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Daytime fatigue is a common problem among people with Parkinson's disease. What causes it, and what can you do to feel more energized?

Fatigue is an extremely common problem among people who live with Parkinson's disease. Everyone will be familiar with the feeling — being tired, low on energy, exhausted, and perhaps feeling like you've not slept at all (in some cases because that's true) — even though the experience is pretty subjective and hard to describe in more concrete terms. 

While it's not yet totally clear why so many Parkinson's patients suffer from fatigue, physical and mental causes both contribute. Frequently-seen symptoms of Parkinson's — rigidity, slowness of movement, depression, and of course sleep problems — can play a role, as can some of the medications you'll be prescribed to manage your Parkinson's. 

The most important message we have for people with Parkinson's who are fatigued is not to simply accept it as the "new normal". Telll your doctor what you're going through, and ask what can be done to help you.

Once you do, in addition to a chat about your symptoms and a more formal questionnaire, your doctor may employ specific tests to determine how fatigued you are and what may be causing it:

  • Your doctor may have you answer questions found in the Multidimensional Fatigue Inventory.
  • Physical exercise tests can determine your level of physical fatigue. 
  • The Attention Network Test was designed to measure your mental fatigue. It determines how well you respond to visual stimuli. 
Once you do seek medical attention for your fatigue, your doctor may have some of the same tips we're about to discuss. You can implement some of them on your own, while you'll need help for others.

1. A closer look at your medications

Parkinson's disease symptoms like tremor, rigidity, muscle contractions and slowness of movement can all take a toll on your muscles, which can feel fatigued all the time. Your symptoms may also have led you to become less physically active, leading to increasingly weaker muscles and reduced stamina. Parkinson's disease patients are prescribed medications, often levodopa, to combat their symptoms — but medication can cause fatigue all by itself as well. That is because it may cause you to suffer from dyskinesia or involuntary movement. Your doctor may take a closer look at your medication when you complain about fatigue, to determine if your dosage can be lowered or another drug may be suitable for you.

2. Regular exercise: Keep fit

It's a vicious cycle, really — when you feel tired, you don't feel like exercising, but when you don't exercise, you'll feel more tired. While this cycle is hard to break as it's hard for fatigued people to get active, keep in mind that research proves that regular physical exercise indeed reduces both physical and mental fatigue. Parkinson's patients may try to take a walk, participate in a yoga or Tai Chi class, go swimming, or at least do some stretching in an attempt to feel more energized. 

3. What should fatigue mean for your daily schedule?

Parkinson's disease patients frequently notice that they're more physically competent during certain parts of the day — symptoms are typically less bothersome right after taking medication than as your dose is about to "run out". They may then schedule their more active daily tasks around the time during which they function best. While this makes sense, concentrated bursts of activity can also leave you feeling exhausted. Schedule periods of rest right after you have been active to reduce fatigue.

4. Short naps can help

People with Parkinson's may suffer from insomnia, REM behavioral disorder, sleep apnea, and other sleep disorders that contribute to fatigue. Whenever you don't sleep well, daytime fatigue is the result. Give in to that urge to take a nap, but don't make it any longer than 40 minutes and schedule your "siesta" for the same time each day. While short naps can invigorate you, taking it to an extreme will actually leave you feeling more tired. 

While we're here, always make sure to talk to your doctor if you're not sleeping well. It may be a side effect of one of the medications you are taking, and something that can be addressed by changing your dose.

5. Destress yourself

Stress takes a lot of energy — leading to increased fatigue — so try to eliminate stressors from your life wherever possible. Where they're not, counter them with relaxing activities like meditation, reading, exercise, spending time with friends, journaling, or whatever else is your soul food. 

6. Talk to your doctor about antidepressants

People with Parkinson's disease suffer from depression at higher rates than the general population — and feeling hopeless, helpless, angry, apathetic, and no longer enjoying the things you used to are some of the symptoms. Fatigue, too, is a very common symptom of depression. If you think you may be depressed, mention this to your doctor. Antidepressants, most commonly SSRIs or tricyclic antidepressants, may be the answer for you.

7. Wait? There's a drug for that?

There might be. Medications can help you fight fatigue include:

  • Modafinil was designed for to treat the sleep disorder narcolepsy, but it can also help people with many other medical conditions feel more energized and alert. 
  • Amantadine is an antiviral also used for Parkinson's that might help you reduce your fatigue. The dopamine agonists pergolide and cabergolide, and the MAO inhibitor selegiline may also help you.
  • ADHD meds like Ritalin are not just for kids — they're currently being researched in the context of Parkinson's-related fatigue, so ask your doctor about them.

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