Do you have profound, debilitating fatigue with ankylosing spondylitis (AS)? If so, you’re not alone. Studies suggest that over 85 percent of people with AS experience fatigue. Unfortunately, this type of tiredness doesn’t go away with rest or sleep.

It’s important to talk to your healthcare provider about fatigue, especially if you notice sudden changes in your energy levels. They can order tests, check for related conditions, and recommend strategies that may help.

Here’s what you should know about ankylosing spondylitis fatigue including causes and tips for managing it.

Does Ankylosing Spondylitis Cause Fatigue?

Along with chronic pain and stiffness, fatigue is one of the most common symptoms of ankylosing spondylitis. For some people with spondylitis, fatigue is their biggest concern.

This isn’t the same as tiredness after an intense workout or a long day. Fatigue from AS comes from chronic inflammation, and possibly even brain changes related to the condition. Fatigue from ankylosing spondylitis can worsen flares and have a major impact on your quality of life.

“Tired is my new normal,” shared one member of MySpondylitisTeam.

“I’ve turned into Rip Van Winkle,” said another.

“I’m so tired I could sleep on a coat hanger, just to survive,” said a third member.

What Causes Ankylosing Spondylitis Fatigue?

Fatigue usually comes from a mix of factors. Some are a direct result of inflammation from ankylosing spondylitis. Others may be linked to comorbidities (coexisting health problems).

Inflammation

Uncontrolled disease activity is one of the main drivers of fatigue in inflammatory arthritis. In AS, the immune system releases inflammatory proteins called cytokines, producing fatigue. As one member put it: “Pain makes us exhausted; exhaustion creates pain that fogs our brain. One symptom leads to another (and back again)!”

Sleep Disorders

Around 53 percent of people with ankylosing spondylitis experience sleep disorders. This is a broad term that includes problems like difficulty falling or staying asleep, or conditions like sleep apnea, where breathing repeatedly stops and starts. Poor sleep can increase pain, which makes sleep even harder — a frustrating cycle.

One MySpondylitisTeam member shared, “For two to five weeks, I can’t sleep at all. Then, I sleep for a solid week, waking every hour for 10 to 30 minutes. After that, I’m back to not sleeping again.”

Medications

Some medications prescribed for ankylosing spondylitis can cause or worsen exhaustion. For example, corticosteroids like prednisone, which are often prescribed to control AS flares, can trigger fatigue-promoting side effects, such as anxiety and sleeplessness. Pain medications and antidepressants can also lower energy levels.

Some members of MySpondylitisTeam also report fatigue from disease-modifying antirheumatic drugs (DMARDs). These medications may be used in ankylosing spondylitis when peripheral joints — like the knees, ankles, or wrists — are affected. This is called AS with peripheral arthritis.

As one member explained, “My fatigue appeared once I started methotrexate. Now it’s hard to function throughout the day.”

If you suspect your medications are causing side effects that are adding to your fatigue, talk with your doctor. They may be able to adjust your treatment or suggest alternatives.

Underlying Conditions

Sometimes fatigue can be a sign that you have another health condition in addition to AS. People with ankylosing spondylitis have a higher risk of issues like hypertension (high blood pressure), thyroid disorders, and type 2 diabetes. Some lung diseases, cancers, and other heart diseases are also more common. These conditions can contribute to fatigue, especially if they’re left untreated. This is why regular checkups and monitoring are so important.

Depression

Depression is common in people with AS. Common symptoms of depression include fatigue, low energy, and lack of motivation. The good news is that mental health support, including therapy and medication, can help you cope with the psychological challenges of living with a chronic disease.

What Does Ankylosing Spondylitis Fatigue Feel Like?

Fatigue from AS goes beyond just being tired. Some of the symptoms people may experience include:

• Less interest in social activities
• Restlessness at night
• Muscle weakness
• Brain fog and trouble making decisions
• Depression
• Anxiety
• Headaches
• Frustration and anger
• Poor memory or forgetfulness
• Low self-esteem
• Decreased productivity

Here’s how some MySpondylitisTeam members have described the feeling of fatigue:

• “I can power through pain, but this exhaustion is tough.”
• “Tired isn’t the word. It’s run-down, lacking energy, feeling stressed, on edge, and yo-yoing through the day.”
• “Feel dead on my feet.”
• “Tired and brain foggy today. Another lost day.”
• “It feels like the drain plug has been pulled, and I’m sitting on empty.”
  

  “I can power through pain, but this exhaustion is tough.”
  — A MySpondylitisTeam member

How Fatigue Impacts Daily Life

Fatigue doesn’t just drain your energy levels. It can also dramatically impact your mood, relationships, physical activity, job, and overall quality of life.

Daily Responsibilities

Many people with AS find fatigue makes even basic chores difficult. One member shared, “I can’t clean house or cook. I try to dust a little, then pay for it later. My husband now does 99 percent of the grocery shopping.”

Fatigue doesn’t just drain your energy levels. It can also impact your mood, relationships, exercise, work, and well-being.

Another member was so exhausted, they fell asleep waiting in the parent pickup line at their son’s school. “A guy knocked on my car window to wake me,” they said. “It was so embarrassing.”

Work

Job performance can also suffer when fatigue and brain fog show up at work. Research shows that up to 90 percent of people with ankylosing spondylitis eventually become work disabled over time.

“I stopped scheduling morning appointments with clients because I am so tired,” shared one member. “Even if I have a long to-do list, I nap when I can, then work when I’m awake — usually a two-to-four-hour window in the afternoon.”

Relationships

Fatigue can also affect relationships with families and friends, and many members of MySpondylitisTeam have shared such experiences:

• “I’m sick of my family asking if I’m drunk or high.”
• “Can’t even get up to make a cup of tea. My family thinks I’m lazy. No friends or social life.”
• “I wanna be the fun grandma, but I’m too tired and totally drained.”
• “I have sleep marathons followed by a day or two of energy.”

5 Tips for More Energy

If you’re dealing with ankylosing spondylitis fatigue, you don’t have to face it alone. There are options you can discuss with your healthcare provider, including medications, therapy, and lifestyle changes.

1. Biologic Therapies

Biologics — a type of DMARD — target specific parts of the immune system to reduce inflammation. Anti-TNF therapies and interleukin (IL)-17 inhibitors are commonly prescribed for ankylosing spondylitis. In one study, about 35 percent of people with AS reported complete relief from fatigue after starting a biologic.

Some people with AS may also benefit from antidepressants, but more research is needed on their role in managing fatigue specifically.

Biological DMARD medications have been shown reduce fatigue in 35 percent of people with spondylitis.

2. Therapy

Managing pain may help you sleep better. Along with medication, psychological therapies can teach skills to cope with chronic pain and reduce its impact on sleep.

These include:

• Mindfulness-based stress reduction — Focuses on calming your nervous system through breathing and awareness techniques
• Cognitive behavioral therapy (CBT) — Helps you reframe unhelpful thoughts about pain and sleep
• Acceptance and commitment therapy (ACT) — Encourages you to focus on what matters most to you, even while living with discomfort

3. Gentle Exercise

Movement is a natural fatigue fighter. Exercise triggers the release of feel-good brain chemicals and can help reduce inflammation. Many people with spondylitis say that staying active actually feels better than resting, so keep moving if you're able.

Try starting with low-impact activities like yoga, tai chi, swimming, walking, or stretching. Work with your healthcare provider or a physical therapist to create a safe, personalized exercise plan. Over time, you can gradually increase your distance, time, or intensity. Regular movement may also help you sleep better and lift your mood.

4. Anti-Inflammatory Diet

No diet can cure fatigue, but an anti-inflammatory diet may help lower inflammation and support better energy levels. This type of diet focuses on fruits, vegetables, whole grains, legumes, and other nutrient-rich foods that fuel your body.

A registered dietitian nutritionist can help you find anti-inflammatory foods that match your preferences, health needs, and lifestyle. They can also work with your care team to make sure your diet supports your overall treatment plan.

5. Other Tips From MySpondylitisTeam Members

Some MySpondylitisTeam members use medical marijuana to ease fatigue and exhaustion. Others find vitamins and supplements helpful, including vitamin D or B12. These may help, but always talk to your doctor before adding any new supplement or treatment, even if it’s available over the counter.

Join the Conversation

On MySpondylitisTeam, people share their experiences with spondylitis, get advice, and find support from others who understand.

Do you have any fatigue-fighting tips to share? Let others know in the comments below.