Fatigue

Chronic fatigue that doesn't improve with rest

Feeling exhausted no matter how much sleep you get is one of the most common complaints there is, and it's usually approached through sleep hygiene, stress levels, diet, and ruling out thyroid or iron problems.

Those are reasonable first steps, and they resolve fatigue for a lot of people. When fatigue persists despite all of that, it's worth looking further.

The Hypermobility Link Behind Rest-Resistant Fatigue

We're not doctors. Here's a piece of the research that connects fatigue to something most fatigue workups don't check: dysautonomia, meaning dysfunction in the nervous system that regulates blood pressure, heart rate, and related automatic functions.

De Wandele et al. (2014) studied a cohort with the hypermobility type of EDS and found orthostatic intolerance in 74% of that group, compared to 34% of controls. The study also found this correlated with fatigue, pain severity, and reduced quality of life, so the connection isn't incidental.

A separate, broader 2024 review looked across multiple studies of dysautonomia in hEDS and found prevalence estimates ranging from 31% to 94%, depending on the study. That's a wide range, and it's worth stating as its own separate figure rather than folding it into the De Wandele number. What the two sources agree on is the direction: dysautonomia turns up often in hEDS, and it's tied to the kind of fatigue that doesn't respond to rest alone.

What to bring to a doctor

If fatigue hasn't improved despite addressing sleep, iron, and thyroid function, it's worth asking a doctor about screening for dysautonomia or orthostatic intolerance, particularly if there's any history of joint hypermobility. Our Fatigue and Post-Exertional Crash page covers this research in more depth.

Sources referenced on this page

01De Wandele et al. 2014, orthostatic intolerance in EDS-hypermobility type cohort (link not yet sourced)
022024 review, dysautonomia prevalence range in hEDS across studies (link not yet sourced)