Fibromyalgia is a chronic condition that’s commonly characterized by chronic widespread pain. Fatigue can also be a major complaint.

According to the National Fibromyalgia Association, fibromyalgia affects between 3 and 6 percent of people worldwide. Roughly 76 percent of people with fibromyalgia experience fatigue that doesn’t go away even after sleep or rest.

The fatigue caused by fibromyalgia is different from regular tiredness. The fatigue may be described as:

  • physical exhaustion
  • unrefreshed sleep
  • lack of energy or motivation
  • depressed mood
  • difficulty thinking or concentrating

Fibromyalgia fatigue often has a major impact on a person’s ability to work, meet family needs, or engage in social activities.

Doctors and scientists are still working on understanding the connection between fibromyalgia and fatigue. Disrupted sleep likely plays a role in causing the fatigue and pain associated with fibro, but more research is needed to find out why.

Read on to learn more about the connection between fatigue and fibromyalgia, and what you can do to manage this symptom.

Though the cause of fibromyalgia isn’t fully understood, the condition is believed to be the result of the brain and nervous system misinterpreting or overreacting to normal pain signals.

The exact cause of fibromyalgia is unclear, but it may be related to injury, emotional distress, or viruses that change the way the brain perceives pain.

That could explain why it causes widespread pain in the muscles, joints, and bones, along with areas of tenderness.

One theory for why fibromyalgia also causes fatigue is that the fatigue is the result of your body trying to deal with the pain. This constant reaction to pain signals in your nerves can make you lethargic and exhausted.

People with fibromyalgia frequently also have trouble sleeping (insomnia). You may have problems falling or staying asleep, or you may still feel exhausted after waking up.

The fatigue may be made worse by complications of fibromyalgia.

These are called secondary causes and may include:

It’s possible to manage fibro fatigue with medications and lifestyle changes, though it may be difficult to make the tiredness completely go away.

Here are some strategies that may help you reduce your fatigue:

1. Identify your triggers

Learning the triggers for fibro fatigue might help you combat it.

Fatigue can sometimes be influenced (made worse or better) by:

  • diet
  • environment
  • mood
  • stress levels
  • sleeping patterns

Start keeping a written or electronic record of your fatigue level each day. Record what you ate, when you woke up, and when you went to bed, along with any activities you did that day.

After a couple of weeks, see if you can identify any patterns. For example, maybe you feel the most fatigue after eating a sugary snack or when you skip your morning workout.

You can then use that information to avoid or limit the things that tend to make you more tired.

2. Exercise regularly

Finding the motivation to exercise can be hard when you’re tired or in pain, but exercise is one of the most effective ways to manage fatigue. Exercise may also help reduce fibromyalgia pain if done properly.

Exercising helps increase your muscle mass and strength, as well as your overall health. As an added bonus, the endorphin release you experience during exercise can also improve your quality of sleep and increase your energy.

One older study from 2008 compared the effects of aerobic training to a muscle-strengthening program in people with fibromyalgia. The study found that both types of exercise significantly reduced symptoms of pain, sleep, fatigue, tender points, and depression.

If you’re unsure of where to begin, try starting with just 5 minutes of walking per day and then slowly increase the pace and duration over time. Discuss any changes in your exercise regimen with your doctor.

Strength training using resistance bands or weights can help you regain muscle. Be sure to pace yourself — start with low resistance or very low weights and build up slowly from there.

3. Change your diet

No specific diet has been shown to reduce the symptoms of fibromyalgia for everyone, but it’s always a good idea to aim for a healthy, balanced diet.

To follow a balanced diet, look for ways to include fruits, vegetables, whole grains, healthy fats, and lean protein in your daily meals. Avoid processed, fried, salty, and sugary foods, and try to maintain a healthy weight.

There’s also evidence that the following foods may increase symptoms in people with fibromyalgia:

Try avoiding (or limiting) these foods or food groups and see if your fatigue improves.

4. Create a relaxing bedtime routine

Fibro fatigue isn’t necessarily something that can be fixed with a good night’s sleep, but quality sleep can help over time.

A relaxing bedtime routine is an important first step toward getting a good night’s rest.

Here are a few tips for a healthy sleep routine:

  • go to bed and get up at the same time every day
  • avoid alcohol, nicotine, and caffeine
  • invest in a good quality mattress
  • keep your bedroom cool and dark
  • turn off screens (computer, cell phone, and TV) at least an hour before bedtime
  • keep electronics out of the bedroom
  • avoid having a large meal before bedtime
  • take a warm bath before bed

5. Treat other conditions

People with fibromyalgia often have other health conditions (co-morbid conditions), like restless leg syndrome (RLS), insomnia, depression, or anxiety. These conditions could make fibro fatigue worse.

Depending on your health history and other underlying conditions, your doctor may recommend:

  • sleeping pills to help manage insomnia, such as zolpidem (Ambien, Intermezzo)
  • multivitamins to treat nutritional deficiencies if you’re malnourished
  • antidepressants like milnacipran (Savella) or duloxetine (Cymbalta)
  • iron supplements to treat anemia

6. Reduce stress

Living in constant pain can cause stress. Stress, in turn, can make your fatigue worse.

