• Stress can contribute to worse autoimmune hemolytic anemia (AIHA) symptoms.
• Stress-management techniques may help reduce stress-related issues.
• Exercise, relaxation techniques, and improved sleep hygiene can help lower stress.

Stress can create a complicated cycle for people who have an autoimmune disease like AIHA. Navigating doctor visits, treatment options, medical bills, and symptoms of a chronic condition can all cause stress. In turn, increased stress levels can worsen AIHA symptoms, such as rapid heartbeat and shortness of breath. Managing stress is very important for maintaining a good quality of life, especially if you have a condition like AIHA.

Doctors and researchers are working to better understand the connection between stress and conditions like AIHA. Stress-management techniques provide a practical way to potentially disrupt the cycle of stress and AIHA.

The Relationship Between Stress and AIHA

AIHA develops when the immune system mistakenly attacks healthy red blood cells (RBCs) and a process called hemolysis occurs, leading to potentially severe anemia. The destruction of RBCs results in a lack of hemoglobin (the protein that carries oxygen in the blood), which reduces the amount of oxygen that gets sent to vital organs and tissues. AIHA is linked to a variety of factors, which may include genetic mutations, immune response to infections, cancer, and other conditions.

Stress can worsen existing AIHA symptoms or bring on new ones, which can be challenging when you’re already living with the fatigue of anemia.

“I’ve had fatigue for years and depression — on top of PTSD,” one myAIHAteam member wrote. Another said, “I have developed alopecia, a stress-related disorder, and my hair has fallen out and grown back several times.”

One 2022 study of people living with cold agglutinin disease (a subtype of AIHA) found that participants were 1.7 times more likely to take prescription medications for depression and anxiety than those without the condition. Additionally, AIHA symptoms fluctuate, so their unpredictability and potential for sudden onset may also contribute to feelings of stress.

Although stress can become overwhelming at times, a wide variety of tools and techniques may help reduce stress-related AIHA symptoms. Stress-management techniques are tangible lifestyle habits that can improve your quality of life and overall well-being.

Techniques for Reducing Stress

Many types of coping strategies can help manage stress. Here are a few that are effective for some people. You can try out several and find what works for you.

1. Get Active

Exercise causes the body to release feel-good chemicals called endorphins that help reduce feelings of stress. Engaging in exercise may be difficult if you have symptoms such as chest pain and fatigue, but you don’t need to exercise very intensely or long to gain the benefits.

The National Institute of Mental Health suggests that 30 minutes of walking each day can help improve mood. If half an hour seems too long, start with a shorter session and slowly increase. If you have physical limitations, talk to your health care provider before beginning any new exercise routine. They can help you determine what exercises are safe for you or refer you to a physical therapist.

In addition to improving mood and reducing stress, physical activity can help you reduce your risk factors for developing related conditions, including heart disease.

Several myAIHAteam members have recommended swimming as a gentle form of exercise. “I swim from one pool corner, diagonally, to the most distant corner. It’s roughly 25 meters per lap, and I typically do 20 laps each day,” one member wrote. “Getting the heart and respiration elevated for 30 or more minutes is beneficial, both mentally and physically. And yes, there’s a definite psychological benefit from the exercise regimen.”

2. Try Meditation and Mindfulness

Relaxation techniques such as meditation and mindfulness are useful for reducing stress and managing chronic disease. They calm your body and mind, allowing you to organize your thoughts, and instill a sense of inner peace. Meditation and mindfulness are also low-cost and relatively easy to incorporate into your daily life.

Mayo Clinic suggests several techniques for relaxation and stress relief, like:

• Meditation
• Guided imagery
• Visualization
• Deep-breathing techniques

Digital apps such as Headspace and Calm are popular resources for different types of meditations to improve mental wellness. Other relaxation techniques, like yoga and tai chi, incorporate movement. You can find classes and tutorials online, at local fitness centers, or sometimes in community parks.

3. Set Boundaries

Many sources of stress are out of our control, such as family difficulties and natural disasters, but we do have some level of control over some other stressors. One of the most useful tools for stress management involves identifying your stressors, realizing what you can and cannot control, and establishing personal boundaries.

First, make a list of things that cause you stress or worry. Next, ask yourself which of these factors you have control over (like preparing dinner or making weekend plans) and which you don’t (like a winter storm or economic changes).

As you assess the items on your list, cross out those you don’t have control over. For the remainder — what you do have control over — ask yourself some questions:

• Is it necessary that I complete all these tasks?
• Do I need to complete all these tasks today or even this week?
• Is it reasonable to ask family or friends for help with these tasks?

Learning how to say no to requests or tasks can also help you manage your stress. You have a limited amount of time and energy each day, and managing a chronic disease like AIHA might further limit your capacity. Prioritize doing what is important to you, and consider saying no to things for which you don’t have the time, energy, or interest.

4. Improve Sleep Hygiene

Getting quality sleep is important for managing stress. Unfortunately, that can be difficult if you have AIHA. You may be tired during the day, which could throw off your ability to sleep well at night.

“I feel like I sleep all the time, and sometimes I have the opposite,” one myAIHAteam member wrote. “Then I won’t sleep for long periods of time.”

Getting quality sleep will help you manage your stress levels. Tips for improving your sleep include the following:

• Avoid caffeine, alcohol, and large meals several hours before bed.
• Put away electronic devices, such as phones and computers, at least half an hour before turning in.
• Establish a relaxing bedtime routine.
• Keep a consistent sleep and wake schedule.

5. Seek Professional Help

Sometimes, the stress of life with AIHA can become overwhelming. It’s OK to seek professional help if you feel like you need it. If stress starts to interfere with your daily life and responsibilities, and your self-care and stress-management techniques aren’t helpful enough, it might be time to reach out to a counselor, therapist, or doctor.

“Eventually, one comes to realize that AIHA is here to stay,” one myAIHAteam member wrote. “It may be better sometimes and flare up at other times, but it will be part of your ongoing life going forward. It is of course a loss and a change that eventually must be accepted if one is to move on. This involves a grieving process. Grief takes time, some talking, and some acceptance if the end goal is peace.”

Counselors and therapists often assist people when their burden of psychological stress has become too heavy. They can provide professional advice and practical tools to help you manage stress. Your health care provider or rheumatologist may be able to refer you to mental health support and other resources for better stress management.

Connecting With Others

AIHA is a rare condition, but you’re not alone. On myAIHAteam, people with AIHA and their loved ones come together to ask questions, give advice, and share their stories with others who understand life with this condition.

Does stress seem to worsen your AIHA symptoms? Have you found any effective ways to manage stress? Share your experience in the comments below, or start a conversation by posting on your Activities page.