Fatigue is more than a feeling of tiredness. It is typically described as extreme tiredness, exhaustion or a complete lack of energy which limits what you are able to do and affects quality of life. Pathological fatigue is that fatigue which interferes with day to day activities, such as work, social life. It is not relieved by simple rest. Fatigue and sleepiness are often confused but are separate symptoms. Sleepy people may fall asleep at inappropriate times whereas people with fatigue need to rest but they generally do not fall asleep during the day.
Fatigue can be a normal physical, mental or emotional reaction to working too hard or being under stress but it is also a symptom of many illnesses. It can sometimes be difficult to work out the cause. Whilst fatigue can range from a degree of slight tiredness to exhaustion, it is considered to be indicative of an underlying disease when it disrupts daily activities.
Fatigue and Parkinson's
Fatigue is one of the most common symptoms of Parkinson’s, with various studies confirming that the majority are affected. Each person’s experience will be different; some cope well with it whilst others find it quite disabling. Fatigue can occur at any time, fluctuating in severity from day to day and even hour to hour.
There is no correlation between fatigue and the severity of Parkinson’s, or how long a person has had the condition. People who are newly diagnosed are just as likely to experience fatigue as someone who has had Parkinson’s for a long time, and the severity may be the same in both cases. Fatigue may be accompanied by memory or cognitive difficulties, dementia or muscle weakness.
It is important to recognise fatigue and find strategies to manage it so as to minimise the impact on quality of life. If you experience fatigue you may feel less inclined to pursue your usual hobbies and activities. You may also feel you cannot continue working, particularly as stress is likely to worsen fatigue and it can then be difficult to concentrate for long periods of time. It is important though to continue social activities to avoid becoming withdrawn or losing stamina and fitness. So try to keep as active as possible. Friends and family can also help by encouraging you with this.
What causes fatigue in Parkinson's?
The precise mechanisms that cause fatigue are unclear but research suggests that any neurological disorder which involves the basal ganglia area of the brain is likely to be associated with significant fatigue. This includes Parkinson’s.
In some cases Parkinson’s medication may be a factor, for example dopaminergic medications may affect sleep and so add to fatigue. Dosage and timing of medication may also affect energy levels.
Fatigue may be linked to other Parkinson’s symptoms, for example depression. With depression there is usually also fatigue, as well as loss of motivation, a general lack of interest and difficulty in sleeping. It is important that these symptoms are recognised as they are very treatable, and overcoming them can reduce fatigue.
If you experience tremor, rigidity or dyskinesia your muscles will have to work harder in order to carry out simple movements or tasks which can mean muscles fatigue more quickly and easily. Slowness of movement (bradykinesia) may also increase fatigue by making activities and tasks more prolonged.
You may have sleep problems and poor quality sleep tends to lead to excessive day-time sleepiness and a tendency to ‘nap’. Although sleepiness is a separate symptom to fatigue, it clearly adds to the problem and fatigue is hard to overcome if you are sleepy.
How is fatigue treated?
Although fatigue is common in Parkinson’s, it has often been rather neglected by doctors. There are numerous causes of fatigue that are unrelated to Parkinson’s but these still need to be recognised for treatment to be successful.
You should first talk with your doctor or specialist to let them know how fatigue affects you and what changes you have noticed over recent months. They will then carry out any tests they feel are appropriate.
Medication: If your doctor suspects that your Parkinson’s treatment is a factor they may recommend a change in medication so that symptoms are better managed, which should give you more energy.
Sleep: It is important to understand the reasons for poor sleep and to treat symptoms that disturb your sleep pattern. For example tremor, stiffness or restless legs may interrupt your sleep, or you may need to use the toilet at night. Your doctor will be able to suggest ways to manage these symptoms and so improve your sleep and reduce fatigue.
Depression: If you experience depression your doctor may suggest a course of appropriate antidepressant medication or may recommend counselling, cognitive behavioural therapy or relaxation therapy. It is important to manage anxiety and stress too as these can worsen fatigue. Your doctor may suggest medication to help with this.
Apathy: Fatigue may imitate a condition known as apathy, which is increasingly recognised in Parkinson’s. Apathy can lead to a loss of interest in activities that have been previously enjoyed. Like depression, apathy needs to be diagnosed so it can be treated.
Lifestyle: Advice to improve fitness through regular daily exercise may be useful. Depending on where you live, you may be referred to an occupational therapist or physiotherapist specially trained in the management of fatigue who can suggest a personal programme of activity and relaxation. In some countries your doctor may refer you to specialist community teams who help people manage chronic fatigue syndrome and can advise on fatigue disorders.
Advice on sleep hygiene or weight reduction may also be considered if appropriate.
General physical activities, together with social activities and mental activities, play an important role in overcoming fatigue. So the more energetic you are, both mentally and physically, the less likely it is that fatigue will become intrusive.
How can I help myself?
The general rule is to keep as mentally and physically active as possible. The following suggestions may be helpful:
Plan your most vigorous activities around when your medication is most effective. You may find keeping a symptom or medication diary helpful for timing when you are likely to be more mobile and energetic.
Learn how to pace yourself, taking regular short rests and periods in which to relax throughout the day.
If tasks are complicated or likely to take time, break them down into smaller stages so that you can rest between each stage, Share tasks if you live with someone and make use of labour saving devices such as a dishwasher or microwave.
Recognise your limitations, identify the priorities of the day and get to know your energy reserves.
Plan your major activities in advance and ensure that you have time for recovery afterwards. For instance, if you have a big social function such as a wedding, rest more in the days leading up to the event and also plan to have a few restful days afterwards.
If you work, talk with your employer to see if you can take regular short breaks, even if it’s only to make a drink or talk with colleagues
Diet and exercise:
If possible, ask a specialist occupational therapist or physiotherapist with experience in managing fatigue to help plan a regime that suits you.
Build up stamina slowly. You are more likely to stick to a regime that is sensible and steady
Mental exercise is also important so keep hobbies and interests going so that your brain also keeps fit.
Eat a healthy diet. Some people find small but frequent snacks improve energy levels. A balanced diet also helps if constipation is a problem. Constipation can make you feel lethargic so it’s important to treat bowel problems. If you are worried or need advice about your diet, ask your doctor if he can refer you to a nutritional therapist or dietician.
Sleep and rest:
Keep to strict sleep hygiene principles, that is a regular bedtime, regular hours of sleep and avoid day-time napping. If you must nap, try to keep it under an hour.
Caffeine and tobacco are stimulants and should be avoided in the evenings as they can interfere with sleep. You should avoid excessive alcohol but social amounts of alcohol can act as a relaxant.
You may find you feel fatigued after a large lunch. A short nap may help with this, or you could try having a smaller, lighter meal at lunchtime.
Incorporate time for relaxation into your daily routine and try to manage stress and anxiety as these can affect fatigue. Formal relaxation training can help, as may activities such as yoga, aromatherapy, light massage, long baths, light reading, relaxation tapes etc.
Maintain as many of your interests as possible – this helps with morale and wellbeing, which can help with alleviating fatigue.
Remember that fatigue won’t disappear overnight but with time and a considered approach you should be able to recognise your limitations and manage it more effectively. Achieving a good balance between rest and activity will help you handle fatigue in general and so improve your quality of life.
Our thanks to Parkinson’s UK for permission to use the following source: