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Understanding Fatigue After Stroke: Causes, Symptoms, & Management

woman sitting on couch demonstrating fatigue after stroke

Fatigue after stroke differs from normal tiredness. While some people with fatigue feel better after a nap, stroke survivors with fatigue might not feel energized even after a full night’s rest or daily naps.

Post-stroke fatigue can affect anyone: young or old, active or sedentary, male or female. Fortunately, there are ways to combat fatigue so that you can stay motivated on the road to recovery.

To help you feel better, this article explains the causes of post-stroke fatigue and how you can manage it.

Causes of Fatigue After Stroke

The exact cause of post-stroke fatigue varies from person to person.

One example from the Stroke Association is that the body uses energy differently after a stroke. For example, if a leg has become difficult to move, then it will take more energy to move around. Alternatively, it will take more energy to use your arm for daily activities such as dressing and cooking if the arm has been affected.

Fatigue after stroke could also be a secondary condition that stems from other stroke-related complications. For example, if you struggle with post-stroke pain, that requires an enormous amount of energy to cope with. This can deplete energy levels quickly, leading to post-stroke fatigue.

Furthermore, fatigue after stroke could also be the result of emotional factors. Grief, depression, and other emotional changes after stroke can each contribute to fatigue in their own way.

On the other hand, age and physical fitness levels before stroke are not directly correlated with post-stroke fatigue. Although women and older individuals are more likely to experience post-stroke fatigue, it’s even possible for a young “fit” male stroke survivor to experience more fatigue than the average person.

Also, the size of a stroke is not correlated with the severity of post-stroke fatigue. Someone that survived a massive stroke could have little fatigue, while a mild stroke survivor may feel tired all the time.

With so many factors, how do you know if you suffer from post-stroke fatigue?

Quick Summary

When it takes more energy to move your body or cope with emotions after stroke, it can contribute to post-stroke fatigue.

What Post-Stroke Fatigue Feels Like

Post-stroke fatigue is different from simply feeling tired after a long day.

Some patients with post-stroke fatigue report “hitting a wall” where their energy levels crash. It can happen after certain activities or suddenly throughout the day.

It’s possible for stroke survivors to feel fatigue even after waking up from a long nap. That’s because post-stroke fatigue doesn’t always improve with rest.

If you find yourself struggling with fatigue after stroke, you’re not alone. This is one of the most common stroke side effects, affecting 39-72% of stroke patients.

Post-stroke fatigue is also associated with physical disability, likely because low energy interferes with rehabilitation.

Fortunately, by understanding the causes of fatigue after stroke, you can identify ways to relieve the symptoms.

Quick Summary

Fatigue after stroke can result in crashing energy levels throughout the day, and it's not always associated with demanding activities.

Managing Fatigue After Stroke

Here are some tips that can help you cope with post-stroke fatigue:

1. Talk to your doctor

Fatigue is common during inpatient rehabilitation where you’re working hard for hours each day. But if fatigue is still affecting you after discharge, then it’s important to talk to your doctor. They can diagnose your condition and suggest methods for treatment.

2. Check your medication for side effects

Sometimes fatigue is a side effect of certain medication. Check to see if fatigue is listed as a side effect on any of your medications. If so, talk to your doctor. They may be able to switch medications, or offer other ways to improve fatigue.

Even if you’re fairly certain your medication is contributing to your fatigue, always talk with your doctor before making any medication changes.

3. Conserve your energy

An occupational therapist may be able to educate you on energy conservation strategies to use to limit post-stroke fatigue. These strategies involve simple changes that you can make to your daily routine that may help you to conserve energy and avoid fatigue.

The 4P’s  of energy conservation are:

  • Prioritize which activities are most important to complete.
  • Plan the best way to complete those activities (e.g. making a grocery list before shopping or cooking enough food to have leftovers).
  • Pace yourself by spacing out more taxing activities throughout your day and week.
  • Position (or posture). Pay attention to your positioning. Try to perform more activities while sitting, as it requires less energy than standing.

Be mindful of your rehabilitation exercises or household chores. Try not to do too much at once, otherwise you might aggravate your fatigue.

Sometimes post-stroke fatigue has delayed onset. If you push hard one day, you may experience fatigue the next day. To prevent this burnout, take breaks throughout the day and stay mindful of your energy.

4. Keep an energy journal

Keep a journal of your activity levels and energy levels. You may find patterns, like feeling fatigue the day after lots of activity. Then identify a nice balance of recovery-boosting activity and rest, and stick to it.

5. Improve your stamina

Exercise is a surprising solution for post-stroke fatigue. Even though exercise takes energy, it could help build stamina and reduce fatigue long-term.

One study suggests that treadmill training “lowers the energy cost of hemiparetic gait.” When it takes less energy to move around, it could help relieve fatigue after stroke. Start slow, and increase your duration gently.

6. Eat well

Your diet has an impact on your energy levels. For example, consuming sugary foods causes blood sugar to spike and then drop, which causes tiredness and a “crashing” feeling. To avoid diet-induced fatigue, focus on eating healthy foods for stroke recovery like vegetables and whole grains.

7. Sleep!

Neuroscientist Jill Bolte Taylor suggests sleep as her #1 recommendation for stroke survivors. When the brain is busy recovering, sleep is one of the best ways you can aid recovery. While post-stroke fatigue doesn’t always improve with sleep, it’s still good to get plenty of rest. Sleep allows the brain to recover.

8. Focus on one thing at a time

Multi-tasking is an energy drain, mentally and potentially physically as well. While some stroke patients report that they cannot multitask to begin with, it’s important to stay mindful of your attention. To reduce fatigue after stroke, it’s best to slow down and do things one at a time.

9. Manage emotional changes

Post-stroke fatigue could be a combination of physical and emotional factors. Depression and anxiety are common among stroke survivors with fatigue. Seeking treatment for mood disorders like depression can help relieve fatigue. When you spend less energy struggling with emotions, there’s more left for rehabilitation.

Getting Support for Post-Stroke Fatigue

If you struggle with post-stroke fatigue, reach out for help from your medical team.

Your doctor may be able to adjust your medication if fatigue is listed as a side effect of any current prescriptions.

If you have demanding secondary effects, like post-stroke pain or paralysis, your therapist might be able to help. For example, they can try electrical stimulation to see if it helps accelerate recovery.

Ultimately, you should experiment with as many treatments as possible until you find something that helps you. Remember to pace yourself and rest when you need it. Good luck!

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