Parkinson’s and Fatigue: Understanding the Challenge and Finding Effective Solutions

Fatigue is one of the most common and often debilitating symptoms experienced by people with Parkinson’s. It is characterised by an overwhelming sense of tiredness that is not necessarily alleviated by sleep or rest, and it can significantly impact your daily activities. Whether you describe yourself as tired, fatigued, or experiencing excessive daytime sleepiness, understanding the nuances of these conditions is essential to managing your energy levels and maintaining your quality of life.

What Is Fatigue in Parkinson’s?

Fatigue in Parkinson’s goes beyond the normal tiredness that everyone feels. It may be:

  • Physical Fatigue: A deep, persistent sense of physical weariness or exhaustion not relieved by rest.
  • Mental Fatigue: Difficulty concentrating, diminished motivation, and struggling with tasks that require sustained mental effort.

For many living with Parkinson’s, fatigue can emerge early in the disease, regardless of whether movement symptoms are mild or severe. Approximately half of the people with Parkinson’s experience some form of fatigue, and its causes can be multifactorial. It is thought to be linked to motor symptoms (such as tremor and stiffness), sleep disturbances, pain, depression, stress, and even the side effects of medications.

Fatigue, Tiredness and Excessive Daytime Sleepiness: What’s the Difference?

While these terms are sometimes used interchangeably, they describe distinct issues:

  • Being Tired: This is a normal response to a busy day or a lack of sleep. It is usually relieved by a good night’s rest.
  • Fatigue: This is more profound and chronic. It persists regardless of rest and can be both physical and mental. Fatigue in Parkinson’s may not have a singular cause and can be compounded by several factors.
  • Excessive Daytime Sleepiness (EDS): Although it may seem similar to fatigue, EDS involves an overwhelming urge to sleep during the day, which is not fully corrected by nighttime sleep. EDS can be a separate issue that sometimes coexists with fatigue and may be treated differently—for example, through medications like modafinil.

Understanding these differences helps in communicating your symptoms effectively to your care team, ensuring that you receive a treatment plan tailored to your specific needs.

Managing Fatigue: Tackling the Challenge

Managing fatigue in Parkinson’s requires a multifaceted approach. Here are several strategies that can help you conserve energy and improve your daily functioning:

  1. Optimise Your Medications: Work closely with your neurologist and Parkinson’s Nurse Specialist to review your medications. Some medications may contribute to fatigue as a side effect, while others might help to improve motor function and overall alertness. Regular Home Medicines Reviews (HMRS) can ensure that your treatment remains suitable as your condition evolves.
  2. Incorporate Regular Exercise: It’s a vicious cycle, being fatigued and not motivated to move, but engaging in regular physical activity, such as walking, cycling, yoga, or tailored exercise programmes, can boost your energy levels over time. Exercise helps improve cardiovascular fitness, mood, constipation, medication uptake and overall stamina—even if it feels counterintuitive when you are fatigued. Remember, consistency is key, and any movement is better than no movement. See your Exercise Physiologist so your exercise plan is adapted to your comfort and abilities.
  3. Practice Good Sleep Hygiene:
    • Napping Wisely: Short naps (no more than 30 minutes) taken before mid-afternoon can provide a quick recharge without interfering with nighttime sleep.
    • Sleep Routine: Establish a regular sleep schedule and create a restful environment to help ensure restorative rest at night.
    • Address Sleep Disorders: Conditions like insomnia or sleep apnoea should be diagnosed and treated, as they can significantly contribute to fatigue and excessive daytime sleepiness.
  4. Adopt Energy-Conserving Strategies: Think of your energy as a “body budget”—a finite resource that must be managed carefully throughout the day:
    • Pace Yourself: Spread out your physical and mental activities to avoid overexertion.
    • Plan Ahead: Prioritise tasks during times when you naturally feel more energetic.
    • Break Tasks into Smaller Steps: This can prevent feelings of overwhelm and provide frequent breaks to recover your energy.Maintain a Balanced Diet and Stay Hydrated
  5. A nutritious diet can play a significant role in managing fatigue:
    • Low Glycaemic Foods: These help provide sustained energy without the rapid spikes and crashes associated with high-sugar foods.
    • Healthy Fats and Whole Grains: Include plenty of leafy greens, fruits, whole grains, fish, nuts, and seeds in your diet.
    • Hydration: Adequate fluid intake is essential for optimal energy levels. Aim to drink water throughout the day and avoid evening caffienated or alcoholic drinks, as these can disrupt sleep quality.
  6. Consider Medications for Excessive Daytime Sleepiness: If excessive daytime sleepiness (EDS) is a prominent issue, your doctor may consider treatments such as modafinil. However, it is important to have a thorough discussion with your neurologist about the potential benefits and risks, as well as the distinction between treating fatigue and EDS.
  7. Mental Health and Stress Management: Fatigue can be exacerbated by depression, anxiety, and high stress. Psychological support, mindfulness, and meditation can help:
    • Talk Therapy: Speaking with a psychologist or counsellor experienced in Parkinson’s can provide strategies to manage stress and emotional challenges.
    • Mindfulness and Meditation: These practices can help lower stress levels and may contribute to improved energy management.

