep can reduce inflammation, improve pain tolerance, and increase overall energy levels. Unfortunately, Axial SpA can severely disrupt sleep due to nocturnal pain, stiffness, and frequent waking. Studies have shown that people with inflammatory arthritis, including Axial SpA, often suffer from poor sleep quality and sleep disorders, such as obstructive sleep apnoea (OSA) .

Why Tracking Sleep Matters

Many people are not aware of how deeply sleep affects their overall health until they start paying close attention to it. Tracking your sleep can help you:

• Identify patterns: Keeping track of when and how well you sleep can help you spot trends. For example, does your fatigue worsen after a particularly bad night of sleep, or is it more consistent?
• Assess sleep quality: Quantity isn’t everything. Tracking sleep can help you understand if you’re getting restorative sleep. Even if you’re in bed for eight hours, frequent waking or shallow sleep can mean you’re still exhausted the next day.
• Tailor interventions: Sleep tracking can help identify areas for intervention, such as trying relaxation techniques before bed, changing your sleep environment, or discussing sleep disturbances with your healthcare provider.

How to Track Sleep

You don’t need to invest in expensive gadgets to start tracking your sleep, though wearable fitness trackers can provide detailed data on sleep cycles and duration. You can begin by keeping a simple sleep diary. Each morning, jot down the following:

• Time to bed and time you woke up.
• How many times you woke up during the night.
• How you felt upon waking – refreshed or still tired?
• How long it took you to fall asleep.
• Any significant dreams or night-time disturbances.
• Energy levels throughout the day.

Several apps are available that can help automate this process, which can provide information on your sleep stages and overall sleep quality.

The Role of Pain and Stiffness in Disrupting Sleep

Axial SpA causes significant stiffness and pain, particularly during periods of inactivity, such as sleep. Many people report that pain and stiffness are worse at night, which disrupts their sleep and leads to frequent waking.

To manage this, experts recommend the following strategies:

• Regular exercise: Staying physically active during the day can help reduce stiffness, especially if you engage in stretching or low-impact activities such as swimming or walking. According to the NHS, exercise can help improve both fatigue and sleep quality in people with inflammatory arthritis.
• Pain management: Taking anti-inflammatory medications or prescribed pain relief before bed can help manage nocturnal pain. Additionally, heat therapy, such as using a hot water bottle, can provide comfort and relieve pain at night.
• Sleep positioning: Ensuring proper sleep posture can help alleviate discomfort. Some people with Axial SpA find sleeping with a firm mattress and additional pillow support helpful. Sleeping on your back with a small pillow under the knees, or on your side with a pillow between your legs, can reduce spinal strain and improve comfort.

Tracking Energy Levels

Energy levels fluctuate throughout the day for everyone, but for those with Axial SpA, these fluctuations can be extreme. Some days you may feel relatively energetic, while others can be marked by profound fatigue. Tracking your energy levels allows you to identify patterns and pinpoint factors that may influence your fatigue.

What Affects Energy Levels?

Energy levels in people with Axial SpA can be influenced by several factors:

• Inflammation levels: When the body’s inflammation is higher, fatigue tends to increase. Flares of Axial SpA are often associated with heightened fatigue.
• Physical activity: Paradoxically, while excessive activity can worsen fatigue, regular and appropriate exercise can help combat it. Over time, exercise can help improve energy levels by increasing stamina and reducing stiffness.
• Diet: A healthy, balanced diet rich in anti-inflammatory foods can have a significant impact on energy levels. Omega-3-rich fish, fruits, vegetables, and whole grains can help manage inflammation and boost energy.
• Sleep quality: As discussed, sleep has a direct impact on energy levels, with poor sleep leading to more severe fatigue.

How to Track Energy Levels

Just like tracking sleep, monitoring energy levels can be done through a simple diary or mobile app. Consider rating your energy levels at several points throughout the day on a scale from 1 to 10. Make notes about how you’re feeling, and record any activities you’ve done or factors that could have influenced your energy (e.g., meals, medications, stressful events).

Managing Fatigue Through Lifestyle Modifications

Once you have a clearer picture of your sleep patterns and energy fluctuations, you can start to make lifestyle changes that can help manage your fatigue. Here are some strategies:

• Pace yourself: Avoid doing too much on days when you feel more energetic, as this can lead to burnout or fatigue crashes later. Pacing and energy conservation are key principles in managing chronic illness.
• Plan rest breaks: Incorporating rest breaks into your day can help prevent over-exertion. Even short periods of rest can help recharge your energy levels.
• Stay active: Though it might feel counterintuitive when you’re tired, regular physical activity can help reduce fatigue in the long run by improving cardiovascular health and increasing muscle strength. Low-impact activities, such as yoga or swimming, are particularly beneficial .
• Mind your mental health: Fatigue can take a toll on mental health, and stress or anxiety can exacerbate feelings of exhaustion. Consider mindfulness practices, such as meditation or breathing exercises, to reduce stress.

When to Seek Help

If fatigue becomes overwhelming or unmanageable, it’s important to seek professional advice. Your rheumatologist or GP can help determine if your fatigue is related to disease activity or other factors, such as sleep disorders, anaemia, or depression. Additionally, they can recommend appropriate treatments, which may include medication adjustments or referrals to specialist services, such as occupational therapy or sleep clinics .

Conclusion

Fatigue is a challenging symptom of Axial SpA, but by tracking sleep and energy levels, you can gain valuable insights into the factors contributing to your fatigue. Understanding these patterns can help you and your healthcare provider develop strategies for managing fatigue more effectively, improving your overall quality of life.

By making small, incremental changes to your daily routine, such as improving your sleep hygiene, pacing your activities, and incorporating gentle exercise, you can start to regain some control over your energy levels and reduce the impact of fatigue on your life.

For more information on managing fatigue and other symptoms of Axial SpA, you can visit the NHS website or speak to your healthcare provider.

References:

1. NHS. Ankylosing Spondylitis.
2. Arthritis Research UK. Physical activity for people with arthritis
3. NHS. Inflammation: Anti-inflammatory diet
4. Versus Arthritis. Managing energy levels with arthritis
5. Law, R., et al. "Sleep disorders in patients with ankylosing spondylitis." Rheumatology, vol. 57, no. 3, 2018, pp. 499-506.
6. Sariyildiz, M.A., et al. "The relationship between fatigue and sleep disorders in ankylosing spondylitis." Rheumatology International, vol. 35, 2015, pp. 543-550.
7. National Ankylosing Spondylitis Society (NASS). Advice for sleeping