Category: California

1. Sleep Apnea

There are two main types of sleep apnea: Obstructive sleep apnea (OSA) — the most common type — occurs when muscles in the back of the throat collapse too much during sleep, partially or completely blocking the airway. In central sleep apnea (CSA), the brain doesn’t send the necessary message to the muscles that control breathing. Both OSA and CSA interrupt nighttime breathing and contribute to daytime fatigue.

“Both conditions can result in a periodic drop in blood oxygen levels, which increase the adrenaline levels in the body and result in awakening,” says Rami Khayat, MD, a pulmonologist and sleep medicine expert with UCI Health in Orange, California, who works with cardiac patients. “And all these activities are detrimental to heart failure control.”

Get screened for sleep apnea. Since sleep apnea is so common among people with heart failure, screening for OSA is a good place to start. “Whenever one of my patients has heart failure, I always send them for a sleep evaluation, but it’s low-hanging fruit to improve heart failure by checking for sleep apnea,” Dr. Freeman says.

In cases of OSA, a continuous positive airway pressure (CPAP) machine or other treatment may be prescribed. “In some of the patients who have this [CPAP] treatment, we see improvement of the ejection fraction, which is the pumping function of the heart, and there’s even some data to support that arrhythmias may be decreased by this intervention as well,” says David Markham, MD, an associate professor of medicine at Emory University in Atlanta and an expert in advanced heart failure and transplant cardiology.

Over time, use of eXciteOSA can reduce snoring and other symptoms of mild OSA by preventing your tongue from collapsing backward and blocking your airway during sleep. You’ll wear the device for 20 minutes once a day (while you’re awake) for six weeks, then once a week after that.

Change your sleep position. If you have sleep apnea, side sleeping can also be beneficial for those who don’t tolerate CPAP, says Dr. Khayat. “In heart failure patients, lateral sleep positions — on the side, left or right — can often decrease sleep apnea.”

It’s controversial whether the left or right side is best, says Khayat. If you have an implanted defibrillator, sleep on the opposite side. Most defibrillators are implanted on the left side, so sleeping on the right side may feel more comfortable.

“If they don’t have an implant, sometimes the left side is more comfortable because, just like in pregnancy, it relieves the pressure off the inferior vena cava (IVC), the body’s largest vein, which is on the right,” says Khayat.

2. Insomnia

“If you have a chronic condition, often there’s a degree of concern or anxiety. Sometimes there’s concern over hospitalizations and medication schedules. Or there’s decreased activity. All of these things affect your ability to maintain sleep,” says Khayat.

Change the timing of your medication. If you’re taking diuretic medication and waking up frequently during the night to use the bathroom, the diuretic may be the cause. “Something most people don’t realize is that diuretics can last in the body for six hours,” Freeman says. “If you take it after 4 p.m. and go to bed at around 10 p.m., you’ll be up peeing all night.”

To increase your chances of getting the recommended seven hours of quality sleep, try taking your diuretic earlier in the day.

Seek help for depression and anxiety. If you feel depressed or anxious most of the day, nearly every day, for two consecutive weeks, tell your doctor. Medications are available for depression and anxiety disorders in people with heart failure, which may, in turn, help improve your sleep.

In addition to seeking out a sleep apnea treatment, you can also fight next-day fatigue with these strategies to help you sleep better.

1. Sleep on Your Side

People with mild cases of sleep apnea may just need to sleep on their side, a position that helps keep the airway open, says Mendez. You can help prevent yourself from rolling onto your back at night by propping a body pillow against your back or even wearing a T-shirt with a tennis ball attached to the back.

2. Lose Weight

3. Seek Out Insomnia Treatments

To combat insomnia, Mendez recommends limiting caffeine, avoiding screens at night, and not looking at the clock. If you’re tossing and turning, get out of bed and do a calming activity before trying to fall asleep again. You should also be evaluated for other conditions that can affect sleep, such as leg movement disorders, anxiety, and depression.

