If you’ve lived with rheumatoid arthritis (RA) even for a short time, you know the trademark fatigue that comes with it. It’s the kind of mental and physical exhaustion that can’t be cured by a good night’s rest, and it’s so prevalent, the RA community has embraced a common hack for keeping exhaustion at bay: It’s called “spoon theory” and it might be just what you need to get through the next 24 hours (and beyond).
RA and Fatigue: What You Should Know
RA fatigue is caused by biological, even genetic, factors. It is so much a part of the condition that up to 80 percent of people with RA feel it, with 50 percent having high levels of fatigue. When inflammation increases, it can trigger sickness behavior — the need to rest and withdraw. Just like animals hide to lick their wounds when they are hurt or ill, our bodies heal better when we rest.
One of your first tools to combat fatigue is to talk to your rheumatologist about how best to treat your RA to reduce inflammation. Steven Eyanson M.D., a rheumatologist from Cedar Rapids, Iowa, says effective RA treatment reduces inflammation, which in turn tends to reduce fatigue. In fact, many people find that increased energy is one of the first signs that their medication is working. Unfortunately, even if you’re in remission, you may still find yourself dealing with fatigue. Dr. Eyanson says that’s probably because when you’re living with chronic pain, you may also live with the effects of physical inactivity, sleep problems, and depression.
But life doesn’t stop with an RA diagnosis. There is a way forward.
How Spoon Theory Can Save Your Energy
The “spoon theory” was invented by Christine Miserandino of Long Island, New York, when a friend asked her what it was like to live with lupus, another type of autoimmune arthritis. She asked her friend to imagine a set of spoons; each one represents a certain amount of energy. As you do different activities throughout the day, your spoons begin to disappear one by one. Ideally, they’re replenished while you sleep, but depending on how low you run and how active your RA is, getting back up to full-spoon could take a couple of days or more. This visual has become so popular that now many people in the chronic illness community identify themselves as “spoonies.”
How many spoons you have—and how many it takes to do any specific task—varies from person to person depending on the state of the chronic illness, and you may even find that your reserves differ from day to day. People with RA generally would say they have fewer spoons than the average healthy person and each spoon holds less.
How to Put Spoon Theory to Work
Here’s how a typical day of managing spoons might look, but everybody is different, so use this as a baseline and adapt it however it makes sense for you.
Daily Total: 12 Spoons
Typical Morning Rush = Minus 3 Spoons
The typical morning frenzy of getting yourself, your home, your pets, and your family members ready for the day can bring on a total depletion of your spoons if you’re not careful. You’re probably familiar with the consequences of overdoing it. It usually results in being flat out in a flare on the couch for days. One of the keys to managing your spoon reserves is to spread out tasks, or to break them down into smaller parts.
Plan and Delegate! = Save 2 Spoons
For goodness sake, you don’t have to do everything yourself! Breakfasts and even to-go lunches can be made the day before or via a family meal-prep session on Sunday afternoon, taking strain off your weekday mornings. If you have a bit of wiggle room before dashing out the door for the day, ask everyone to do one quick chore—loading cereal bowls in the dishwasher, wiping the kitchen counter, or sweeping the floor—before you leave. Future you, coming home exhausted at the end of the day, will thank you.
Typical Workday = Minus 7 Spoons
Managing your energy takes mental flexibility at home and at work. Just because you’ve always done your job a certain way, doesn’t mean that it will work now that you have RA. Talk to your employer about accommodations to make the physical process of working easier on your body. A more comfortable you = a more productive you. This can include allowing for flextime, working from home, or setting up an ergonomic workstation.
Schedule in Mini Breaks if You Can = Save 2 Spoons
Pay attention to when fatigue hits. If your workplace has a sick room, you may be able to arrange having a quick nap during your lunch hour. If that’s not possible, try to just sit for a few minutes. Find a quiet corner or a bench outside—five minutes of downtime can do wonders. Don’t forget to also listen to what your body needs. Something as basic as keeping hydrated by drinking water throughout the day can improve your energy.
Typical Evening Routine = Minus 3 Spoons
If you’re returning from work to the chaos of helping your kids with their homework, getting them dinner, bathed, and in bed, there’s no way around it. You’re going to be using spoons. But you can reduce the pressure by getting dinner ready together, splitting tasks with your spouse, and perhaps having a PJ pizza party on the couch. You might be tired, but if you immerse yourself in the love and laughter that surrounds you, some of those spoons might magically return
Spend Time With People Who Lift You Up = Save 1 Spoon
An after-work activity that seems like a spoon-spiller when it comes to physical stamina— happy hour with a friend who always makes you laugh, for example—may end up giving you emotional energy, and that can be a significant boost for your well-being. Be sure to build in some time to rest either before or after the outing to ward off a potential flare from staying out too late or overdoing it.
Don’t have the energy to go out after work? Ask a friend to pick up some take-out and come over to binge your favorite show. But resist the temptation to frantically round up clutter beforehand. Good friends won’t mind the mess, and your joints will thank you in the morning.
Repeat after me: Go to bed! = Restore All 12 Spoons
Sleep is the ultimate healer. It’s a time when your body and mind relax and shed the day’s worries and strain. But it’s more than that. Research shows that during sleep, your brain is engaged in activities relevant to your quality of life, such as processing what happened during day. Getting good sleep on a regular basis is an important part of being able to adapt, and helps protect your immune system.
Unfortunately, people with RA often have trouble sleeping. You’re more likely to experience inflammation during the night and the day’s activities can cause pain, which leads to more sleeplessness. Treating your RA will help, but you may also need to talk to your doctor about a pain-management program that can help you get back to bed.
Whichever way you cut it, living with RA means becoming intimately acquainted with feeling exhausted. Learning to pace yourself and manage your energy, keeping track of what goes out and what comes in, can help you stay ahead of the kind of drain on your reserves that will make you crash. Using the imagery of spoons can be useful not just to explain RA fatigue and how it affects your life to others, but doing a little spoon math can also help you maintain your highest energy level possible.