Yoga, qi gong, tai chi, meditation, and other mind-body activities can be excellent ways to reduce stress.

In fact, one 2017 study of 53 women with fibromyalgia found that an 8-week yoga program significantly improved symptoms such as pain, fatigue, and mood, as well as coping strategies for pain. Participants practiced yoga 5 to 7 days a week, for 20 to 40 minutes per day.

Additionally, a 2013 systematic review of seven studies was done to evaluate the effects of meditative movement therapies, such as qi gong, tai chi, and yoga. Of these, only yoga was found to be significantly effective in reducing pain, fatigue, and depression in people with fibromyalgia.

Though the evidence is still limited, these activities may also lead to an increase in quality of life.

If you’re unable to manage stress using home remedies, try speaking to a counselor or mental health specialist.

7. Consider alternative therapies

There’s not a lot of evidence regarding complementary and alternative medicines (CAMs) for fibro fatigue.

Massage therapy has been shown to provide some benefits. Results from one 2009 study of 50 women with fibromyalgia suggested that a specific type of massage, known as manual lymph drainage therapy (MLDT), may be more effective than connective tissue massage for reducing morning tiredness and anxiety.

More research is needed, however.

If you’re interested in trying MLDT, search for massage therapists in your area who are experienced in this type of massage therapy for fibromyalgia. You can also try some lymphatic drainage massage techniques yourself at home using this guide.

Balneotherapy, or bathing in mineral-rich waters, has also been shown to help people with fibromyalgia in at least one older study. Participants in the study who spent 10 days at a Dead Sea spa had a reduction in:

  • pain
  • fatigue
  • stiffness
  • anxiety
  • headaches
  • sleep problems

Acupuncture is also often touted as a way to reduce pain, stiffness, and stress. However, a review of several studies in 2010 found no evidence for reduction of pain, fatigue, and sleep disturbances in people with fibromyalgia receiving acupuncture treatment.

8. Nutritional supplements

There isn’t much research to show whether supplements work well for treating the symptoms of fibromyalgia. Of the clinical research performed, most studies are small, involving few participants.

While many natural supplements haven’t been shown to offer any help, a few supplements have shown promising results:

Melatonin

A small, older pilot study with just 21 participants showed that 3 milligrams (mg) of melatonin taken at bedtime significantly improved sleep and pain severity in people with fibromyalgia after 4 weeks.

Co-enzyme Q10 (CoQ10)

A double-blind, placebo-controlled clinical trial found that taking 300 mg a day of CoQ10 significantly reduced pain, fatigue, morning tiredness, and tender points in 20 people with fibromyalgia after 40 days.

Acetyl L-carnitine (LAC)

In a study from 2007, 102 people with fibromyalgia who took acetyl L-carnitine (LAC) experienced significant improvements in tender points, pain scores, depression symptoms, and musculoskeletal pain.

In the study, participants took two 500 mg LAC capsules a day, plus one intramuscular injection of 500 mg LAC for 2 weeks, followed by three 500 mg capsules per day for 8 weeks.

Magnesium citrate

Researchers who conducted a 2013 study observed that 300 mg a day of magnesium citrate significantly reduced the intensity of fibromyalgia and the number of tender points in premenopausal women after eight weeks.

The study was relatively small, and included 60 participants.

While magnesium citrate was shown to offer relief, participants who also received 10 mg a day of the antidepressant medication amitriptyline saw increased reduction of symptoms, too.

If you want to try one of these therapies, be sure to discuss it with your doctor to be certain it is safe to do so.

9. Schedule in your rest time

A good way to manage fatigue caused by fibromyalgia is to schedule rest into your day. Sitting or briefly lying down at some point could be what you need.

Try to plan your most rigorous tasks for times when you think you’ll have the most energy. Similarly, take time to pace yourself and find balance within your day.

The National Fibromyalgia Association offers a helpful guide to pacing, including:

  • setting a schedule
  • splitting activities into smaller tasks (using a stopwatch might help)
  • changing positions regularly
  • stretching regularly
  • prioritizing and adjusting priorities as needed
  • delegating tasks to others if you can
  • learning to say no when necessary

If lifestyle changes to reduce stress and get better sleep don’t seem to be working, a healthcare professional may be able to prescribe medication to help.

Keep in mind that medications like sleeping pills carry risks, including addiction, so you should only use them as directed by your doctor.

Your doctor may also want to run additional tests to make sure that your fatigue symptoms aren’t caused by something else, like iron deficiency anemia or an underactive thyroid.

Although it’s an invisible symptom, fibro fatigue is very real. It can be difficult to manage, and also difficult to explain to other people.

If you’ve already made lifestyle changes — like modifying your diet and reducing stress — and fatigue is still affecting your daily life, talk with your doctor.