4. Eat an Energy-Boosting Diet

5. Avoid Alcohol

A glass of wine or bottle of beer may help you drift off at night, but that nightcap can worsen sleep apnea. “Alcohol affects the muscle tone in your upper airway, making your palate floppy, so it’s more likely to close up and collapse,” says Mendez. You should also try to avoid taking sedatives, such as benzodiazepines, which may worsen the number of apnea episodes you have at night.

6. Stay Hydrated

Downing a large amount of water before bed will lead to middle-of-the-night bathroom trips, so stay hydrated by regularly sipping on H20 throughout the day.

7. Get Moving

When you’re running low on energy, exercise may be the last thing you want to do, but a good workout is exactly what you need. Exercise helps battle fatigue and has the added bonus of improving your sleep by helping you relax at night, says Mendez.

8. Quit Smoking

9. Reevaluate Your Treatment Plan

Together, you’ll get to the bottom of it — and feel energized in the future.

There’s a lot going on as we age, and not all of it is welcome. “A lot of women are blindsided by the changes that occur from menopause,” says Lauren Streicher, MD, a clinical professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine in Chicago.

During menopause, women experience a drop in estrogen levels and physical changes to the vagina, vulva, and vaginal opening, which can cause symptoms like dryness and urinary tract infections. These changes, which used to be called vaginal atrophy, are now known as genitourinary syndrome of menopause (GSM), a condition that affects more than half of postmenopausal women, according to a research review.

The good news is that these changes can be treated — and reversed, says Dr. Streicher. Here’s what’s up down there.

1. Sex Can Be Uncomfortable — or Even Painful

Premenopause, the vagina has a thick wall that’s comprised of rugal folds, which are “accordion-like wrinkles that allow the vagina to expand to accommodate a baby or penis,” says Streicher. During menopause, she says, many women experience a thinning-out of that layer; what’s more, those rugal folds flatten, preventing the vagina from expanding.

The result of these changes: Penetration may be painful, even if you are aroused, says Streicher.

If intercourse is particularly painful — think “stabbing” or “fiery” pain — there may be a problem near the opening of your vagina. For example, doctors will sometimes see inflamed red patches in this area, says Streicher. “If a doctor touches a [cotton swab] here, people will say it’s painful,” she says.

Aside from intercourse, you may feel irritation or vaginal burning in general.

Over-the-counter vaginal lubricants or moisturizers can help improve comfort during intercourse or alleviate dryness, research has shown. “If you’re feeling dry, there’s no reason not to try one and see what it can do for you,” says Mary Jane Minkin, MD, a clinical professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine in New Haven, Connecticut.

If those options don’t work, you may want to talk to your doctor about whether you should take vaginal estrogen.

2. It Can Also Burn When You Pee

Feeling the burn? You aren’t the only one. The tissues that line the vagina and urethra are similar, in that they both have estrogen receptors, says Dr. Minkin. When estrogen levels decrease, these tissues begin to dry up, which gives “bad” bacteria a chance to populate. “You have this perfect storm for infection in the bladder and urethra,” she says. Drinking a lot of fluids and urinating regularly are both good habits to practice. Cranberry supplements can also help prevent bacteria from sticking to the wall of the bladder, says Minkin.

3. The Vulva Looks … Different

Menopause triggers changes to more than just the vagina; it can also alter the look of the vulva. “We see an actual thinning and flattening out of the labia minora,” says Streicher. “Over time, some women completely lose their labia minora.”

Here’s why that’s important to know: It’s not always enough to treat the inside of your vagina; outside problems can make penetration impossible, she says. At your appointment, a doctor should evaluate both areas.

