Fibromyalgia can cause chronic fatigue and pain throughout the body, from headaches and jaw pain to stomachaches and tingling in the hands and feet.
The cognitive symptoms of fibromyalgia, often referred to as “fibro fog,” can be just as disruptive as the physical manifestations of the condition.
“Fibro fog refers to common cognitive symptoms that impair day-to-day functioning in individuals with fibromyalgia, including forgetfulness, lapses in concentration, word-finding difficulties, altered thinking, and mental slowing,” says Devika Das, MD, an internal medicine doctor and clinical assistant professor of medicine at Stanford University School of Medicine in Palo Alto, California.
Fibro fog can have a significant impact on work, relationships, and overall well-being. You may find yourself feeling mentally drained long before your day winds down, forgetting appointments or scheduled plans, or losing your train of thought midsentence. Though fibro fog can be draining (and, frankly, aggravating) there are things you can avoid or start to do to manage it.
Common daily practices, some of which you may not even realize you’re doing, can worsen cognitive symptoms. Avoid these habits to keep fibro fog in check:
You Do Too Much or Too Many Things at Once
Even without fibromyalgia, multitasking can lead to increased
stress and making more mistakes.
Add fibromyalgia into the mix — which may reduce mental flexibility — and multitasking becomes even more strenuous.
“Multitasking, overexertion, and activities requiring divided attention or prolonged cognitive effort can contribute to fibro fog,” says Dr. Das. Your best bet: Tackle tasks one at a time and take breaks (often known as pacing — more on that later) as needed.
You Get Poor Quality Sleep
“Sleep plays a key role in memory formation, information processing, and mood regulation,” says Das. “Lack of sleep may also activate inflammatory and stress pathways.”
Even if you think you’re getting adequate z’s, the physical symptoms of fibromyalgia could be keeping you up. “Pain during the night causes micro awakenings — brief interruptions in sleep — that interfere with your ability to progress into (and maintain) deep sleep, which is when most of the brain’s restorative processes occur,” says Ira Chang, MD, a neurologist at HCA HealthONE in Englewood, Colorado.
Talk with your doctor about how to shore up your
sleep. If you have trouble falling asleep or frequently wake through the night, they may suggest getting tested for a sleep disorder (common in fibromyalgia) or interventions, such as
cognitive behavioral therapy (CBT) or medication.
You Stress Out
It’s a good goal to limit stress wherever possible, because it can trigger fibromyalgia symptoms, including brain fog. “Oftentimes, fibro fog is driven by a combination of things — poor sleep, stress, pain, medications, and additional causes — because they are so closely tied together,” says Das.
Although you probably can’t remove all stressors from your life, you can turn to strategies such as
breathing exercises,
massage,
meditation, and
yoga to help keep stress at bay. “Stress-reduction techniques can help calm the brain, reduce cognitive load, and preserve mental clarity,” says Dr. Chang. Yoga in particular was shown to improve many fibromyalgia symptoms in one systematic research review.
Try integrating some of these practices into your routine to feel more clearheaded and focused:
Exercise Regularly
Staying active can preserve neural pathways in the brain and improve cognition in people with fibromyalgia. “While the mechanisms behind this have not been fully defined, some studies have shown that these activities increase the brain volume in the frontal cortex and improve brain electrocortical activity,” says Das.
Start slowly by adding aerobic activities (such as
walking or cycling) and strength training to your routine several days a week.
Improve Your Sleep Hygiene
Chang recommends “prioritizing restorative sleep and addressing pain at night.” To do so, avoid caffeine late in the day, try white noise to fall asleep, and leave yourself at least seven to eight hours to sleep regularly. If you still feel foggy or fatigued, chat with your doctor about possible sleep meds or supplements.
Practice Pacing
Pacing is a technique that helps you balance activity and rest in daily life to better manage fibro symptoms. “Break tasks into smaller chunks, and take breaks before becoming exhausted or overwhelmed,” says Chang. You can write breaks into your schedule or set a timer on your phone as a reminder. Scheduling more demanding tasks earlier in the day can also help, she adds.
Try Cognitive Behavioral Therapy
This type of talk therapy “has been shown to be very effective in improving functioning in individuals with fibromyalgia, possibly through its impact on different networks in the brain,” says Das. CBT also helps by reducing pain-related catastrophizing, which harms cognitive and emotional processes.
Ask your rheumatologist for a referral to a mental health professional in your network who specializes in CBT.
Fibromyalgia fog can be challenging, but there are a things you can do to feel empowered and improve your overall focus and mental clarity. As you test new techniques to reduce brain fog, try not to be too hard on yourself. “Practicing self-compassion and realistic expectations by allowing for breaks, setting boundaries, and giving yourself grace on tough days can reduce stress for mental performance,” says Chang.
