Living With Iron Deficiency Anemia

Iron deficiency anemia (IDA) occurs when the body doesn't have enough iron to produce all of the hemoglobin necessary for healthy red blood cells (RBCs). Hemoglobin carries oxygen throughout the body.

If you have IDA, you may have trouble sleeping, fatigue weakness, exercise intolerance, or headaches. These symptoms can continue for up to six to eight weeks after you have begun iron replacement therapy and are likely to affect your day-to-day function and your quality of life.

This article discusses some of the symptoms of iron deficiency anemia, including how it might affect your sleep.

Managing Sleep Issues

Studies suggest that people with anemia are significantly more likely to have trouble sleeping. Anemia has been associated with breathing problems during sleep and other sleep disorders such as night terrors and sleepwalking. These problems can contribute to the daytime fatigue you experience when you have anemia.

Insomnia

Studies have found a strong association between iron deficiency anemia and insomnia. Iron supplementation appears to help improve insomnia in people who have IDA.

Other ways you can help improve your sleep include:

• Keep the same sleep schedule: Try to go to bed at the same time every day, and get up at the same time each morning, even on the weekends.
• Stay active: IDA can take away the energy you need to exercise, but exercise can make you less tired long-term and help you sleep at night. Try to do what you can to keep moving. Even a short 10- to 15-minute walk a day can boost your energy and help you increase activity levels gradually.
• Relaxation exercises: Relaxation exercises like meditation and visualization may help you fall asleep at night.
• Avoid liquids and large meals right before bed: Large meals right before bed can cause indigestion and trouble sleeping. Drinking a lot of liquid before bed can also disrupt your sleep since it can lead to extra trips to the bathroom.
• Avoid alcohol: While alcohol can help you fall asleep, you sleep poorly after consuming it. That means you will be tired the next day, even if you got a full night’s sleep. Avoid alcohol at bedtime to improve energy levels.
• Avoid caffeine: Caffeine can interfere with sleep and can also contribute to daytime fatigue. Cut down on caffeine slowly to avoid caffeine withdrawal headaches.

Fatigue

Fatigue is a common symptom of anemia. You might experience fatigue even if you are getting enough sleep at night. Fatigue can make you feel weak and tired.

Managing your insomnia is an important way to keep fatigue in check. Try to get at least seven to nine hours of sleep each night. Avoid sleeping too much because that will add to fatigue. Naps are fine but limit yourself to one short 20- to 30-minute nap each day.

Some of the other ways you can manage fatigue include:

• Diet: To keep your energy up, eat smaller meals and healthy snacks every three to four hours, rather than large meals less often.
  
• Reduce stress: The stress associated with not feeling well takes a lot of energy. Conserve your energy by making use of relaxation activities throughout your day. Manage stress by working out, spending time with friends, listening to music, or practicing yoga or relaxation breathing.
  
• Drink more water: Make sure to stay hydrated during the day. Being dehydrated—even mildly—can add to your fatigue regardless of what caused it. Ensure you are drinking plenty of water and eating water-rich foods, such as fruits and vegetables, to help replenish water in your body and maintain energy.

Restless Legs Syndrome

Studies have found that people with IDA are more likely to have restless legs syndrome. People with restless legs syndrome have sensations in their legs that can lead to involuntary leg movement during sleep.

Healthcare providers recommend testing people with restless legs syndrome for iron deficiency anemia. Iron supplements can help improve symptoms in people with IDA who also have this condition.

Addressing Underlying Causes

Treatment for IDA won’t help much if the underlying causes of IDA are not addressed. Common causes of IDA include:

• A diet low in iron: A diet low in iron is a common cause of iron deficiency anemia. Vegetarians, for example, may not get enough iron from dietary sources.
• A medical condition such as celiac disease: People with unmanaged celiac disease may develop anemia. This is because celiac disease causes your immune system to mistakenly attack the lining of your small intestine when you eat gluten. This can impair your body's ability to absorb iron and other nutrients.
• Pregnancy: Pregnancy causes an increase in the volume of blood in the body. This leads to an increased need for dietary iron. Insufficient iron intake during pregnancy can lead to iron deficiency anemia.
• Chronic inflammation: People with conditions that cause chronic inflammation may develop anemia. This happens because inflammation can prevent your body from using iron to make red blood cells.

Work with your healthcare provider to investigate and treat the root cause of your IDA. Treatment of that condition is often vital to replacing iron and increasing hemoglobin.

