Fatigue with Lupus

Reviewed by: HU Medical Review Board | Last reviewed: January 2020

Fatigue is defined as feeling tired or lacking energy, no matter how well or how long you sleep. This exhaustion can be both physical and mental. Some people describe it as a similar feeling to having the flu.

Almost all people living with lupus experience fatigue at some point during the course of their disease. Long-term, severe fatigue occurs in 40 percent of those with lupus.1

What causes fatigue in lupus?

Many things may cause someone with lupus to feel overly tired, including:1-3

  • Anemia
  • Flares and inflammation
  • Infection
  • Gastrointestinal issues
  • Thyroid imbalance
  • Stress or doing too much
  • Depression and anxiety
  • Medicines
  • Lack of sleep caused by pain and other symptoms

Other medical issues besides lupus can cause fatigue, so it’s important to talk to your doctor about how you are feeling. For example, low vitamin D levels or poor nutrition can cause fatigue but can be easily fixed with supplements or dietary changes. Fibromyalgia, a different disease that some people with lupus have, also causes deep exhaustion.1,3

How do doctors diagnose lupus fatigue?

Your doctor will ask you a series of questions to understand what may be causing your fatigue. These questions may be followed up with blood work or other tests to rule in or rule out related conditions called comorbidities. Common questions include:1

  • How well do you sleep?
  • How many hours can you work before you hit the wall?
  • What do you try to do every day?
  • How often do you feel exhausted? How long does it last?
  • Is there something you want to do but can’t because of how tired you feel?
  • Have you had to give up activities you enjoy because you’re too tired?

How is lupus fatigue treated?

How your fatigue is treated will depend on what seems to be causing the issue. For instance, if you have an infection, treating the infection with antibiotics should improve your energy levels. If a medication seems to be the issue, your doctor may prescribe a different drug or suggest taking it at a different time of day.

Anemia, or low red blood cell count, affects about 50 percent of people with lupus and the main symptom of anemia is fatigue. If your anemia is caused by an iron deficiency, you will be given iron supplements. If it is caused by inflammation, antibodies, or steroids, other medications might be prescribed. If kidney issues are preventing the creation of key hormones that stimulate red blood cell production, you may be prescribed a drug called erythropoietin.2

In general, controlling your lupus flares as much as possible will also reduce feeling exhausted since inflammation makes you feel tired.

Lupus medications and fatigue

Some drugs commonly used to treat the various symptoms of lupus may also cause fatigue. For instance, steroids used to manage inflammation such as prednisone may cause insomnia or otherwise interfere with good sleep. Other medicines that may contribute to feeling tired include1:

  • Cold and allergy medicines
  • Muscle relaxants
  • Blood pressure medicines
  • Antidepressants
  • Opioids

Managing fatigue symptoms

While you probably cannot completely control lupus fatigue, there are steps you can take to manage some of the issues that contribute to it, such as3,4:

  • Give yourself a break. If you cannot do everything on your to-do list in one day, let yourself take 2 days or a week to get chores done without guilt.
  • Take frequent breaks at work. Sitting for long periods can make you feel stiff, so get up and walk around and stretch. The movement will get the oxygen flowing throughout your body again.
  • Eat a balanced diet. A mix of protein for long-term energy and nutrient-rich carbohydrates for short-term energy can help your body function better.
  • Exercise and stretch. Regular exercise, even when you are tired and sore, will help you build lung capacity and muscle strength. Stretching will improve your range of motion and improve joint mobility.
  • Practice good sleep habits. There are several techniques you can learn to improve the quality of sleep you get so that you feel more rested upon waking.

Tips for restful sleep

The National Sleep Foundation offers several suggestions for getting a good night’s sleep, including:4

  • Stick to a schedule so your body is used to falling asleep and waking at certain times
  • Exercise daily.
  • Avoid bright light, including lights from electronic devices, an hour before bedtime.
  • Don’t nap, especially in the afternoon.

Fatigue can greatly impact your quality of life, so it is vital that you do what you can to manage your exhaustion.

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