Is it normal to be tired after a stroke

The Norwegian version of the BI has demonstrated validity and reliability in stroke patients [ 38 ]. The instrument consists of 21 groups of four statements by severity of the symptom 0—3 , where the patient is required to select one in each group. The best possible score is 0. The BDI-II has been found to be an acceptable screening instrument for depression in stroke patients [ 40 ]. Body mass index was calculated as weight in kilograms divided by the square of the height in meters. Patients who reported fatigue lasting longer than three months before the stroke were defined as having prestroke fatigue.

For each time point, the fatigue scores were analysed for possible differences between the groups by a linear regression controlling for similar covariates as in the two-way ANOVA analyses. A Rasch measure of the FSS-7 [ 30 ] was used when FSS-7 scores were treated as a continuous variable; the mean scores are presented in the text and figures for ease of interpretation.

Informed written consent was obtained from all patients. The mean age for the whole cohort was Compared with the women, the men were more likely to have higher education, be in a paired relationship, and belong to a higher social class see Table 1.

Clinical characteristics at baseline are shown in Table 2 for the 95 participants who completed all four time points. A previous report from the baseline data on the entire sample [ 6 ] showed that, except for a higher proportion of circulatory diseases and higher proportion of cases with severe fatigue among women, there were no differences in clinical profiles between men and women.

The level of physical functioning at baseline ranged from 0 to , and The depression scores ranged from 0 to 22 and 26 participants Twenty-six of the patients The mean FSS-7 scores by sex for the different time points are shown in Figure 1. No sex difference in fatigue scores was found when separate analyses of fatigue scores for each time point was assessed in separate multivariate linear regression analyses.

The course of fatigue among patients with low versus high scores on depressive symptoms is shown in Figure 2. Mean scores for the course of fatigue among patients with and without prestroke fatigue are shown in Figure 4. To our knowledge, this is among the first studies describing the course of fatigue in patients with first-ever stroke. Longitudinal studies on poststroke fatigue have mainly reported the prevalence of poststroke fatigue at different time points [ 13 , 41 ], and findings from previous studies are contradictory.

While an increase in prevalence of fatigue during the 18 months after a stroke has been reported [ 13 ], other studies find a lower prevalence [ 41 ]. The important new finding from our study is that patients report different trajectories of fatigue depending on their experience of prestroke fatigue and their level of physical functioning in the acute phase.

These two clinical factors independently predicted the long-term course of fatigue in our sample. The relationship between prestroke fatigue and poststroke fatigue has previously been reported in cross-sectional studies [ 5 , 6 ]. However, a new finding from our study is that patients who reported prestroke fatigue showed a relatively high level of fatigue over time in the poststroke period, while patients with no history of prestroke fatigue showed a stable course of relatively low fatigue over time.

When studying poststroke fatigue, it is important to take into consideration that the prevalence of fatigue in the general population is relatively high, and that fatigue measured in the early period after a stroke may not necessarily be caused by the stroke. When the course of fatigue among patients with or without depression was assessed in our study, the differences in fatigue levels observed at the acute phase and at six-month follow-up were not evident 12 months after stroke.

Another study [ 17 ] showed that depressive symptoms had a tendency to predict fatigue at one year after stroke. Direct comparison between these studies is complicated because one of the studies included patients with recurrent stroke [ 42 ], while the other study had patients from a rehabilitation clinic [ 13 ] where the patients might have more impairment.

Although several studies have shown that depression is related to high levels of fatigue [ 10 , 13 — 15 , 23 ], this association does not seem to be evident from a longitudinal perspective.

It is possible that both fatigue and depression are common responses to the experiences of the acute phase of stroke, with a positive relationship between them, while poststroke experience in the later stages may have an independent effect on fatigue and depression with no observable relationship.

In the acute phase, we found a higher proportion of women than men with severe fatigue [ 6 ], but no significant differences between sexes in mean fatigue. This study showed that mean fatigue did not differ over time in relation to sex. Similar findings are reported in most other studies of poststroke fatigue [ 5 , 15 — 18 , 46 ].

However, other studies [ 11 , 12 ] have shown that vitality is inversely associated with fatigue. Because female stroke patients reported lower vitality than men, it is possible that the observed effect of sex on fatigue may need to be examined further in terms of vitality. Further study of the relationship between fatigue and vitality is needed in order to interpret the sex differences in fatigue and vitality and to clarify the concepts of fatigue and vitality.

In studies exploring the aetiology and possible antecedents of poststroke fatigue, these factors need to be considered.

For example, the aetiology of chronic fatigue might be different from fatigue that develops after stroke, and would require a different intervention approach. Fatigue needs to be studied more intensely in homogeneous groups during poststroke recovery. Strengths of this study include the low attrition over 18 months and perhaps because of the large number of participants who were interviewed, there were no missing responses on any of the questionnaire items.

One limitation with the study is that prestroke fatigue was measured retrospectively. Furthermore, the sample was recruited from only two hospitals in Norway. Although only patients with first-ever clinical presentation of stroke were included in the sample, and none of the participants had a history of clinical stroke, the CT findings showed that nine had signs of previous stroke. People who are interviewed face to face may have a tendency to give more socially acceptable responses than those who respond by means of a questionnaire [ 47 ].