4. The Vagina’s Microbiome May Shift

It’s not unusual for the vaginal pH to change with menopause. A normal, healthy vaginal pH is low, but as a woman develops GSM, that pH increases, says Streicher. A rise in pH alone won’t cause symptoms, but this change can alter the vaginal microbiome (a network of bacteria), leading to an increased risk of vaginal infections, says Streicher. Treatment with vaginal estrogen to manage other menopause-related symptoms can help decrease your pH levels and improve “good” vaginal bacteria, although estrogen treatment is not typically used solely to address pH issues. Talk to your doctor about your options.

5 Scenarios When Journaling Can Help

Whether you’ve never journaled before or you’re a lifelong reflective writer, putting your thoughts on paper in strategic ways may help you cope with some of life’s challenging changes and milestones.

Here, experts have outlined five common life changes when journaling is particularly beneficial and offer exercises on how to get started.

1. It Can Help Strengthen Marriage Ties, Whether You’re Struggling or Not

Journaling can help new couples navigate building a partnership or longtime couples resolve conflict.

You may choose to keep a solo marriage journal. Like other types of journals, a solo marriage journal is a private space for your eyes only but it can offer a big-picture view of your marriage.

“Often, we tend to overlook the highs and lows of our interactions with our spouse in favor of how we are currently feeling, but this can make it hard to see the overall state of our marriage and feelings on it,” says Sarah Buckhead, LCSW, a therapist with the virtual health platform PlushCare based in Riverside, California. “Having a solo journal helps serve as a record of sorts that we can refer back to, and the information in those journals can help identify any repeating patterns in the relationship and communication styles that could use improvement.”

The other option is a couple’s marriage journal, where you and your spouse share your thoughts, feelings, and concerns with one another. This type of journal can be a helpful, positive tool for couples who need a push to show appreciation toward one another, Buckhead says.

She recommends writing in a shared journal at least once a week, and you can use it to voice the small things your partner has done that meant a lot to you but possibly went unvoiced, and then give them a chance to read it. “Often, we think our spouse knows we are grateful or happy with them, but when it is not outright voiced, it can be easy for your spouse to not realize you feel that way, especially when it is easy for people to get stuck in their own heads,” she says. “This is your chance to make your appreciation known.”

Marriage Journal Prompt to Get You Started For a solo marriage journal, Buckhead recommends asking yourself: What aspects of the relationship match your ideal vision of what a relationship should be? Have you communicated your needs for the parts that don’t?

And for a shared journal, consider: What is something your partner did this week that made you smile? “Imagine how positive you would feel reading your partner’s writings about how the new nickname you gave them had them smiling the entire day or how picking up their favorite food when they told you they had a hard day made them feel cared for,” Buckhead says.

2. It Can Help You Process Grief From the Loss of a Loved One

Regardless of how grief shows up for you, journaling is a helpful way to release the emotions so you can begin processing them. “Journaling or letter writing can be cathartic, especially during moments when you feel overcome with emotion,” Buckhead says.

Instead of trying to journal on a regular schedule, Buckhead recommends striking while the iron is hot. “Grief often hits hard and suddenly, like a wave,” Buckhead says.

Use a notepad app on your smartphone or a small notebook to jot down how you’re feeling when an emotion becomes overwhelming or you want to share something with the person you lost. “Let the words wash over you and bring you comfort,” Buckhead says. “Whether you had months, years, or decades to get to know your loved one, you know what they would tell you or what they would think. That is a powerful presence in your life.”

Grief Journal Prompt to Get You Started If you need help getting started with grief journaling, try writing directly to your loved one as if they are right by your side, Buckhead suggests.

What do you wish you could tell them right now? What positive memories have you been thinking about lately? What random things have happened lately that made you think of them? Or tell them why you’re angry they left you, or why you know you’ll be OK, even if it doesn’t always feel that way.

3. It Can Help You Through the Pain of a Divorce or Breakup

“Journaling is a healthy way to untangle these feelings and figure out where they’re coming from,” says Kara Nassour, a licensed professional counselor practicing at Shaded Bough Counseling in Austin, Texas. This way, you don’t act impulsively or say something you later regret.

