Tiredness and fatigue after stroke

Fatigue affects the majority of people who have a stroke or transient ischaemic attack (TIA or mini-stroke). It can have a big effect on your life. This page looks at the causes and impact of fatigue and suggests practical ways you can help yourself and seek support.

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What is post-stroke fatigue?

Fatigue is different from normal tiredness, as it doesn’t seem to get better with rest. It can happen after any type of stroke, big or small. It can also happen after a transient ischaemic attack (TIA, or mini-stroke).

The signs of fatigue vary between individuals, but you may feel like you lack energy or strength, and are constantly tired, physically and mentally. It can be mild or more severe.

It’s not always caused by being more active or working harder. You might need to rest or sleep more than normal. Fatigue could make it difficult for you to take part in everyday activities. It can also affect your recovery and rehabilitation.

If you think you have fatigue, it’s a good idea to speak to your GP or therapist. They may be able to help to find out if something like a medication or infection is causing the fatigue, or if it’s more likely to be due to the stroke. They may also be able to suggest ways to manage your fatigue.

You can find out how to understand the triggers for your fatigue, and how to manage it. Fatigue can get better over time, and you can help to improve your recovery by getting support and trying techniques for managing fatigue.

Who can get post-stroke fatigue?

Fatigue can happen after any type of stroke, and you can have severe fatigue after a relatively mild stroke or a TIA. Even if you have made a full physical recovery, or your stroke was some time ago, fatigue can still be a problem. It can start soon after a stroke, and often improves over time, but it can also appear some time later.

Many people describe fatigue as the most difficult and upsetting problem they have to cope with after a stroke. You may not feel able to engage fully in rehabilitation because you feel so tired. It can affect your ability to regain your independence in day-to-day life, and it can be difficult to return to work or to socialise and enjoy everyday activities. It can also affect your quality of life and relationships, as family and friends may not understand how genuinely exhausted you feel on a daily basis.

Why do I feel so tired?

Both physical and emotional factors can contribute to fatigue after stroke.

Physical effects of stroke

The physical impact of the stroke on your brain and body can trigger fatigue. In the early weeks and months after a stroke, your brain and body are healing.

The rehabilitation process can involve trying to do things in a completely new way, or learning and doing exercises which can be very tiring.

You may have lost some of your fitness and strength while in hospital, or as a result of the stroke. If you’re not able to move around much, this can also lead to feelings of fatigue.

If you have muscle weakness after your stroke, walking and other movements could take up much more energy than they did before your stroke.

Emotional changes

Although fatigue shares some of the signs of depression, such as feeling low, having anxiety, sleep problems and tiredness, it’s not the same thing.

But it isn’t always easy to tell the symptoms of fatigue apart from depression. People can have both at the same time, and fatigue may cause low mood and anxiety.

Talk to your GP and explain what you are going through. Discuss the treatment options available, and what would work best for you. You are the expert on your own situation, and you might feel sure that your symptoms are due to the stroke rather than emotional changes.

You can ask if there is a local fatigue management service. There may be help available with healthy eating, being more active and increasing your fitness and strength, such as physiotherapy or a cardiac rehabilitation programme.

If you feel that emotional changes play a part in your fatigue, you can ask about treatment for depression, including medication and counselling. Find out more in our ‘Emotional changes after stroke’ page.

Other factors

Sleep problems

Sleeping problems such as insomnia and sleep apnoea (interrupted breathing) can make you feel sleepy during the day. You might have trouble sleeping due to muscle stiffness or joint pain.

Diet

If you have trouble with swallowing or chewing, this could affect the amount of energy and nutrients you gain from your food.

Health problems

Some health conditions such as anaemia (low levels of iron in the blood), diabetes or an underactive thyroid gland can also make you feel tired.

Pain

If you have pain after stroke such as muscle pain or headaches, this can also affect your energy levels.

Medication side-effects

Some common medications have fatigue as a side effect, such as beta blockers for high blood pressure, epilepsy drugs and antidepressants.

If you think your medication is causing side effects, your GP or pharmacist can give you help and advice. You may be able to try different types of medication. Don’t stop taking your medication without speaking to your GP.

Managing your fatigue

Although there isn’t a clearly defined treatment for post-stroke fatigue, there are some practical steps that you can take to reduce and manage your fatigue.

It is important to get individual advice from a GP or other health professional, to ensure that you have identified any underlying health problems. They can also help you to get the right support with your fatigue.

Find out the cause of your fatigue

Try to find out if there are any treatable causes for your fatigue. Your GP or stroke nurse can check if you have any medical conditions that could be making you feel tired.

Ask the GP for a review of your current medication. If your fatigue is at least partly caused by side effects of your medication, it usually improves with time or once you start a new medication. Never stop taking your medication suddenly, and ask your GP for advice if you have any problems with side effects.

Help others understand your fatigue

Your tiredness may not be obvious to other people so they may not understand how you feel. This may be frustrating for you. Show your family and friends this guide to help them understand what you are going through. They can offer you support with your recovery and dealing with tasks.

Pace, plan and prioritise (the ‘three Ps’)

Try thinking about the ‘three Ps’ to help you form your own coping strategies. Fatigue can follow a pattern, and learning to understand this can help you make the most of your energy.

Pace: thinking about how you can take things step-by-step at a manageable speed, without triggering your fatigue.
Plan: working out what you want to do, and planning when and how you can do it.
Prioritise: deciding which activities are important to you, and which ones you can leave or get some help with.

Don’t make it hard for yourself by trying to do all the things you used to do. You might need to slow down to save your energy. 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.

Don’t push yourself to do too much if you’re having a ‘better day’. Although it is tempting, it may leave you exhausted for the next day or two.

Take proper breaks before or after doing things. Even gentle activities like talking with friends, a car journey and eating a meal can be tiring.

For more about the three Ps, and practical tips on managing daily life with fatigue, visit the Royal College of Occupational Therapists website.

More tips for reducing and managing fatigue

Give yourself plenty of time to recover from your stroke. 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.
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.
Keep a written or visual diary of what you are doing, even if it’s just a few notes or a photograph each day. Over time this really helps to remind you of the progress you’ve made. It will help you understand how much activity you can cope with, and what triggers your fatigue.
Celebrate your successes. Many people feel frustrated by what they can’t do and forget to feel good about what they can do.
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.
Start to wind down during the evening and get into a bedtime routine.
Build up stamina and strength slowly or you may well feel you are going backwards if your fatigue worsens. Increase your activity gradually. For ideas and advice see our ‘Getting active after a stroke’ resource page.
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. Try to eat at least five portions of fruit and vegetables each day. If you have trouble swallowing or eating after a stroke, you will need support from a dietician to help you eat the right types of food. Ask your GP to refer you for help.
Seek support. Your GP or occupational therapist can put you in touch with different types of support, for example stroke clubs, counselling, relaxation programmes, exercise groups or alternative therapies. Contact us for details of stroke clubs and other support in your area.