Who Else Can Help?

Your care team is crucial in managing fatigue effectively. They include:

  • Neurologists: To review and adjust your Parkinson’s medication regimen based on which symptoms you talk to them about.
  • Parkinson’s Nurse Specialists: To provide education and ongoing monitoring of your condition, side effects and symptom changes.
  • General Practitioners (GPs): To assist with overall health management and coordinate specialist referrals.
  • Physiotherapists and Occupational Therapists: To guide exercise routines and energy conservation techniques. Can also prescribe assistive technology and home safety modifications.
  • Dietitians: To help customise a diet plan that supports sustained energy.
  • Social Worker: Can provide various supports and coordination/training.
  • Psychologists/Counsellors: To assist with mental health challenges and stress management.

Fatigue in Parkinson’s is a complex and often misunderstood symptom that can impact every aspect of life. Whether it is physical fatigue, mental fatigue, or excessive daytime sleepiness, recognising the differences is essential for effective management. Through a combination of optimised medications, regular exercise, strategic energy conservation, good sleep hygiene, a balanced diet, and professional support from your care team, you can make strides toward managing fatigue and improving your quality of life.

Taking an active role in your care—through regular Home Medicines Reviews and close communication with your care team ensures that your treatment remains responsive to your needs.

References

Haß, U., Herpich, C., & Norman, K. (2019). Anti-inflammatory diets and fatigue. Nutrients, 11(10), 2315. https://doi.org/10.3390/nu11102315

Johns Hopkins University. (n.d.). How to fight Parkinson’s disease-related fatigue. Retrieved from https://www.hopkinsmedicine.org/

Kluger, B. M., Pedersen, K. F., Tysnes, O. B., Ongre, S. O., Øygarden, B., & Herlofson, K. (2017). Is fatigue associated with cognitive dysfunction in early Parkinson’s disease? Parkinsonism & Related Disorders, 37*, 87–91. https://doi.org/10.1016/j.parkreldis.2017.02.005

Siciliano, M., Trojano, L., Santangelo, G., De Micco, R., Tedeschi, G., & Tessitore, A. (2018). Fatigue in Parkinson’s disease: A systematic review and meta-analysis. Movement Disorders, 33, 1712–1723. https://doi.org/10.1002/mds.27461

Stocchi, F., Abbruzzese, G., Ceravolo, R., Cortelli, P., D’Amelio, M., De Pandis, M. F., et al. (2014). Prevalence of fatigue in Parkinson disease and its clinical correlates. Neurology, 83, 215–220. https://doi.org/10.1212/wnl.0000000000000587

Andrew Huberman Lab. (n.d.). Toolkit for sleep. Retrieved from https://hubermanlab.com/

This article is provided by Parkinson’s Australia to support and empower those living with Parkinson’s. We hope it serves as a useful resource in managing fatigue and maintaining an active, fulfilling life. If you have concerns about fatigue or any other symptoms, please speak to your care team for personalised advice.

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