The most important thing is to be honest when you’re journaling. Acknowledge even the ugly feelings you’d never tell anyone else, Nassour says. Your journal is a private space where you can be angry, selfish, scared, pitiful, or even happy or vindictive.

“Remember that just writing the words down won’t hurt anyone,” Nassour says.

It may also help to read what you write once you’re in a calm state of mind. “It can give you a more objective perspective and ideas for how to act on these feelings constructively,” Nassour says. Here are two of her favorite prompts to support your healing process.

Divorce or Breakup Prompt to Get You Started If you wanted the breakup, what are the reasons you stayed in the relationship as long as you did? What are the reasons you wanted to leave? If you were to begin another relationship, how would you want it to be different?

If you didn’t want the breakup, have you ever experienced a loss like this before? Who and what helped you get through it? What did you do to cope? Can any of the people, resources, or strategies from that time help you now?

4. It Can Prepare You for Having a Baby

Becoming a parent is a time filled with so many new experiences and worries that some can forget to slow down and reflect on their own feelings and needs.

“Many parents I know want to be able to be present with their kids, and that’s really hard to achieve if we struggle with being present with our own emotions,” says Jordan Olsen, LCSW, a perinatal mental health therapist with Ad Astra Therapy in Milwaukee.

Journaling gives new and expecting parents an outlet to express the many emotions they’re feeling. Simply setting aside 10 minutes per day — or even a few days a week, if you can’t manage a daily practice — to focus on your thoughts and articulate them on paper may help.

“I often give my clients prompts for a self check-in that promote reflection on their emotional state and where those emotions are showing up in the body,” Olsen says. She recommends setting a timer on your phone for 10 minutes and responding to these prompts below.

Pregnancy Journal Prompt to Get You Started What lessons did you learn about what it means to be a “good parent” from watching your parents? Are there any lessons you want to keep for your parenting journey? Are there any lessons you want to let go of?

Here’s another prompt: Pick a time when you felt scared, worried, overwhelmed, angry, or sad in the past week. Think about that moment and reflect on the question: “Does this point to an unmet need of mine?”

5. It Can Help You Work Through a Health Crisis or Diagnosis

Journaling allows structured time and an opportunity to process these feelings, says Julia Kogan, PsyD, a health psychologist and stress expert in Chicago.

Some people may not have friends or family who can help them make sense of their feelings. Or they may not feel comfortable sharing what’s going on with their health. “Journaling allows for a neutral way to express yourself any time you’d like,” Dr. Kogan says.

“Therefore, journaling can be a helpful strategy to manage overall health and chronic health conditions,” Kogan says. Use her exercise below to get started.

Health Crisis or Diagnosis Prompt to Get You Started Find a quiet and calm environment. Set a timer for 15 to 30 minutes and write about what’s upsetting you. This may include your current health status, any information you received from your doctor, how you’re feeling about the information, and any worries or fears. If you need a mood boost, use your journaling time to identify 5 to 10 things you’re grateful for, describe a goal for managing your health, or write a list of your coping mechanisms and tools, as well as the people in your life who can support you.

The Takeaway

• When you’re feeling stressed or navigating difficult life changes, journaling can help you work through your emotions and determine a path forward.
• Journaling has been shown to help you process emotions that come with significant life changes and may offer physical health benefits as well.
• Experts say that journaling can help strengthen marriage ties, process the loss of a loved one, work through a breakup, prepare for a baby, and deal with a health crisis.

With additional reporting by Moira Lawler.

Mouth Ulcers

• Canker sores are not contagious; cold sores are.
• Canker sores only appear inside the mouth; cold sores can also develop outside the mouth.
• Canker sores show as a single, rounded sore; cold sores can also appear in clusters.

