context: If you have rheumatoid arthritis and struggle with fatigue, you aren't alone. It's a common symptom of the disease. Fatigue is much more than just being tired. It makes you feel like you're totally out of energy. It can be so severe that you think you have the flu. You might feel worn out even though you haven't done more than usual. Often, nothing seems to help -- not even sleep. Fatigue doesn't get better with more sleep or rest. Fatigue can take a toll on your body, mind, and emotions. You may feel weary, foggy, or forgetful. It might be hard to enjoy get-togethers with friends or family. Antibodies that cause the inflammation that comes with RA affect your central nervous system, not just your joints. High inflammation levels can lead to severe fatigue. RA also causes chronic pain. It, too, can leave you feeling worn out by the end of the day. When your joints hurt, it's hard to sleep. RA fatigue makes it hard to feel refreshed when you wake up in the morning. When you have RA, fatigue, pain, and mood problems can become a vicious cycle. Doctors think high levels of inflammation might cause all three of these symptoms. You may need a combination of treatments, lifestyle changes, and a new attitude to keep fatigue under control. Accept that fatigue is a part of life with RA. You can't always control it. You can't predict when you'll be too tired to work or join a social event. Listen to your body. You'll feel better if you take the time to rest when you need to. Take breaks if you have a task that takes a lot of energy. Tune out the guilt. Your friends and family may not really get how bad you feel. You aren't lazy. You're exhausted by your arthritis. Don't feel guilty if you have to rest instead of going out or leave early because you're too tired. Explain that fatigue is a symptom your disease. Don't push yourself to keep up with everyone else. If you need help with household chores that exhaust you, ask others to give you a hand. Cut out any steps you don't need to complete a task. Set your own pace. You decide what you can and can't do on days when fatigue is high. Get regular exercise. The last thing you may want to do is work out. But activity lowers fatigue if you have RA. Simple things like a daily walk or a swim can build stronger muscles and soothe achy joints. Try to do something, even if you just stretch, even on days when you're really tired. Yoga and tai chi are two gentle activities that help ease fatigue and lower stress that can keep you awake. Fuel up with the right foods. Your body gets energy from the foods you eat. Choose fresh, whole items like fruits and veggies, lean protein, dairy products, and healthy fats. Omega-3 fatty acids, found in foods like nuts and cold-water fish, help ease fatigue by reducing inflammation. Start your day with a healthy breakfast, even if you wake up tired. Choose foods that are rich in fiber, complex carbohydrates, and lean protein. A bowl of high-fiber cereal, fresh fruit, and low-fat milk can give you more energy for the rest of your day. Drink water. Your body needs fluids to keep going. Fatigue may be a sign that you're dried out. Aim for about eight glasses a day. You may need more if you're extra active or when it's hot outside. Stick to a sleep routine. Good habits help you get enough rest so you feel less fatigue the next day. Go to bed at the same time each night. Get up at the same time each morning. Cut back on caffeine, alcoholic drinks, and nicotine. All of these can disrupt your sleep. Fight the urge to take an afternoon nap. Sleeping during the day can make it harder for you to nod off at night. When it's time for lights out, turn off devices like your smartphone or tablet. You'll rest better in a dark, quiet room. Ask your doctor about medications. If fatigue hits often, talk to your doctor. If you can't get to sleep, prescription sleep aids could help you get a full night's rest. The doctor can also test your blood to make sure it's not another condition making you tired. Seek counseling or therapy. Cognitive behavioral therapy or counseling with a mental health professional can ease the stress that worsens your fatigue. It can also help you control how fatigue affects your life. Explore alternative treatments. Massage therapy often eases stress and anxiety. It helps you let go of your thoughts and get to sleep. Acupuncture also works for many people. Talk to your doctor before you take any herbal treatment or try any nonmedical therapy.