Assessing Psychological Affects

Studies have found a link between iron deficiency and mental health. People living with IDA can experience multiple psychological symptoms, including anxiety, depression, and bipolar disorder.

There are many different things you can do to manage and lessen the psychological effects of IDA. Talk to your healthcare provider if you find you are struggling to cope.

There are different options to help you manage anxiety or depression. This might include:

• Talk therapy: Also called psychotherapy, this involves talking to a psychotherapist to help work through the root causes of anxiety and depression. Up to 75% of people find talk therapy helpful. Reviews find most people who engage in talk therapy are better off by the end of treatment than 80% of people who don’t attempt therapy.
• Medication: If symptoms of anxiety and depression are severe and/or affecting your quality of life, your healthcare provider can recommend different medicine options, including anti-anxiety medicines and antidepressants, to reduce symptoms of anxiety or to help improve your mood.

Creating a Support Network

Treatment for IDA may include taking iron supplements and eating an iron-rich diet to improve iron levels. You may start to feel better in a couple of weeks, but it can take several months to build up a steady supply of iron in your body.

In the meantime, you might need support from family and friends to manage tasks and the physical and psychological effects of IDA. It can be helpful to reach out to family and friends when you are struggling with high levels of fatigue and severe IDA symptoms.

This support can help you manage household tasks or care for loved ones. Family and friends might be able to help with preparing meals and caring for young children. But they won’t know that you need help or how you feel if you don’t speak up.

Try to communicate clearly and directly to loved ones. This is especially important on days when fatigue, headaches, and other IDA symptoms are making it hard to get through your day. Let people know how you are feeling, and don’t be afraid to ask for help.

Managing Other Symptoms

Fatigue is not the only symptom of IDA you will need to manage so that you can better cope. In addition, you will want to pay attention to pica (eating non-food items), headache, cold hands and feet, fast heartbeat, and shortness of breath. These are common symptoms of IDA that are manageable.

Manage Pica

Pica is the term used to describe cravings for nonfood items, such as dirt, paper, and chalk. This is something that occurs in pregnant people and children who have IDA.

If you or your child experience this symptom, it is important to let your healthcare provider know so you have a complete understanding of the risks associated with pica. Consider possible substitutes for your cravings, such as sugarless chewing gum, or ask a friend or family member to help you avoid nonfood items.

Treat Headache Symptoms

Headache is a common symptom associated with IDA. Over-the-counter (OTC) pain relievers can be helpful, but if you find you are still struggling with headache symptoms, talk to your healthcare provider. If you are pregnant, ask your healthcare provider which OTC pain relievers might be safe for you to take.

Many different prescription therapies can help manage and prevent headaches associated with IDA, including prescription headache medicine and antidepressants. Relaxation therapies like biofeedback and eating a healthy, balanced diet can also help you manage headaches.

Keep Your Body Warm

Feeling cold in your hands and feet is common with IDA. Wearing appropriate footwear and socks can keep your feet warm. Wearing mittens and gloves can keep your hands warm. You might also consider your core temperature and wear thin, layered clothing to keep the rest of your body warm.

It might also be helpful to avoid caffeine and nicotine because they are vasoconstrictors and can exacerbate cold.

Reduce Symptom Triggers

Unless your healthcare provider diagnoses you with a heart condition, IDA symptoms like fast heartbeat and shortness of breath do not require treatment. However, your healthcare provider will still want you to find ways to avoid triggers, which might include caffeine, stress, and overexertion.

You can reduce triggers by utilizing relaxation techniques (yoga, meditation, or deep breathing) and avoiding stimulants, including caffeine and nicotine.

When to Get Help

While IDA does cause a fast heart rate and shortness of breath, you should still pay attention to these symptoms and know when to reach out to your healthcare provider or call 911.

You should get immediate medical help for:

• Any new chest pain or discomfort that is severe, unexpected, and comes with shortness of breath, weakness, sweating, and nausea
• A fast heart rate of 120 to 150 beats per minute, especially if you are short of breath or dizzy
• Shortness of breath not relieved by resting

Change Your Diet

The single most important thing you can do to manage IDA and to better cope with the condition is to prioritize your diet. Diet is vital and helpful in managing many IDA symptoms and preventing the emotional effects of IDA:

• Eat an iron-rich diet: Lean meat and seafood contain heme iron, which is more easily absorbed by the body. Non-heme iron can be found in plant foods like nuts, beans, legumes, vegetables, and fortified breads and cereals. Non-heme iron is harder for your body to absorb. People who don't eat a lot of heme iron, such as vegetarians, may develop iron deficiency anemia.
• Eat and drink foods that help iron absorption: Orange juice, strawberries, and a variety of fruits and vegetables that contain vitamin C help you absorb iron from non-heme sources.
• Avoid caffeine: Caffeine-containing foods and drinks can make it harder to absorb iron. You don’t have to completely rid your diet of caffeine, but avoid consuming caffeine with an iron-rich meal or with iron supplements.

