Drinking coffee as part of the a.m. routine with rheumatoid arthritis
Credit: Eileen Davidson

Everyone wants to wake up feeling refreshed, revved, and ready to start the day. But mornings with rheumatoid arthritis (RA) or other chronic illnesses are often anything but. Waking up with rheumatoid arthritis can feel as though you went binge drinking or ran a marathon the night before.

Some days are harder than others. But even on good days, it can take a bit of effort to wake up and feel your sharpest when you have rheumatoid arthritis. Thankfully, after years of living with this disease, I’ve developed a few habits and tricks that help me have a smoother morning and get out the door on time.

What Arthritis Feels Like in the Morning

I’ve always been an early riser. No matter how hard I try to sleep in, I just can’t. Once I wake up, I have to get up, even if I’m unable to fully function for a while. When I was in high school I was always up by 6:30 a.m., and that wake-up time has stayed with me even after school and when I worked later shifts.

There was a point though, around age 24, that I realized that it wasn’t my internal clock waking me up — it was pain or a feeling of discomfort enveloping my body.

I would wake up feeling sore, stiff, foggy, and heavy. I just couldn’t bring myself to get ready on time. It felt like invisible cement was being poured all over my body, forcing me to lie in bed or move around very lethargically. Over time, mornings got more and more difficult until I finally received my rheumatoid arthritis diagnosis at age 29. That’s when my sleep problems started to make sense to me.

When I asked my rheumatologist why mornings suck so much with this disease, she explained that a lot has to do with the underlying inflammation from RA.

Morning stiffness is one of the telltale symptoms of inflammatory arthritis like RA. Rheumatoid arthritis happens when your overactive immune system causes inflammation in the synovial lining that surrounds the joints. After you’ve been lying down while asleep overnight, those inflammatory chemicals pool in the joint lining, which can cause swollen, achy, and stiff joints, often lasting for a couple of hours after you wake up.

And as if my RA weren’t enough, a year after my diagnosis, I learned that I had osteoarthritis (OA) too. The “wear-and-tear” form of arthritis, OA typically affects joints as cartilage wears down over time so it’s much more common with age. It’s not that common for a 30-year-old to have OA, which makes me even more stiff and achy in the morning. OA affects my feet and ankles, neck and lower back, and hands and wrists. I have one bad pinky that throbs most mornings and after rest from osteoarthritis.

The Added Impact of Anxiety and Depression

I also have anxiety and depression, which makes life extra bumpy in the early hours (and throughout the rest of the day).

Anxiety is a big reason I have trouble sleeping at night or getting back to sleep when I wake up in the middle of the night. My head likes to spin while I am trying to rest. Anxiety makes me nervous about the day because if I have a lot to do. I get overwhelmed and worry about how my arthritis will get in the way. Anxiety is very connected to my brain fog — I worry that I might be forgetting something important like an appointment or promise I made.

Depression can leave me in a slump where it takes longer to get going in the morning, especially on top of arthritis symptoms that are already slowing me down. It can make me skip things I need to do for my health or everyday life, like self-care, prepare breakfast, or make it to appointments or social gatherings. It can make the simplest of activities — things we take for granted during a morning routine — feel like a chore.

Arthritis Triggers Make Rough Mornings Even Rougher

Even though people talk about morning stiffness with arthritis, on really bad days the pain, stiffness, fatigue, and heavy sensation never really goes away. The day becomes a write-off.

Those days are usually predictable because of other triggers, like if I over-exerted myself the day before, if there is a weather change (heavy rain or snow), or if I’ve gone through a stressful emotional experience. Stress is a major culprit for all my disease activity.

The week before my monthly biologic infusion — when my inflammation levels are creeping back up — is when my mornings become the most difficult. It takes me longer to get going and I can handle doing less.

But bad days can come without any warning, too.

How I Make Mornings Easier with My Arthritis

I know that my mornings will never look like those in a happy-go-lucky coffee commercial, where once you’ve brewed, sipped, and caffeinated enough, all is right with the world. But I have found that approaching my mornings in certain ways can make them easier, and I’ve learned to adjust my routine accordingly.

Of course, the first step to an easier morning is trying to get the best night’s sleep you can. Read more about how I tackle painsomnia with rheumatoid arthritis.

Here’s what else I’ve learned for a less pain- and fatigue-filled morning.

I take advantage of my natural wake time.

I live on the West Coast of Canada, but my arthritis makes me an early riser, so I find myself on more of an East Coast schedule.

I use this early alone time in the morning to slowly start the day. It can take me a few hours to muster the energy or ability to function enough to leave the house. During this quiet time when I am awake before my son, I sit with my coffee and I write these CreakyJoints essays. The important fact here is that I found a routine that works with my disease, not against it.

I exercise in the a.m.

One of the best ways to ease morning stiffness is to follow my favorite “motion is lotion” adage. Regular exercise helps reduce inflammation and acts as lubricant for stiff joints. This doesn’t mean you have to hit the elliptical the minute you pop out of bed; you could try a simple yoga or stretching routine, take a light walk around the block, or spend some time maintaining your garden. The key is to do something active. The sooner you get moving, the more it helps reduce that morning heaviness.

I try to make it to the gym, go for a hike, or do whatever exercise I’m planning that day as early as possible. This will make me feel better throughout the day. Plus, my joints aren’t as irritated from other activities and I have more energy to power through a workout then.

I catch fresh air and let the light in.

