Hypermobility and Fatigue

Why am I so tired?

10 Ways Hypermobility and Chronic Fatigue Can Be Linked and What You Can Do About It

We’ve recently been discussing hypermobility, also known as being double jointed, and its effects on the body. I often see patients who have chronic fatigue and are also hypermobile. There is indeed a link between fatigue and hypermobility. It’s not just all in your head.
 
What is the difference between fatigue and just being tired? Many people deal with fatigue, which is actually much different than simply being tired. Tiredness is usually related to exertion from exercise or not having a good night’s sleep. After a day or two of rest, we usually recover from tiredness. Fatigue lingers.
 
If you’re hypermobile and have experienced fatigue, know that you’re not alone. Today I’ll walk through 10 reasons why hypermobility can increase your risk for fatigue and what you can do about it.

1. Ligament laxity

The definition of hypermobility is that the joints are a bit loose to some degree. As a result, when you’re sitting in a chair, for example, you don’t rely on your ligaments and tendons to keep your body in position because they’re loose, so you have to contract your muscles. This means that your muscles need to chronically contract to keep your joints in place. This excessive load places an increased energy demand on your system. Certain exercises like pilates and other muscle-strengthening exercises can be helpful in strengthening the muscles to support the joints. It’s also important to take regular breaks throughout the day.
 

2. Orthostatic intolerance (POTS)

Postural orthostatic tachycardia syndrome (POTS) is very common in people with hypermobility spectrum disorder. People with POTS experience a racing heart when they stand from a sitting or lying position. Their blood doesn’t shift well, so their heart has to race in order to keep up the pressure. Sometimes people’s pulse will increase 30 or more beats per minute just upon standing. As a result, there is lower blood flow to the brain and body, causing a low-grade level of fatigue. Exertion makes the fatigue worse. The basic four tenets to treat POTS are adequate fluids, electrolytes, compression, and exercises to help build muscle.
 

3. Mast cell activation syndrome (MCAS)

This condition can cause a low-grade, flu-like feeling, including aches, fatigue, and the feeling of feverishness and warmth without an elevated temperature. I’ve written more about MCAS in this post on the innate immune system.

4. Sleep apnea

I frequently see sleep apnea in my hypermobile patients. People with hypermobility have laxity of the soft tissue throughout the body, including in their throat and/or trachea, which can cause them to collapse easily during sleep. People with hypermobility also tend to have narrower airways which can cause mild sleep apnea. I typically refer to this as “skinny people sleep apnea” because almost all of these patients are not overweight. They look healthy. They don’t look like they could possibly have sleep apnea, but they do. So if you have hypermobility, you should consider getting checked for sleep apnea.
 

5. Low energy production

This is also referred to as mitochondrial dysfunction. Dysfunctional energy production tends to be more common in the hypermobile community for several potential reasons. It is probably related to other underlying issues such as autoimmune issues and nutrient deficiencies. Hypermobile people have a greater need for certain nutrients such as collagen, trace minerals, and vitamin C. Blood testing is typically normal in these cases because the deficiency is considered “mild”. However, supplementation with B vitamins, folic acid, carnitine, creatine, or niacin can be helpful in supporting the mitochondria in energy production.
 

6. Inadequate restorative sleep

While sleep apnea can cause sleep deprivation, there are other reasons that a hypermobile person might not be getting the quality sleep that they need. Because of the underlying stressors in the body that we’ve mentioned above, cortisol is often elevated. In these cases, the body can’t quite get out of fight-or-flight mode and into a rested state to sleep and repair. Magnesium supplementation, meditation, and prayer before going to bed at night can be very helpful here. Managing light exposure is also important for restful sleep. Getting at least 10 minutes of natural light in the eyes in the morning and avoiding blue light two hours before going to sleep can help reset the circadian rhythms for better sleep patterns. Phosphatidylserine, Relora, ashwagandha, and magnesium salt baths, just to name a few, are some things that can lower your sympathetic tone, so you can get a good night’s rest. Check out our podcast on stress management for more ideas!

7. High or low intracranial pressure

Intracranial pressure is simply the pressure inside the head. This is common in people with hypermobility due to instability in the joint between their skull and spine. This is referred to as atlantoaxial instability. Cervical instability, which is excessive movement in the first and second vertebrae of the neck, can also cause issues with pressure inside the head. The ducts in that part of your brain that allow cerebral spinal fluid to flow are compressed and the pressures can become relatively elevated inside your head. Also with hypermobility, sometimes small micro tears form in the lining of your lower spine. This can result in small leaks and low back pain – seen commonly after epidurals – which can result in low intracranial pressure. Both of these affect the function of the brain, blood flow to the brain, and hormonal function which can all result in low-grade fatigue.
 

8. Hormonal dysfunction

Hormonal dysregulation is very common in hypermobility. This can be for many reasons including underlying inflammation, nutrient deficiencies, and increased intracranial pressure. These can all affect your pituitary which is the center of hormone regulation. Many people refer to this as the HPGA (hypothalamus pituitary gonadal) axis.

9. Autoimmune dysfunction

Autoimmune issues are a common characteristic of hypermobility. Basic lab testing for auto antibodies are used to diagnose these. Underlying inflammation related to the immune system commonly causes fatigue. For more information on this topic, check out these blog posts on autoimmune issues.
 

10. Anemia

I mention anemia in this context specifically because it’s a bit unique for hypermobile people. I often see “normal” hemoglobin levels (12-15), but with low ferritin (less than 60). Although the hemoglobin is normal, they have low active iron in their body. Iron is important for liver function, brain function, detoxification, and transporting oxygen to the cells. These patients can have low-grade fatigue that can simply be addressed by iron supplementation. I tend to use liver powders or extracts for this because they do not cause constipation and GI distress, as many iron supplements do.
 

Bonus:

While not directly related to hypermobility, some medications can also cause fatigue. Certain blood pressure medications can cause magnesium and potassium deficiencies, which can lead to fatigue. Beta blockers and other medications like Benadryl used for allergies can cause low-grade fatigue as well. If you’re on any medications and are experiencing fatigue, you should review these with your provider to see if any of them may be contributing.
 

Conclusion

As you can see, hypermobility and fatigue can be closely related for many reasons, and there are interventions that can alleviate this fatigue. Seeing a skilled practitioner or getting educated about this can be super helpful.
 
For more information on this topic, check out a book that I read recently on this topic. Disjointed: Navigating the Diagnosis and Management of Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders by Diana Jovin. This book is a deep dive on many issues related to hypermobility and is a great read!
 
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