The motor symptoms of Parkinson’s disease (PD) are often the most recognized and treated, but the non-motor symptoms can have just as significant an impact on everyday life. One of the most common and overlooked of these symptoms is fatigue.
Fatigue in PD is more than just feeling tired after a busy day. It can be an overwhelming lack of physical or mental energy that makes everyday activities more difficult. It is also a symptom that may not go away even after getting ample sleep or taking breaks from activities. It is important to understand why fatigue occurs and recognize factors that may make it worse in order to start working toward managing it.
Fatigue is Not The Same as Sleepiness
Even though fatigue and sleepiness can occur together, they are not the same thing. Someone who experiences excessive daytime sleepiness may have difficulty staying awake during daily activities, but fatigue on the other hand is characterized by a lack of energy or the feeling that physical or mental activities require excessive effort.
For people with Parkinson’s, fatigue can appear in different forms including:
- Physical fatigue: walking, exercising, household chores, or other physical activities may feel unusually difficult or require extra energy
- Mental fatigue: concentrating, decision-making, reading, or remaining engaged in activities for long periods of time may become excessively difficult
- Mixed fatigue: many people experience physical and mental fatigue at the same time, as one can exacerbate the other
Recognizing these differences is important because the causes and strategies for managing them may differ in each individual case.
Why Does Fatigue Occur in PD
There isn’t just one explanation for fatigue in PD. In fact, any individual may have more than one factor that causes their fatigue.
Parkinson’s may involve changes in the brain systems involved in attention, motivation, alertness, and sleep, which all can contribute to fatigue. PD can indirectly affect the amount of energy required to complete everyday activities as well. The common motor symptoms of PD such as stiffness and slowed movement can make everyday tasks such as getting dressed or preparing a meal much more physically demanding.
Some other factors that may contribute to fatigue include:
- Poor sleep (due to sleep disorders associated with PD)
- Depression/anxiety
- Pain
- Low blood pressure
- Medication side effects
- Physical inactivity
- Other medical problems such as anemia or nutritional deficiencies
Given there are so many factors that can contribute to fatigue, it is best to talk with your doctor to delineate the cause or causes. Once fatigue has been identified, the next course of action is to work on strategies to manage it.
Strategies to Manage Feelings of Fatigue
Exercise
You may think that if you increase your physical activity, you will be more tired, but in fact maintaining regular physical activity is an important part of keeping up strength, endurance, mobility, and overall function in PD. The more inactive a person is, the more they lose strength and endurance, leading to a negative cycle where fatigue can get worse with everyday activities.
The key is finding the right balance. Start exercise gradually and slowly increase. Break exercise into short sessions or schedule it for times of the day when your energy is at its highest. Coordinate your exercise for times when your PD medications are working the best.
Finally, work with a physical therapist familiar with PD to develop a safe and suitable exercise program to make sure it is challenging enough to provide benefit, without leaving you more fatigued the rest of the day.
Prioritize Better Sleep
There are a variety of sleep problems that are common in PD, and they can contribute substantially to prolonged fatigue. These include insomnia, restless leg syndrome, and sleep apnea. In addition, some PD motor and non-motor symptoms can interrupt sleep, including stiffness, tremor, and frequent urination. Talk with your doctor about treating these nighttime PD symptoms to help improve sleep.
Finally, maintaining a consistent sleep schedule and creating a comfortable sleep environment can be critical to improving sleep.
Review Medications
Many different medications – both for PD and for other medical problems – can contribute to fatigue, so review all your medications with your doctor. Sometimes changing the timing of a medication so that it is taken before bed, for example, can be helpful to mitigate the side effect of fatigue.
Check for other medical problems
It is important to note that some medical problems such as anemia, thyroid disease, and vitamin deficiencies can cause fatigue. Your health care provider should screen for these conditions if you are complaining of fatigue. Neurogenic orthostatic hypotension (NOH), or episodes of low blood pressure particularly when you change head position (i.e., stand from a seated position), is a common non-motor symptom of PD. NOH can cause episodes of decreased blood flow to the brain and contribute to fatigue. If you have this non-motor problem, there are lifestyle modifications such as increasing fluids and salts, using compression stockings, and taking prescription medications that can help maintain blood pressure. It is very important to note that depression, which is also an extremely common non-motor symptom of PD, can contribute to fatigue. Therefore, depression needs to be screened for and treated.
There are no medications approved to directly treat fatigue in PD. Medications such as modafinil and methylphenidate have been investigated, but the evidence for directly treating fatigue in PD patients is very limited. Light therapy has been tried with some success for these symptoms. The mainstay of treatment for fatigue usually focuses on addressing contributing conditions and implementing behavioral and lifestyle strategies to combat it.
Track Your Fatigue
It is important to keep track of fatigue to help your doctor understand how to best treat it. Ask yourself the following questions:
- Does the fatigue appear after taking medication?
- Is it worse during “off” periods?
- Does it follow a poor night of sleep?
- Does physical activity make it better or worse?
These answers can help distinguish fatigue from other symptoms and help address other treatable problems as well. Fatigue can be a very difficult symptom of PD, and it is important to identify it correctly and implement the right combination of interventions to help provide the best quality of life.
Tips & Takeaways
- Fatigue is a common non-motor symptom of PD
- Fatigue is different from sleepiness and may not improve with rest
- Look for contributing factors such as poor sleep, medications, depression, and other medical conditions
- Regular exercise can improve strength and endurance to help reduce fatigue
- Talk with your healthcare team about your fatigue to identify potentially treatable causes and develop a plan to improve quality of life
- Tracking your fatigue and what makes it worse – and sharing that information with your doctor – can really help your doctor create a treatment plan that is best suited for you
This blog was written by Clark Jones, PhD, and was reviewed, edited, and approved by Dr. Rebecca Gilbert.