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Coping With Brain Fog and Fatigue

I just read that last chapter, why can’t I remember what happened?

I’ve never missed a deadline and I just forgot a major one!

I feel like I’m slogging through thick pudding, I just can’t focus.

Do those thoughts sound familiar? Brain fog and fatigue are two very common symptoms of axial spondyloarthritis (AxSpA). Brain fog is the feeling of being unable to concentrate and access words, thoughts, or maintain the organization that is typical due to a dense mental fog. Fatigue is a bone-deep weariness in which you struggle to function. Both of these often occur during AxSpA flares.1-4

Why does brain fog happen?

Recent studies using the results of MRIs taken over a period of time have shown that sustained inflammation can cause changes in the brain. Brain fog and fatigue are related to ongoing inflammation in the body as inflammation disrupts communication and processing. Other reasons for brain fog and fatigue can be a lack of good, consistent sleep.

Pain and stiffness can make it difficult to sleep, which can lead to increasing levels of fatigue. When feeling exhausted it can continue to exacerbate those symptoms of pain and inflammation, which perpetuates the cycle of pain and fatigue. Depression is another cause of fatigue and brain fog. Depression can interfere with sleep and lower energy levels. Those with chronic illnesses, including AxSpA, are more likely to experience depression.1-2, 4

Talk with your doctor

When experiencing brain fog and fatigue the first thing to do is consult with your doctor! When your AxSpA is not well controlled and you are experiencing flares it is more likely to lead to symptoms of brain fog and fatigue. Your doctor may order blood work to test for low iron levels (also called anemia)) or thyroid issues, as these can also contribute to fatigue. Next, your doctor may recommend certain medications. If you do have anemia or a thyroid issue, your doctor will prescribe a medication to help you regain the correct levels.

Your doctor may also recommend vitamins or changes in diet to help address any nutritional gaps. A sleeping aid may also be prescribed to help you get better, more consistent sleep. Occasionally, medications to treat depression that increase energy may also be indicated. Your doctor will also look at what medications might help to prevent AxSpA flares so that your disease is better controlled overall, which can also reduce the brain fog and fatigue. Also, review your current medications with your doctor to see if any of them could be contributing to these symptoms.1-4

Tips to help manage brain fog and fatigue caused by ankylosing spondylitis

There are also ways you can adapt your lifestyle to help manage the brain fog and fatigue!

Sleep routine

Develop and maintain a consistent sleep routine, waking and going to sleep at the same time every day, including weekends and holidays. Keep your bedroom as a dedicated space for sleep so your body knows this is the space I rest. Read, watch TV, surf the internet, etc. from a different location in your living space.


Make regular time for exercise so it becomes part of your routine. Exercise can help tire you out for sleeping, strengthen the muscles that support your joints, and reduce inflammation. Cycling and swimming are good low-impact exercises that can give you good exercise without causing pain to the joints. Start slow and build up your ability and endurance.

Record your patterns

When you experience brain fog or fatigue, make a note of it. Write the day, the time of day, and what you were doing to see if any patterns emerge. Share these with your doctor so together you can brainstorm ways to manage those trouble times.

Create an organization system

Find what works for you, be that a planner, alarms, alerts, a white board calendar, checklist, etc. to help you stay organized and on top of your appointments and deadlines. Based on your identified patterns, schedule those activities that require you brain power at the times you are less likely to experience brain fog.

Take your time

Rest when you need to, ask for help, say “no” or postpone plans if your body does not feel up to gathering. Avoid situations with lots of stimulation, as those can tax your brain and make the brain fog worse.

Engage in mindfulness

Practicing meditation or taking a yoga class can help you focus and clear your mind.1-4

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