Fatigue after stroke

June 09, 2014
Fatigue is one of the most common challenges reported by many stroke survivors. Recovering from a stroke, participating in rehabilitation, learning new ways of doing things and adjusting to life after stroke can be exhausting.

Fatigue can present as a feeling of weariness, tiredness, or lack of energy that does not always go away when you rest. People may feel fatigued – in body or mind. Post stroke fatigue can be described as physical, mental or psychological. Some stroke survivors experience all three. With physical fatigue, your muscles may tire easily and your endurance may be much lower. You might notice this when climbing stairs or carrying bags of groceries in from the car. With mental fatigue, it may be difficult to concentrate for as long as before and being exposed to loud noises or crowded environments may exhaust you. Psychological fatigue can also occur due to the emotional changes, depression and anxiety that can be experienced after stroke. In severe cases, you might not feel like getting out of bed in the morning and completing daily activities might be extremely challenging.

Stroke survivors and care-givers need to be patient and recognize that fatigue may be a long-term issue. For some stroke survivors fatigue improves significantly over time, whilst for others it can be debilitating. This may mean that you are unable to return to work full time and while you may look “ok” on the outside, the impact of fatigue may tell a very different story. Sometimes this can be difficult for friends and family to understand and also frustrating for stroke survivors.

Fatigue can cause a range of symptoms including:

• Chronic tiredness or sleepiness

• Headache or “brain fog”

• Dizziness

• Sore, aching or weak muscles

• Reduced quality of walking and poor balance

• Slowed reflexes and responses

• Impaired decision-making and judgement

• Moodiness or irritability

• Impaired coordination

• Loss of appetite

• Reduced immune system

• Blurry vision

• Increased pain

• Memory problems

• Poor concentration

• Reduced ability to pay attention

• Overwhelm, anxiety or depression

• Feeling out of control or helpless

• Low motivation.

Here are some suggestions which may help with your fatigue:

• Listen to your body and know your limits. Notice what activities increase your fatigue and spread them out throughout the day or across the week.

• Plan regular rest breaks during each day. Rest may mean sitting down in silence, stopping for a drink of water, doing some deep breathing, listening to some relaxing music or having a lie down.

• Break one large task into several smaller tasks. For example, you may choose to vacuum one room at a time and spread the task across the week.

• Get to know any patterns to your fatigue. Plan activities for when you have the most energy. Keeping a fatigue diary can be helpful.

• Do tasks in a way that uses the least amount of energy. For example, sit down on a shower chair to shower or get dressed seated on the edge of the bed. This uses less energy than standing. This strategy is called energy conservation.

• Prioritise – on days when you feel tired only do the tasks which are most important to you. Some tasks may have to wait.

• Have a good sleep routine. Try going to bed at the same time each night and switch off electronic devices at least an hour before bed.

• Eat a healthy diet filled with fresh vegetables and fruit to fuel your body and promote healing. Drink adequate amounts of water to stay hydrated. You may need to eat regular snacks throughout the day. Low kilojoule diets, low carbohydrate diets or high energy foods that are nutritionally poor don’t provide the body with enough fuel or nutrients to function at its best. Quick fix foods, such as chocolate bars or caffeinated drinks, only offer a temporary energy boost that quickly wears off and worsens fatigue.

• Even if you feel tired it’s important to do some exercise or physical activity in your day. This will help stimulate the good endorphins and help with mood. Talk to your physiotherapist about an appropriate exercise program. Build up stamina and strength slowly and sensibly.

• Talk to your doctor about your medications. Some medications, especially those with a sedating effect, can increase fatigue.

• Avoid drinking excessive amounts of alcohol. Drinking will increase your fatigue and can also exacerbate any impairments you have as a result of the stroke, such as impaired balance. Alcohol slows the nervous system and disturbs sleep patterns. Other drugs, such as cigarettes and caffeine, stimulate the nervous system and can cause insomnia.

• Ask for help! You don’t have to do everything yourself. You may decide to arrange a cleaner so you have more time to spend with your children.

• Celebrate your success and be kind to yourself. Lower your expectations of yourself while you are adjusting to life after stroke and your new “normal”. Surround yourself with supportive friends, family and other stroke survivors who have been or are going through a similar situation.

“Fatigue has always been present and each new major challenge in my life seems to set me back in a major way fatigue-wise. I no longer sleep every afternoon like I did in the first 6 months but need to take chunks of time out of my day to decompress and days out of my week to rest.” Karen Bayly – stroke survivor.

If you are struggling with fatigue after stroke please speak to your doctor or rehabilitation team. An occupational therapist can work with you to minimise the impact of fatigue on your daily life and discuss appropriate strategies. You might be tempted to dismiss how you are feeling or stoically carry on regardless. However, if you do ignore fatigue, it can lead to more serious problems in the future and you will not be giving yourself the best opportunity to recover. Remember you are not alone. You can also call StrokeLine on 1800 STROKE (787 653) to discuss or to request a copy of our fact sheet on fatigue.