Lots of people living with axial SpA (AS) find mornings particularly difficult, due to pain, fatigue and joint stiffness. This blog will explain what can cause these symptoms and how you can help manage them, to make mornings easier.
Why mornings with axial SpA (AS) can be difficult
Axial SpA (AS) is an inflammatory condition and the nature of inflammation means that periods of inactivity can feel worse. When keeping still for long periods of time, such as overnight, inflammation can cause increased pain and stiffness.
If you’re sleeping poorly because pain is waking you, this will cause fatigue and also make pain during the day more difficult to manage. Fatigue isn’t just feeling tired, it’s an overwhelming feeling of exhaustion. If you’re waking not feeling refreshed, it can be helpful to look at how to manage night pain to sleep better or how to manage fatigue generally.
When to speak to your doctor
If you’re experiencing a lot of pain and joint stiffness in the morning or your axial SpA (AS) generally feels poorly controlled, speak to your doctor about ways you can help manage your condition. It’s also important to speak to your doctor if you notice a sudden increase in your pain, particularly if it’s waking you at night.
Allow plenty of time
The best advice to make mornings easier, is to allow plenty of time in the mornings. Allow time for you to loosen up by doing some gentle exercises. It can be helpful to do these in bed before sitting up or after a warm shower when your muscles are warm and relaxed. Allowing more time can also help if you take painkillers or anti-inflammatories in the morning. Giving your medication time to take effect before starting your day can cause a noticeable improvement.
It’s really nice to take time over a warm drink and your breakfast in the morning. This can allow you to loosen up, have some relaxation time and mentally prepare for the day ahead.
Use heat
Heat can be incredibly helpful to ease pain and relax muscles. As mentioned earlier, you can also use heat to make exercises more beneficial. You can apply heat in a number of different ways:
- Electric blanket in bed (this is particularly helpful to use during lying exercises)
- A topical heat pad
- Heat rub/cream
- Hot shower/bath
- Hot water bottle wrapped in a towel
Morning exercises
Exercise and movement can help reduce joint stiffness, improve your mobility and ease pain. It’s natural that the movements you do in the morning may be slower and smaller than the movements you do during the day, so take your time with them and really listen to your body. This routine of lying exercises can be perfect in the mornings or some gentle exercises sat on the edge of the bed.
Walking in the morning is a perfect all round exercise, so if you have time to get out even for 10-minutes, try making a routine of it for around a week to see how it feels. It can also be a great way to start the day and prepare your mind.
Pain relief
There are lots of different painkillers and anti-inflammatories available, so speak to your doctor or pharmacist about your options. Discuss when you can take them, because some medications taken in the evening can reduce the symptoms you experience through the night and in the morning.
Preparation is key
Spending some time the day before to prepare for the next day can help make mornings easier, especially if you have an early start or a busy day planned. Have your morning medication and a drink beside the bed. Setting out your clothes and preparing your bag the day before saves any decision making while you’re still waking and loosening up.
If you can prepare a healthy breakfast ahead of time, this can make the morning easier and also give you energy to start the day. If you need to take lunch with you, preparing this the night before also removes something from the morning “to do list”. If you experience shoulder or upper back pain/stiffness in the mornings, fill the kettle the night before with the right amount of water so you don’t have to lift a heavy kettle while you’re still loosening up.
Improving your sleep
Good quality sleep is really essential, but lots of people with axial SpA (AS) find this difficult. You can read more about improving your sleep and reducing night pain in our previous blog post. (Link to night pain blog post) Some key things to consider are:
- Regular check ups with your doctor to ensure your axial SpA (AS) is well managed
- Discussing your medication with your doctor or pharmacist
- Managing stress
- Making your sleeping environment suitable by dimming lights, keeping it cool, using blackout blinds/curtains and removing any screens e.g. TV, games
- Keeping the same sleep/wake cycle (going to bed at the same time each night, getting up at the same time each day)
- Spending time outside or near a window with natural sunlight during the day
- Avoiding high energy exercise before bed, instead do gentle stretches or breathing exercises (do the higher energy exercise earlier in the day)
Managing fatigue
Fatigue is a common symptom of axial SpA (AS) and can have a huge impact on your life. It’s important to ensure your condition is as controlled as possible, but if you still experience fatigue it can be helpful to:
- Keep an activity diary to help pace your activities
- Prioritise tasks and breaker larger tasks into smaller chunks
- Schedule in rest breaks
- Ask your doctor or physiotherapist about an exercise plan to gradually increase your fitness and stamina without aggravating your fatigue
- Eat a well-balanced diet, plan your meals and speak to a nutritionist for help if needed
- Ask for help from friends/family and your medical team
You can read more about managing fatigue in our previous blog post. You can also download our Guide to Fatigue here.
Mental health
It’s really important to actively look after your mental health, particularly when living with a long-term condition. Some people find mornings more difficult because of increased pain/stiffness, so it’s really important to allow plenty of time in the morning. When using his time for stretches to loosen up, you can also reflect on the day ahead and prepare emotionally.
To help with pacing, you can look at the day’s schedule/tasks and then prioritise what is most important. This will allow you to focus on one thing at time and also manage your energy well.
Some simple activities you can do in the morning include:
- A cuppa’ with loved ones
- Journalling or reflecting (you can use prompts such as “what am I most looking forward to today?” and “who needs me at my best today?”)
- Using a ‘joy jar’
- Listening to music
- Relaxation or mindfulness techniques
- Planning your schedule for the day
- Taking time to note down three things you’re grateful for today (you can also do this in the evening)
A ‘joy jar’ is a jar where you can place notes of all the activities and things you’re looking forward to doing, even if they are far off in the distance, as you think of them. You then do each activity when you’re able to and gradually empty the jar (although you can keep adding ideas as you think of them, so you always have things to look forward to).
The important thing is to experiment to find what works best for you to get your morning off to the right start.
Managing axial SpA (AS) well
Some keys ways you can manage your condition to make mornings a little easier include:
- Exercising regularly
- Stretching in the mornings
- Including some strengthening exercises in your daily routine to improve your muscle strength and general stamina
- Regular check ups with your doctor or physiotherapist
- Taking your medication correctly and at the right times/doses
Summary
- Mornings can be difficult due to pain, stiffness, fatigue and mentally preparing for the day ahead
- Some preparation the day before and altering routines can make mornings a lot easier
- Speaking to your health team can ensure you’re managing your condition as well as possible (including medication, exercise routine and mental health)
- There is lots you can do to improve your sleep and help manage fatigue
Zoë Clark is an osteopath living with axial SpA herself and has joined the NASS Helpline team to help with the unprecedented demand over COVID-19. You may have seen her blog posts previously written for NASS and she spoke at the latest parliamentary meeting in January and appeared on Channel 5 News. She’s joining the NASS team to help you keep active and feeling well during this difficult time of isolation.
Zoë is available on the Helpline each day, so if you’d like to have a chat then please get in touch and we can arrange a call. She’ll also be sharing some of her top tips and answering any common questions, so please let us know in the comments if there’s any particular advice you’d like.
The Helpline is open 1000-1600 Monday to Friday on 020 8741 1515 or you can email zoe@nass.co.uk