Other Mouth Symptoms of Crohn’s Disease

Besides ulcers, changes in and around the mouth that may be due to Crohn’s include:

• Angular cheilitis, which is cracked, red, sore skin at the corners of the mouth
• Gingivitis, or gum inflammation that can lead to bleeding, swelling, and redness (one of the most common mouth symptoms of Crohn’s disease in children)

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• Foul-smelling breath
• Abscesses, or pus-filled lumps, that keep growing back
• Dental decay due to repeated vomiting
• Red, scaly skin around the lips
• Glossitis, or a swollen, inflamed tongue

Oral symptoms that are specific to Crohn’s disease include:

• Inflammation and redness in the groove between the cheeks and gums, an area known as the sulcus
• Long, narrow ulcers that often form straight lines in the gum, sulcus, and the insides of the cheeks
• Scar tissue on the lining of the mouth, sometimes also including small, fleshy lumps in the mouth called mucosal tags

Ulcerative colitis affects individuals differently, and the foods each person finds tolerable can vary. Still, there are some general guidelines to follow when deciding what you may want to include in your diet and what you’re better off avoiding.

What to Eat

Consider including the following foods in your diet.

“I would highly recommend cooking, steaming, or boiling these foods whenever possible, just to make the texture a bit easier on the already inflamed intestinal lining,” Deal says. While fiber is essential for a healthy digestive system, too much can cause problems, especially for people with UC.

Lean Proteins Healthy, lean proteins, including chicken, fish, eggs, legumes, nuts, soy, and tofu provide energy and nutritional support whether you have UC or not. But these foods can have additional benefits if you’re living with IBD.

Note that for some of these foods, you may need to change the texture to make them easier to digest. “For example, consider eating peanut butter instead of whole peanuts or having hummus instead of whole chickpeas,” suggests David Gardinier, RD, a registered dietitian with the Cleveland Clinic Center for Human Nutrition.

But whole grains can be difficult for some people with UC to digest during or right after a flare. For these individuals, Gardinier says refined grains like white rice or non-grain carbohydrates such as sweet potatoes or regular potatoes are better choices at these times.

“Oats and buckwheat are both whole grains that may be tolerated better by UC patients in a flare up,” he notes. “For bread, I usually recommend a sourdough since it is not too fiber heavy while also having a low glycemic index.”

What to Limit or Avoid

Certain foods may trigger or worsen UC symptoms. Here’s a list of foods you may want to limit or avoid.

Spicy Foods When your UC symptoms are flaring, it may be best to avoid spicy foods. “These don’t necessarily cause damage to the lining of the colon but when the colon is already irritated, it’s like adding salt or acid to a scratch on your skin — it hurts,” explains Adeeti Chiplunker, MD, a gastroenterologist who specializes in inflammatory bowel disease at the Ohio State University Wexner Medical Center in Columbus.

Foods High in Simple Sugars Candy, cakes, cookies, soda, and juices can irritate the gut and exacerbate UC symptoms, Dr. Chiplunker says. “If these are not fully digested and absorbed by the bowel or your intake simply overwhelms your normal absorption system, these unabsorbed sugars act like a laxative,” she notes. Most of these foods are also ultra-processed.

High Lactose Foods Some people with IBD are lactose intolerant, meaning their body does not properly digest lactose, the sugar found in dairy products like cow’s milk, cheese, and ice cream. Others may have issues digesting these foods during a UC flare. Both can lead to uncomfortable symptoms like abdominal cramping, gas, and diarrhea.

Living with psoriatic arthritis can mean chronic joint pain and swelling, constant fatigue, and a limited range of motion that makes daily activities a challenge. But working with a physical therapist can help alleviate some of these symptoms.

Regular exercise helps keep joints functioning properly, but it’s important to exercise safely and use correct form. That’s where physical therapy (PT) comes in, according to Maura Iversen, DPT, dean of the college of health and wellness at Johnson & Wales University in Providence, Rhode Island.

• Develop an individualized fitness plan that includes strengthening, stretching, and aerobic exercises, and show you how to execute them properly.
• Demonstrate proper posture and body mechanics for day-to-day activities to help relieve pain and improve function.
• Recommend options such as braces or splints, shoe inserts, and heat or cold therapy to support joints and ease pain and stiffness.
• Teach you how to use assistive devices that can improve your mobility and help you perform daily tasks.
• Suggest modifications to your physical environment (ergonomic recommendations) and lifestyle to help you conserve energy and improve function while protecting your joints.

In this Q&A, Iversen talks about how physical therapy can benefit people with psoriatic arthritis and what you need to know about finding the right physical therapist for you.

1. When Should Someone With Psoriatic Arthritis Consider PT, and What Can They Expect?

Iversen: Joint pain and swelling from psoriatic arthritis, coupled with tendon inflammation (enthesitis), are usually what lead people and their physicians to consider physical therapy as a treatment option. You may also be experiencing severe fatigue due to the systemic inflammatory nature of the disease. Whether you have active or stable disease, a referral to a physical therapist can help you understand how exercise and lifestyle changes can help you manage. If your doctor has not yet suggested PT, consider asking for a referral at your next visit.

A physical therapist would begin the initial clinic session with:

• Your complete health history, including sleep habits, hygiene, and more
• A discussion about your physical environment at home and work
• A vital sign assessment, including blood pressure and heart rate at rest and with exercise
• A full-body exam, including joint range of motion
• A joint alignment exam to determine if malalignment is placing stress on the joint during movement (if so, it indicates a need to practice caution when exercising that joint)
• Strength testing
• Aerobic performance test to assess endurance

A physical therapist may also ask about your goals for treatment and function, discuss potential barriers, and talk about how to implement a comprehensive PT program.

2. What Can a Physical Therapist Do to Help You?

Iversen: A physical therapist can help you manage psoriatic arthritis symptoms in a variety of ways. The PT program can enhance endurance through regular aerobic exercise, such as bicycling, speed walking, and swimming. Low-impact exercises, such as tai chi and yoga, are recommended during flares. High-impact exercise can be implemented when the disease is stable, when there is no joint malalignment, and based on your preferences. Strength and joint motion can be improved with a tailored strengthening program and stretching regimen. Losing weight through lifestyle changes and exercise can also be effective in reducing psoriatic arthritis symptoms. Additionally, passive treatments, such as massage or TENS (transcutaneous electrical nerve stimulation), can be used in conjunction with exercise to help you manage symptoms.

If you’re having trouble functioning at work, a physical therapist can conduct an ergonomic evaluation. They can help you modify your workspace or even speak to your company to create a better work schedule to accommodate you. This could include part-time or fully remote work.

3. What Are Some Common Obstacles to Trying PT, and How Can People With Psoriatic Arthritis Overcome Them?

Iversen: Fear of movement and of engaging in exercise is a common concern for people with psoriatic arthritis. You may worry that movement may cause more joint destruction.

Chronic, inflammatory diseases such as psoriatic arthritis have symptoms that come and go. With psoriatic arthritis, one week you may look and feel fine, and then the next week your symptoms may flare. This fluctuation in symptoms makes it difficult to understand whether the pain you’re experiencing is typical discomfort from exercising after a period of inactivity or from an increase in disease activity.

The benefits of exercise may seem counterproductive, because you’re stressing the joints during exercise. But the goal is to exercise within your pain tolerance and slowly build up strength, endurance, and range of motion. A gradual increase in intensity and frequency of exercise allows you and your physical therapist to determine how your body responds to exercise.

Remember: You are the expert on your body. You know what you can and can’t do. You need to pay attention to your body’s reaction to exercise. If 30 minutes of exercise is too much, you can split the routine into smaller intervals — for example, 10 minutes of exercise, three times a day. If 30 minutes is the threshold for building aerobic capacity, you and your therapist can find ways to complete 30 minutes of exercise while reducing joint pain and stiffness.

