Brain Fog and Rheumatic Disease: It’s Not “Just in Your Head”
When someone tells me they feel fatigued, I always ask a follow-up question: What kind of fatigue are you experiencing?
Because fatigue is not one-dimensional.
Is it physical fatigue, where your body feels heavy and drained?
Is it sleepy fatigue, where you feel like you could fall asleep anywhere?
Or is it cognitive fatigue — what many people describe as brain fog?
Let’s focus on brain fog, because this is one of the most frustrating symptoms patients experience.
Patients often tell me they don’t feel as sharp. They forget words. They lose their train of thought. Tasks that used to feel easy require more effort. It can be subtle, but it affects daily life in a very real way.
How does a rheumatologist evaluate the symptoms of brain fog?
I always start with lifestyle, because these are the foundations of brain function.
Sleep counseling: Getting good sleep is non negotiable
As much as we like to think we can push through and function on inconsistent sleep, the brain doesn’t work that way. Sleep is physiologically necessary.
If you are not getting consistent, good-quality sleep, there will be consequences. Brain fog is often one of the earliest signs.
Your brain needs sleep to restore itself. Without it, cognitive clarity suffers.
Regular exercise: movement and routine matter
Regular movement plays a bigger role than people realize. Even something as simple as walking consistently each day can help regulate your nervous system and improve sleep quality.
You don’t need an extreme exercise program. Consistency is what matters.
When your body has a rhythm, your brain benefits too.
Stress and cognitive overload
I often use this analogy: brain fog can feel like having too many tabs open on your computer.
When there are too many tabs open, everything slows down.
The same thing happens in your brain when you are under constant stress or carrying too much cognitive load. Work, family responsibilities, health concerns — it all accumulates.
This doesn’t mean something is wrong with you. It means your brain is overloaded.
Is brain fog common in rheumatic illnesses?
From a rheumatology standpoint, brain fog is extremely common in any chronic inflammatory disease, such as Systemic Lupus Erythematosus (SLE), rheumatoid arthritis (RA), vasculitis, and Sjogren’s (among many others).
Any chronic inflammatory disease can contribute to cognitive fatigue. Inflammation affects the entire body, including the brain.
This is why brain fog often doesn’t improve with caffeine. Coffee or energy drinks may temporarily help you feel more alert, but they don’t address the underlying issue.
When we treat the underlying inflammatory disease, patients often notice improvement not just in pain, but in mental clarity as well.
Can brain fog be due to more than one underlying cause?
Yes, I see this all the time. There isn’t always a single cause.
Sometimes inflammation is the primary driver. Other times, it’s a combination of poor sleep, stress, and chronic disease.
This is why a comprehensive approach matters.
Creating White Space: What does this mean?
One practical strategy I often recommend is intentionally creating white space.
We live in a constant state of input — notifications, responsibilities, decisions. Your brain rarely gets a break.
Set aside a consistent time each week where you can set aside one hour to disconnect. Ideally, go somewhere outdoors. Pick a consistent spot and let it become your quiet mental oasis.
When you’re there, intentionally focus on your senses (try it for 1 minute with each sense). What do you hear? What do you see? What do you feel?
This helps your nervous system reset. It allows your brain to slow down.
Over time, this can improve cognitive clarity, especially when brain fog is driven by chronic stress.
Try it consistently for a month and see how you feel. Feel free to reach out to me directly and share how this has helped you.
Key Takeaways
Brain fog is real and common in rheumatic disease
Sleep is one of the most important foundations of cognitive function
Chronic stress and cognitive overload worsen brain fog
Inflammation can directly affect brain function
Treating the underlying disease often improves cognitive clarity
Creating intentional white space can help restore mental focus
You don’t have to accept brain fog as your new normal.