Parkinson’s Fatigue

Overview – Around 50% of people with Parkinson’s experience fatigue at some point and many patients say it affects their quality of life more than any other Parkinson’s symptom. Parkinson’s fatigue is more than simply feeling tired after a long day or a few days of bad sleep – it is a deep exhaustion or absence of energy that makes movement challenging. Simple daily tasks like showering, making breakfast, or even getting dressed feel impossible. Parkinson’s fatigue is sometimes characterized by mental exhaustion, sometimes called apathy, which affects concentration and hinders a person’s ability to start a task and follow directions. It can also impact memory. 

Diagnosis – Fatigue is a challenge, but medical and lifestyle interventions can help. The first step is accurately diagnosing the cause of fatigue. Your doctor may send you to a sleep specialist or conduct blood tests to rule out other causes of fatigue. Insomnia, sleep apnea, or even imbalances in your diet could contribute to fatigue symptoms. Once other causes have been ruled out, there are a few reasons why someone with Parkinson’s may experience fatigue. Knowing the cause helps determine the treatment plan: 

Biology – In the same way that brain changes cause movement symptoms like tremor, muscle stiffness, and rigidity, those brain changes can also cause fatigue. In this case, the fatigue is not a symptom of physical or sleep changes, but a symptom of Parkinson’s itself. 

Lifestyle – A sedentary lifestyle can lead to an increase in Parkinson’s fatigue. People with Parkinson’s should exercise at least 2.5 hours a week (or 30 minutes a day five days a week) to improve quality of life and combat fatigue. 

Medication – Certain Parkinson’s medications, like dopamine agonists Mirapex and Requip, can cause daytime sleepiness or fatigue. If these side effects impact your life severely, you can consider reducing these medications. However, be thoughtful about whether the symptoms they treat are more uncomfortable than the side effects they cause. 

Akinesia – Akinesia is difficulty with starting a movement or task, which often feels like fatigue. You may move slowly and struggle to finish a task like washing dishes or getting dressed at a normal pace. You may have to concentrate harder on daily living tasks. Akinesia is sometimes associated with medication “off times.” Keep track of when akinesia is better or worse, and try to plan your high-energy tasks during “on-times” to reduce fatigue. 

Muscle Fatigue – Symptoms like dyskinesia, muscle stiffness, tremor, and cramping put significant stress on the musculoskeletal system. Constant shaking can cause muscle fatigue, while stiffness and rigidity can lead to muscle atrophy (loss of muscle strength) which reduces stamina. Medications used to treat motor symptoms can

help with muscle fatigue, but a regular exercise program is the best medicine to keep your body well-conditioned. Daily exercise has been proven to reduce fatigue. Insomnia – Sleep disorders like sleep apnea and restless leg syndrome cause daytime sleepiness. Likewise, people who struggle with insomnia often experience fatigue. Sleep disorders are a common symptom of Parkinson’s – if nighttime sleeplessness is a problem, do your best to avoid naps during the day, despite your fatigue. 

Mobility Changes – “On” and “Off” times affect your ability to move throughout the day and are closely related to when and how often you take your medications. Keep track of when you have the most and least energy and plan your activity, appointments, and social events accordingly. Be sure to space out your activity throughout the day; trying to get everything done in the morning, for example, can lead to exhaustion and fatigue in the afternoon. Build rest periods into your schedule throughout the day. 

Depression – About 50% of people with Parkinson’s experience depression at some point. Fatigue is a symptom of depression characterized as lack of motivation, exhaustion, or absence of energy. Medications and counseling can be used to combat depression fatigue. It’s also important to build socialization opportunities into your life. 

Combatting Fatigue – Existing Parkinson’s medications do not combat fatigue, although levodopa has been shown to slow the worsening of fatigue over time. Currently the best therapy for fatigue is exercise. Lifestyle adjustments are also helpful. Consider keeping track of your fatigue. Pay attention to factors like: When do I feel fatigued? How long do I feel fatigued? Does my fatigue change when my Parkinson’s symptoms fluctuate? Does my fatigue change when I take my medications? This can help you identify trends in your fatigue and adjust your medication or lifestyle accordingly. Additionally: 

● Maintain high levels of mental activity to combat boredom, which leads to fatigue

● Schedule adequate time for rest in your daily activities 

● Plan your difficult or high-level tasks during “on” times 

● Know your limits – be cautious of scheduling too many activities in your “on” time

● Accept help – reach out to your community for support with taxing activities

● Discuss fatigue with your medical professional to problem solve acute symptoms 

Conclusion – fatigue is a challenging symptom of Parkinson’s. The best way to combat fatigue is to exercise and stay active, but remain practical about when and how much you can do. Involve your medical team to rule out other causes of fatigue and to develop practical or medical solutions. Be your own advocate!