4. Is PT Different for People Who Are Athletic?

Iversen: Athletes tend to be self-motivated and good at goal setting and achieving goals. They often are very aware of their body’s capabilities and listen to their body’s response when exercising. If an athlete can only do five reps instead of 10, it’s not a big deal to them.

Nonathletes often need external motivation and tend to benefit from the support of exercising in a group or with a physical therapist or fitness instructor. Someone who is not athletic may wish they could do more but might be unclear on how to self-motivate. The group setting is very helpful for nonathletes to feel more comfortable with exercise.

The Arthritis Foundation has some wonderful collaborative programs. I keep a list of what’s available for people, and I connect them with the types of resources they’re more likely to use.

5. How Do You Know if You Have the Right Physical Therapist?

Iversen: Exercise is a form of medicine. Just as a rheumatologist will adjust your medication to identify which drug works best, you need a physical therapist who will help you determine the best exercise regimen, use of assistive devices, and adjunct therapy (such as massage) for the different phases of disease activity and based on your current physical condition. When you’re in a flare, the regimen needs to be adjusted according to the active symptoms. When the flare subsides, a greater emphasis on higher intensity, frequency, and duration of exercise can be used.

Physical therapists can specialize in various practice areas, such as geriatrics or pediatrics. Identifying a physical therapist who specializes in rheumatic diseases is important. The American College of Rheumatology maintains a database of providers specializing in rheumatic conditions. You can also search for a physical therapist who specializes in orthopedics through the American Physical Therapy Association.

6. Will Insurance Cover PT for Psoriatic Arthritis?

Iversen: Each insurance company has different fee structures and visit allowances. If you are referred by your rheumatologist or primary care specialist, sessions should be covered. Your therapist’s office should know what the insurance company allows. This can help the physical therapist determine the best way to care for you.

The Takeaway

• Engaging in physical therapy for psoriatic arthritis can greatly improve joint mobility, strength, and daily functioning while helping you stay active safely.
• A physical therapist can also help you overcome barriers such as fatigue or fear of worsening symptoms, guide you through an individualized exercise plan, and help you modify your exercise program as needed during a flare.
• Seeking out a physical therapist with expertise in rheumatic diseases, such as psoriatic arthritis, can help you get specialized care.

Most people associate psoriatic arthritis with joint pain. But if you’ve ever been unable to concentrate and put tasks off as a result — and then gotten frustrated about why you just can’t get it done — it could be brain fog, another symptom of psoriatic arthritis.

Another potential cause of brain fog: “If you have an autoimmune disease such as psoriatic arthritis, you’re more likely to have fibromyalgia,” says Anca Askanase, MD, a professor of medicine and the director of rheumatology clinical trials at Columbia University Irving Medical Center in New York City. “Fibromyalgia is associated with sleep disturbance, sleep fatigue, and brain fog.”

The good news? There are steps you can take to manage brain fog if you have psoriatic arthritis. Here are five strategies to try.

1. Stay Active

2. Eat a Balanced Diet

Although there’s no one diet for managing psoriatic arthritis, what you eat can affect your overall health and your cognitive health.

3. Get More (and Better) Sleep

“It’s important to zero in on why you can’t fall asleep or stay asleep,” says Dr. Zeri. “Things such as limiting caffeine intake, exercising, not having a TV in your bedroom, and turning off electronics close to bedtime can all reduce the chance of a sleepless night.”

4. Meditate

There are many types of meditation you can try. If you’re new to meditating, you can begin by sitting or lying in a quiet room, closing your eyes, and focusing on your breathing for a few minutes a day.

5. Play Brain Games

The Takeaway

• Brain fog is a common yet challenging symptom of psoriatic arthritis, characterized by impaired memory, a lack of focus, and mental confusion.
• Implementing habits such as eating a balanced diet, exercising regularly, prioritizing sleep, meditating, and engaging in hobbies can help boost cognitive function and alleviate brain fog.
• You should also talk to your doctor to determine if related health issues, such as depression or fibromyalgia, may be contributing to brain fog.