Amyloidosis Symptoms and Side Effects/Physical Symptoms and Side Effects

hATTR Amyloidosis and Fatigue: Causes and Relief

Medically reviewed by Kiran Chaudhari, M.B.B.S., M.D., Ph.D.

Written by Emily Wagner, M.S.

Updated on October 16, 2026

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Key Takeaways

Fatigue is a common challenge for people living with hereditary transthyretin amyloidosis (hATTR amyloidosis), a rare condition where abnormal proteins form clumps that can damage organs throughout the body.
The fatigue linked to hATTR amyloidosis can have several causes, including heart problems, kidney damage, and anemia, all of which can disrupt sleep and drain energy. Some medications used to manage related symptoms may also contribute to feelings of tiredness.
Talking with a healthcare provider is a great first step toward feeling better, as they can help identify what is driving fatigue and discuss treatment options, and in the meantime, pacing yourself, taking short rest breaks, and following a nutrition plan tailored to your needs can help you manage your energy day to day.

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Do you feel like you don’t have any energy lately? Maybe you’ve started napping in the middle of the day or counting down the minutes until bedtime. If this sounds familiar, you may be dealing with fatigue related to your hereditary transthyretin amyloidosis (hATTR amyloidosis).

It’s important to get to the bottom of what’s causing your extreme tiredness so you get back to your normal routine.

In this article, we’ll discuss how hATTR amyloidosis can cause fatigue and what you can do to get relief.

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What Causes Fatigue With hATTR Amyloidosis?

Hereditary ATTR amyloidosis is a rare systemic disease caused by changes in the transthyretin (TTR) gene. These changes create microscopic debris of abnormal or misfolded TTR proteins that form clumps known as amyloid fibrils. When the fibrils become stuck in organs, they can damage different areas of the body.

Although fatigue isn’t discussed as often in relation to hATTR amyloidosis, you may notice fatigue while living with the condition. The damage to multiple organs caused by amyloid fibrils can lead to other health conditions, causing fatigue and interfering with sleep.

Keep in mind that fatigue has many possible causes and your doctor can help you get to the bottom of your tiredness. That said, below are some potential causes of your extreme tiredness.

Heart Problems

In hATTR amyloidosis, amyloid fibrils can become stuck in the heart. This is called ATTR-CM, a type of cardiac amyloidosis. ATTR-CM makes the heart muscle stiffer than normal. This stiffness can interfere with the heart’s ability to relax and fill.

Eventually, the heart may lose strength and become unable to pump as much blood as it normally does to the muscles and brain with every single beat. As the condition progresses, it can lead to heart failure.

Both cardiac amyloidosis and heart failure can cause fatigue. You might notice that activities you once did become extremely difficult and wear you out easily.

Congestive heart failure can also interfere with your sleep. Studies show that many people with heart failure have trouble falling asleep and staying asleep. Without enough rest, you’ll wake up feeling much more fatigued in the morning.

Other signs of heart problems with hATTR amyloidosis to look out for include:

Shortness of breath
Edema (fluid buildup) and swelling in your legs
Dizziness or fainting
Weight loss
Palpitations (racing heartbeat)
Arrhythmias (abnormal heart rhythms)

If you find yourself waking up breathless or feeling completely wiped out after minor tasks like walking to the mailbox, let your cardiologist know immediately.

Kidney Problems

Your kidneys constantly work to filter toxins, waste products, and water out of your blood. This waste is then removed from your body as urine. When your kidneys aren’t functioning properly, it can take a toll on your health.

In hATTR amyloidosis, clumps of abnormal proteins can also form amyloid deposits in the kidneys. The deposits damage the delicate filters within the kidneys, making it harder to filter your blood.

As toxins and waste products build up in your bloodstream, you may feel weak and fatigued. Untreated kidney damage can eventually progress into kidney disease and even kidney failure.

Some people with kidney disease also have trouble sleeping. This is because toxin buildup in the bloodstream can interfere with sleep cycles. Difficulty sleeping can lead to a frustrating loop of fatigue.

Anemia

Your red blood cells (RBCs) transport oxygen throughout your body. They use iron and the protein hemoglobin to carry oxygen to your body’s cells and tissues. When you have low iron levels, you may develop a condition known as anemia.

Anemia has several possible causes, including iron deficiency, kidney disease, and chronic illness. Studies show that some people with hATTR amyloidosis — specifically cardiac amyloidosis — may have low iron levels.

Anemia and heart failure are both associated with fatigue. This is because the cells of your body aren’t getting enough oxygen to fuel their activities. Other signs of anemia include:

Pale skin
Headaches
Brittle nails
Elevated heart rate
Shortness of breath

Some Medications May Contribute to Fatigue

All medications come with side effects, but some may make you more fatigued than others. Check with your healthcare provider or pharmacist about your current treatment plan and never stop or change your medications on your own.

Medications known to increase sleepiness include:

Medications used to treat high blood pressure, like beta-blockers
Antihistamines (allergy medications)
Antidepressants
Antianxiety medications
Antinausea medications
Anti-seizure medications
Prescription pain medications such as opioids

If you think your medications may be causing fatigue, talk to your doctor. Be sure to bring a complete list of everything you take, including over-the-counter drugs and supplements, to your next appointment. Your healthcare team can tell you which medications may be contributing to your symptoms and can adjust the dose or suggest another treatment.

Taking Care of Your Body and Mind

Living with a chronic disease like hATTR amyloidosis can take a toll on your physical and mental health. It’s normal to face some fatigue in your daily life, but you may find yourself struggling with long-term exhaustion.

Talk to Your Doctor About hATTR Amyloidosis Treatments

Simply getting more sleep isn’t enough to treat fatigue. It’s important to address the underlying causes driving your symptoms. If you think your hATTR amyloidosis is the culprit behind your fatigue, your doctor can go over your treatment options.

Several therapies are approved by the U.S. Food and Drug Administration (FDA) to help slow disease progression and ease your symptoms. Examples include TTR stabilizers and gene-silencing therapies, which work at the root cause to halt the production or clumping of misfolded TTR proteins.

Consider Your Mental Health

Talk with your healthcare provider if you need support for your mental health. Some studies suggest that talk therapy helps to treat fatigue if it’s related to issues like stress or anxiety, freeing up valuable mental and physical energy for your day. But talk therapy isn’t a treatment for fatigue stemming from hATTR amyloidosis.

Conserve Energy and Combat Fatigue

On days when your energy battery is running low, you can take extra steps to help get you through the day. Don’t try to push yourself past what your body can do. Be sure to pace yourself and take breaks when needed.

Here are some tips to conserve your energy throughout the day:

Try sitting instead of standing for certain activities like washing the dishes or folding laundry.
Follow a nutrition plan tailored to your needs.
Take short naps or rest periods as needed. The recommended length is 10 to 30 minutes.
Give yourself a certain number of tasks to do within a day that you have the energy for. Don’t try to fight your fatigue.
Limit your caffeine intake for a few weeks and see if your fatigue improves.

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