Summary

Iron deficiency anemia can produce symptoms such as fatigue that impact your daily life. It can also lead to trouble sleeping and increase your risk of anxiety and depression.

You can use strategies to manage the fatigue, including changes to sleep, diet, and activity. You may need help and support from family, friends, and medical professionals on days when your symptoms are most severe.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Neumann SN, Li JJ, Yuan XD, et al. Anemia and insomnia: A cross-sectional study and meta-analysis. Chin Med J (Engl). 2020;134(6):675-681. doi:10.1097/CM9.0000000000001306
2. Leung W, Singh I, McWilliams S, Stockler S, Ipsiroglu OS. Iron deficiency and sleep - A scoping review. Sleep Med Rev. 2020;51:101274. doi:10.1016/j.smrv.2020.101274
3. Stanford Medicine Health Care. Treatments for insomnia.
4. Zheng D, Yuan X, Ma C, et al. Alcohol consumption and sleep quality: A community-based study. Public Health Nutr. 2021;24(15):4851-4858. doi:10.1017/S1368980020004553
5. Harvard Health Publishing. Fight fatigue with fluids.
6. Bae H, Kim KT, Heo MH, Do YR, Cho YW. The prevalence and clinical characteristics of restless legs syndrome in patients with iron deficiency anemia in Korea. J Clin Sleep Med. 2021;17(7):1447-1452. doi:10.5664/jcsm.9230
7. Silber MH, Buchfuhrer MJ, Earley CJ, Koo BB, Manconi M, Winkelman JW; Scientific and Medical Advisory Board of the Restless Legs Syndrome Foundation. The management of restless legs syndrome: An updated algorithm. Mayo Clin Proc. 2021;96(7):1921-1937. doi:10.1016/j.mayocp.2020.12.026
8. American Society of Hematology. Anemia and pregnancy.
9. National Institute of Diabetes and Digestive and Kidney Diseases. What is anemia of inflammation?
10. Lee HS, Chao HH, Huang WT, et al. Psychiatric disorders risk in patients with iron deficiency anemia and association with iron supplementation medications: a nationwide database analysis. BMC Psychiatry. 2020;20(1):216. doi:10.1186/s12888-020-02621-0
11. American Psychological Association. Understanding psychotherapy and how it works.
12. Harvard Health Publishing. Cold fingers, cold toes? Could be Raynaud's.
13. American Heart Association. Tachycardia: fast heart rate.
14. National Heart, Blood, and Lung Institute. Iron deficiency anemia.
15. National Institutes of Health Office of Dietary Supplements. Iron.
16. Ahmad Fuzi SF, Koller D, Bruggraber S, et al. A 1-h time interval between a meal containing iron and consumption of tea attenuates the inhibitory effects on iron absorption: a controlled trial in a cohort of healthy UK women using a stable iron isotope. Am J Clin Nutr. 2017;106(6):1413-1421. doi:10.3945/ajcn.117.161364

By Lana Barhum
Barhum is a freelance medical writer with 15 years of experience with a focus on living and coping with chronic diseases.

• Meet Our Medical Expert Board
• About Us
• Editorial Process
• Diversity Pledge
• Privacy Policy
• In the News
• Advertise
• Terms of Service
• Careers
• Contact
• EU Privacy

Verywell Health's content is for informational and educational purposes only. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

We Care About Your Privacy

We and our 100 partners store and/or access information on a device, such as unique IDs in cookies to process personal data. You may accept or manage your choices by clicking below, including your right to object where legitimate interest is used, or at any time in the privacy policy page. These choices will be signaled to our partners and will not affect browsing data.

We and our partners process data to provide:

Store and/or access information on a device. Use limited data to select advertising. Create profiles for personalised advertising. Use profiles to select personalised advertising. Create profiles to personalise content. Use profiles to select personalised content. Measure advertising performance. Measure content performance. Understand audiences through statistics or combinations of data from different sources. Develop and improve services. Use limited data to select content. List of Partners (vendors)