When I asked a psychiatrist how I could make mornings a bit easier because I really struggle to get going, he suggested I try to get outside soon after waking up, even just for a few moments. When I put his recommendation to the test, I found that it does indeed help clear some of my morning brain fogginess.

This is most effective if the sun is shining and you do some movement while outdoors, but any time outside is better than none. On rainy days, I have a coffee on my covered patio to soak up the fresh air and let it recharge me. I try getting out within the first hour of waking because the longer I wait to do this, the greater the chances my fatigue increasing for the day.

I sip coffee.

Speaking of coffee, I am a firm believer in the power of the bean. Seriously, it’s a magical thing. Caffeine stimulates the nervous system, increasing alertness. (Green and black tea are good options too.) I try not to overdo it, as coffee can be a diuretic, causing dehydration. Plus, it increases my anxiety if I consume too much. Drinking coffee also adds an element of routine to my morning. I get excited to wake up and start my day with it.

I use cannabis to ease pain.

A bit of cannabis in the morning can help me get going and forget that I am in so much pain. The right strain is important, though. Sativa is thought to be more energizing compared to an indica, which could make you feel sleepy, foggy, or lethargic.

I listen to upbeat music.

Every morning I put on my headphones (so no one else wakes up with me) and enjoy my tunes. On the days I need to get going I listen to songs I might also listen to at the gym because it makes me want to dance a little while getting ready. The right playlist can set me up for a better mood. Spotify gives me new music recommendations on Mondays and Fridays, which gives me a huge boost in the mornings.

I savor a hot shower.

Some heat on the joints can soothe inflammation, helping to shake off morning pain and stiffness. Some people swear by electric blankets, but I’m not a huge fan. The best heat I can get in the morning is a hot shower (or bath on the real difficult days). For an extra boost, I’ll incorporate essential oils like peppermint and eucalyptus.

I prepare the night before.

If I have a very busy morning where I must leave the house early, I prepare some of what I need to do the night before. Mornings are unpredictable and often full of cognitive dysfunction that leaves me forgetful. The night before a busy day, I’ll often write out a list of what I need to bring and what I need to do each morning to organize myself.

I keep things simple.

This is especially important if you have kids or family to look after in the morning. When I used to work as an esthetician — before my arthritis made me stop — I would have to look my best every day. (Many of the salons and spas I worked in required us to have full makeup and hair nicely styled.) Now six years into my diagnosis with RA, I can’t be bothered to get dolled up every morning or the same way I used to. It requires far too much energy and can be painful some mornings.

If you’re a parent or caregiver and your kid’s school offers a breakfast and or lunch program, sign up for it. Get your kids to start helping you at a young age and develop a routine to keep on track. They can help pick out their own clothes, make their bed, and keep their backpacks organized.

I reflect on something positive and special.

There is no doubt that lack of sleep or pain can leave us quite grouchy in the mornings. What helps me get out of my funk is reflecting on something positive or special to me. Try taking a moment to meditate or reflect on something positive to you.

I eat a healthy breakfast (with a little bit of spice) and hydrate.

Many mornings are a challenge to get food down. Typically in the morning is when I feel the most malaise, which can put off breakfast for me. This is why I stick with breakfasts that are small and easy to eat, not just easy to prepare.

I’ve also observed that what I eat in the morning can impact how I feel the rest of the day. I used to grab a bagel, eat two slices of toast, or maybe have some cereal. But when I started consulting with a registered dietitian (Cristina Montoya, the Arthritis Dietitian, who has RA herself) and listening to my body, I realized those breakfasts were increasing inflammation and sapping my energy levels.

Instead of a quick and easy carb overload I started to eat a more balanced breakfast. Eating a low-glycemic and high-protein breakfast can increase morning energy levels. This includes:

  • Oatmeal with two eggs and fruit
  • One slice of whole grain toast with hummus, cucumber, and two eggs
  • Greek yogurt, cinnamon, chia seed, and berry parfait I prepare the night before
  • Eggs and spinach or asparagus with feta, turmeric, and garlic
  • Smoothie and two eggs

Sometimes I add garlic, chili peppers (capsaicin), and turmeric to the eggs for extra anti-inflammatory properties.

Finally, I make sure to drink water in the morning. I’ve found that I cannot combat some of my morning grogginess without the help of hydration.

I take my anti-inflammatory medications and supplements.

If you have arthritis and other chronic conditions, you may be taking multiple medications and supplements. I’ve found it helpful to ask my pharmacist and providers about the best time of day to take certain medications or supplements. It sounds obvious, but you want to avoid medications that can cause grogginess and fatigue in the morning. I’ve found that taking my anti-inflammatory pills in the morning helps with pain and fatigue and lets me start my day more easily.

I ask for more time when I need it.

A bad night’s sleep can really impact how I function day to day. If there’s a night where I didn’t sleep well and I have an important meeting where I need to be sharp, I’ll ask to reschedule or I’ll warn everyone that I’ve had sleep issues and feel foggy.

One of the most important lessons I’ve learned is that people don’t know what you’re going through unless you tell them. And once they know, they can be more supportive and understanding.

Finally, I’ve learned to use my mornings as a barometer for how I’m doing with my health overall. If I’m noticing my mornings are becoming more difficult — my arthritis pain and fatigue feel worse or are lasting longer than usual — I let my doctor know. Worsening symptoms could be a red flag that something else is going on and it’s important to work with your doctor to get to the bottom of it.

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