May 12, 2014

Fatigue and Stroke, aka I'm Hittin' the Wall

(This post is not only for stroke survivors. It is for caregivers, family, friends, health professionals, and others who want to understand fatigue and stroke).

I always pushed myself to the limit. I was like my father, who was shot in his auto parts store by some robbing druggies in 1971 and died on the spot, putting an end to his boundless energy. He worked twelve hours a day, seven days a week, and yet, when he returned home, he ate dinner at 8pm, and sometimes went out again, and always on the weekends, with my mother, who was a stay-at-home mom and had to deal with my boundless energy.

But now that I've had a stroke, my energy has boundaries. All my friends will tell you. I get an entire list of the things I want to do in a day, but I'm always changing the schedule because when it comes to the list, I'm just too damned tired to finish all of it. Why is that? I wanted to know, and I found out a whole lot.

Everybody feels tired at some point. It's the body's way of saying, "Slow down and rest awhile." But the National Stroke Association (NSA) says that post-stroke fatigue (PSF) affects as much as 70 percent of stroke survivors. PSF happens without warning and happens as much as years after the stroke. PSF is not just feeling tired and wanting to take a nap. With PSF, you have to take a nap.

The NSA identified 3 types of fatigue for stroke survivors:

Cognitive (ex: mental fatigue, difficulty focusing, delirium)

Physical (ex: function limitations, spasms, pain, muscular weakness, interrupted sleep)

Emotional (ex: motivational deficits, depression, crying and laughing at odd intervals)

I encountered all of them. On the cognitive 
side, I still have mental fatigue and usually rest once a day; just resting, not necessarily napping. I seldom have difficulty focusing, and deliriums only the first year. I have all of the physical ones randomly, except for function limitations all the time. I have right-sided weakness—a paralyzed arm and I walk with the aid of a quad cane. As for emotional fatigue, I am still, somehow, motivated, but I had depression the first year and off and on since then, and less now. I cried and laughed at the wrong times and places, but that confusion went away after two years.

Aside from different types of fatigue, some medications may point to or worsen fatigue. The medication dosage, the time of day of the medication, or the actual medication itself may need to be adjusted.

Be aware of time and place. Loud stimulation such as music and crowds can be overwhelming for a stroke survivor and bring on fatigue. Some survivors keep a diary of the times a places where fatigue occurred--hand-written or recorded--and if that's so, don't take this diary lightly. Remember, a stroke survivor doesn't want to take a nap; they have to take a nap.

Look for which activities have the greatest impact on stamina, or energy level. (The ones in parentheses are my reactions). Is it watching a sports events? (If the team is winning, go team!) Going shopping? (Absolutely nothing gets in the ways of shopping, especially for clothes). Having a meal? (I didn't fall asleep during a meal. Ever).

The top 10 foods, according to the NSA, that can help ward off fatigue include:

1.   Walnuts
2.   Pumpkin seeds

3.   Quinoa
4.   Yogurt
5.   Whole grains
6.   Wheat bran cereal
7.   Red bell peppers
8.   Tea
9.   Watermelon
10. Dark chocolate

But listen up! Every stroke, just like snowflakes, as the yarn goes, is different. As for me, once I found this list a while ago, I eat them all except pumpkin seeds. They make me cough. And I don't take as many naps every day since.

According to, survivors expend more-than-normal energy to do everything.

“You may have less energy than before because of sleeping poorly, not getting enough exercise, poor nutrition or the side effects of medicine. You have as much energy as before, but you’re using it differently because of the effects of your stroke. Things like dressing, talking, or walking take a lot more effort. Changes in thinking and memory take more concentration. You have to stay 'on alert' all the time--and this takes energy,” says the association.

In an article entitled “Post-stroke Rehabilitation: Fatigue After Stroke,” Ed Koeneman says, “The medical conditions of a survivor, such as diabetes, heart disease, anemia, respiratory disease, migraines, or pre-stroke fatigue can contribute to a [stroke] survivor's post stroke fatigue. This is because the stroke itself or the side effects of stroke medication may worsen the survivor's fatigue.

"Sleep apnea is also relatively common among stroke survivors and is reported in high rates among individuals who report fatigue after stroke. However, no solid relationship has been proven," says Koeneman.

 And there it is--"no solid relationship has been proven." My belief is that stroke fatigue falls to the back burner, but use the suggestions in this post. They may help. One reader, a stroke survivor, wrote, “Every time I turn the television on and water the plants with one hand simultaneously, I get re-energized.” Good for you, C.L. Whatever works.

In collaboration with


wendy said...

A good post . I had/have ongoing mini strokes that have taken their toll. I also went through depression and get very tired.

Joyce Hoffman said...

Life sometimes gives you curves! I wish you the best!

sasha jones said...

I am 2 years out and noticing fatigue more now than when i 1st came home? I TOLD MY DOCTOR: im tired, he said i was depressed?

Joyce Hoffman said...

Sasha: You are tired from all the extra effort you put in things--getting dressed, walking across the room, and yes, depression makes you tired, too.

Kim Black said...

Thank you for posting this my father had a stroke and has been home for 2 weeks and sleeps a lot. His first doctor's checkup is tomorrow but I was getting real worried. You have made me feel better knowing that this is common. Thanks for the info.

Joyce Hoffman said...

Kim Black, that's my self-appointed job, to make stroke survivors realize that what happens to one, happens to many. Thanks for your comment.

Huckleberry Harrod said...

Another thing - if you have a brainstem stroke, it maybe that the 'reticular formation' has been damaged. This complex 'net-like' structure is said to control consciousness, alertness and sleep patterns. It also has many other functions. Myself I had a stroke in the medulla & think maybe this is the cause of my debilitating fatigue. After 2 to 3 hours of being awake I need to rest and shut down, sometimes falling to sleep. I have tried battling with this, but normally end up 'wiped out' if I push myself too much. I shall try eating some of the food mentioned in your post! Thanks!

teacupg said...

I had a brainstem stroke 4 years ago. I was paralyzed on my left side, had 6th Cranial nerve
deficit - which caused double vision; and also had difficulty with speech, swallowing, sleeping, and spasticity. It has taken a lot of work to get
better. I no longer have double vision, or have swallowing difficulty. Limited mobility and fatigue
have changed my life. It can be quite isolating.
I dream of walking normally again. Good to know that other stroke survivors are out there.

Lyndy said...

Not only stroke victims, I had a brain aneurysm rupture and then repair surgery of nine plus hours. That was 2001 and fatigue became part of my life. Have had to fight against it almost daily. I look fine so people think I am fine. So not the case.

Paul Hoffman said...

I run a FB Stroke group "Stroke Recovery Trials & Tribulations", about 350 members...either those recovering from brain injury or their caregivers/loved ones. Fatigue is experienced by almost all! Said by a 6+ year post stroke, from my afternoon recliner