A possible consequence of this may be under-reporting of depressive symptoms among those who were interviewed. However, at baseline, fatigue scores did not differ by interviewer. A systematic review of empirical studies of poststroke fatigue [ 9 ] concluded that the fatigue experience should be conceptualized and studied as a multidimensional phenomenon including fatigue intensity, quality, timing, fluctuation, and long-term trajectory. As mentioned by Dittner et al. Thus, other dimensions of fatigue, such as severity or frequency, may have a different trajectory than the fatigue described in this study.

Because patients with and without prestroke fatigue experience a different but stable trajectory of poststroke fatigue, future studies need to control for prestroke fatigue experience to develop knowledge about the aetiology of poststroke fatigue. Intervention studies should either control for prestroke fatigue experience or consider excluding patients with prestroke fatigue when studying the effect of interventions for poststroke fatigue.

A more critical approach would be to partition out, both conceptually and in measurement, the components of fatigue that are generic and the components that are stroke related. It is possible that the presence of prestroke fatigue exacerbates the fatigue response after experiencing a stroke.

The Research Council of Norway Grant no. Hesook Suzie Kim is the project director and Drs. The authors acknowledge the support and assistance provided by research assistant Gunn Pedersen and various staff members of Buskerud Hospital Trust in Drammen and Oslo University Hospital, Aker in Oslo, Norway, in carrying out this research project. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles.

Journal overview. Special Issues. Anners Lerdal , 1,2 Kathryn A. Lee, 3 Linda N. Academic Editor: Gillian Mead. Received 07 Jun Revised 22 Jul Stroke survivors are likely to experience some type of physical or mental disability after the incident, due to brain damage. This can make daily activities difficult and decrease the quality of life.

As a result, you may feel low in energy due to these disabilities; for example, walking and talking may take more energy than they did before the stroke, quickly leading to fatigue. Emotional issues such as depression and anxiety can also contribute to fatigue.

There is an increased chance of depression and anxiety in stroke survivors, which has been shown to contribute to fatigue. There are several other factors that can contribute to post-stroke fatigue, including conditions such as sleep disorders insomnia , sleep-related breathing disorders obstructive sleep apnea , deficiencies anemia , diabetes, an underactive thyroid gland, or comorbid conditions.

There are also several medications that are linked to fatigue and can contribute to tiredness after a stroke. These include beta-blockers for high blood pressure, drugs for epilepsy, painkillers, and antidepressants. In newer research, fatigue is suggested to be associated with inflammatory cells and hormones , such as cortisol, which are thrown out of balance after a stroke.

Unfortunately, there is no specific medication for post-stroke fatigue, but there are many things you can do to alleviate the day-to-day strain. The first step is to get a proper diagnosis from a stroke specialist to determine if there are any other causes that may be contributing to the fatigue, such as medications, illnesses, etc.

Make sure to wind down or relax at least an hour before bed. Fatigue after stroke is not well understood in the community, and the signs of fatigue are not always obvious to other people. Family and friends may not understand why you can not do things or attend events. It can help if you educate the people around you about fatigue. If someone offers you help, consider taking it rather than feeling like you have to do everything yourself.

The health professionals at StrokeLine provide information, advice, support and referral. Find an occupational therapist: Occupational Therapy Australia www.

For more information visit the enable me resource topic on Fatigue. Where am I? Home What we do For survivors and carers After stroke fact sheets Fatigue after stroke fact sheet. Fatigue is very common after stroke no matter how mild or severe your stroke was. There are things you should check with your doctor and ways to manage fatigue. About fatigue Fatigue is a feeling of weariness, tiredness or lack of energy.

Causes of fatigue The cause of fatigue after stroke is unclear. Balancing activity and rest Listening to your body and respecting its limits is important. Because the tiredness is not visible, it is unlikely they will know about it unless you tell them.

Think about having a phased return. This could mean returning to work part-time to start with, sometimes only for a couple of hours each day or every other day. To help you manage your energy levels, you can start with tasks and working hours that are manageable for you and build up slowly. Talk to your employer and agree on a plan that works for both of you. Tips for reducing and managing fatigue. Give yourself plenty of time. It can take many months before post-stroke fatigue starts to lift.

Accepting that it takes time to improve can help you to cope better. Keep a written or visual diary of how much you are doing each day. Although it is tempting, it may leave you exhausted for the next day or two. Celebrate your successes. Learn to pace yourself by taking proper breaks before or after doing things. Even gentle activities like talking with friends, a car journey and eating a meal can be tiring. Rest and sleep: you might need to rest or nap during the day. But if you are having trouble sleeping at night, avoid sleeping during the day.

Look for other ways to sleep better such as comfortable bedding and cotton sheets. It can be helpful to lower your expectations of what you can achieve for a while, so you can build up stamina and strength again slowly. Find out how much you can do in a day and stick to it. For example, if you can achieve about four hours of activity a day with rests in between without being too tired then that is the right level for you.

If you do too much, you will probably soon realise, as you will need to rest more or have to spend a day in bed to recover. Build up stamina and strength slowly or you may well feel you are going backwards if your fatigue worsens. Increase your activity gradually. Read our ideas and tips about moving more after a stroke. Start to wind down during the evening and get into a bedtime routine. Try to do some exercise, as this may help to improve fatigue.

Start gently, for example, a very short walk or a few minutes on an exercise bike, and slowly build up without overdoing it. Ask a physiotherapist for help with this. Eat healthily. Carbohydrates such as bread and pasta are good sources of energy, and try to eat at least five portions of fruit and vegetables each day.