Fatigue

Fatigue has been described as an overwhelming sense of tiredness, a lack of energy and a feeling of exhaustion. It is more than a one-off feeling of tiredness that will go away after sleeping well.

Anyone can feel fatigued when they are working too hard, or when pressures at work or at home cause stress. But fatigue can also be a specific symptom of a medical condition such as Parkinson’s.

Up to half of people with Parkinson’s say they experience fatigue.

People who are newly diagnosed with Parkinson’s are just as likely to experience fatigue as those who have had the condition for some time. In fact, it may be one of the earliest symptoms you have.

Many people with Parkinson’s experience fatigue but it’s common in people with other long-term physical health conditions too. We don’t yet fully understand what causes it in Parkinson’s, but it is thought to be linked to chemical changes that happen in the brain.

Fatigue in Parkinson’s may also be related to other symptoms or features of the condition. Such as:

• the timing and dosage of your medication. This can mean that you feel energetic and capable of doing everyday jobs at certain times of the day, but not at other times. 
• tremor, stiffness or involuntary movements, which may put stress on your muscles. It means they work harder, often against each other, in order to move or complete a task, and can become fatigued quickly
• slowness of movement (bradykinesia). If you experience this, tasks can take you longer to complete than they used to, leading to fatigue
• stress. Parkinson’s and its symptoms can cause stress at work or home and this can make fatigue worse, particularly true if stress builds up over a period of time

It’s also important to remember that mental (cognitive) fatigue can be just as difficult to manage. Some people may find it hard to concentrate for a long time without a break. For example, this may cause problems if you are still in work.

Although it’s natural to associate any health problems with Parkinson’s, there are other causes of fatigue that are unrelated. These may include treatable conditions such as thyroid problems, vitamin deficiencies, anaemia and diabetes.

Because of this, you should discuss any feelings of fatigue with your GP, specialist or Parkinson’s nurse. Together, you can look at the possible cause and discuss treatment options.

The effects of fatigue and Parkinson’s vary from person to person. They can change from day-to-day or even hour-to-hour.

You may feel quite fit and able one day and then too fatigued to do much the following day. This might be because things that came naturally before your diagnosis now take more effort. If you are working for example, you may feel much more exhausted in the evenings than you used to and you may not want to do anything else.

Fatigue can sometimes be overlooked by doctors, but it’s important that it is managed properly.

If your feelings of fatigue are related to other Parkinson’s symptoms, such as tremor, stiffness or involuntary movements, they may be helped with Parkinson’s medication. This will also help you manage your symptoms better, so you have more energy to do things that may otherwise be difficult.

However, remember that fatigue in Parkinson’s may not be related simply to these symptoms.

Also, Parkinson’s medication is not always successful at treating fatigue. In some cases, non-drug treatments may work better. One example is cognitive behavioural therapy (CBT) which is a type of talking therapy. This can help you manage fatigue practically by focusing on what is causing it and its impact.

Fatigue can often be related to more complex difficulties such as sleep disturbance or depression. If this is the case, other specific medication may help.

Your GP, specialist or Parkinson’s nurse will be able to discuss options that might work for you.

Sleep and night-time problems 

Many people with Parkinson’s can experience problems with sleep. You may wake up during the night because of tremor or stiffness, when you are having difficulty turning over in bed or if you need to go to the toilet.

This can often leave you feeling tired and lethargic during the day and may mean you are not able to complete tasks so well. Poor sleep does not cause fatigue but may make it worse.

Night-time problems will also make you sleepy during the day and resting may help. However, frequent napping can make sleeping at night more difficult.

It is important that you find the reasons for sleep and night-time problems because many of them can be treated and that may help you feel better during the day.

Understanding the causes can also help you to develop good sleeping habits that give you more energy overall.

Depression

Many people with Parkinson’s experience depression, even if they are not formally diagnosed with it.

Depression involves more than just feeling ‘down’ for a short while. A person who is depressed can experience a range of symptoms, as well as low mood, for long periods of time.

It is common for people with depression to experience fatigue and depression may make fatigue worse. However, not everyone with fatigue feels depressed.

If you are diagnosed with depression, there are effective treatments available. They may involve a combination of medication, talking therapies or counselling.

If you have fatigue and are concerned about depression, speak to your GP, specialist or Parkinson’s nurse.

Apathy

Apathy is described as a lack of enthusiasm and emotion for everyday activities. This can feel like depression and fatigue. You may find you lose interest in activities that you previously enjoyed.

Apathy, like depression, needs to be diagnosed so it can be treated. You may find it helpful to speak to a mental health specialist or counsellor about it.

Measuring fatigue accurately can be difficult as it is unique to each individual, so assessing your own fatigue and what works for you can be a good place to start. We have a non-motor symptoms questionnaire available to help you and your healthcare professional assess symptoms such as fatigue.

You could also try keeping a diary to monitor your fatigue and work out how to manage it. This may help you to arrange to do more difficult daily tasks when you are less tired.

Feeling fatigued or excessively tired can affect your driving.

You must tell the DVLA (DVA in Northern Ireland) if you have a medical condition that affects your driving. If you do not, you can be fined up to £1000.

Having Parkinson's doesn't necessarily mean you have to stop driving. The DVLA (DVA in Northern Ireland) will ask for more information about your condition and assess if it's safe for you to continue driving.

For more information, visit GOV.UK, or call the DVLA on 0300 790 6806.

For Northern Ireland visit the nidirect website, or call the DVA on 0300 200 7861.

You can also speak to your GP, specialist or Parkinson's nurse for advice.

Read our information on driving and Parkinson's. 

The Equality Act 2010 (England, Scotland and Wales) states that employers must make reasonable adjustments for people with disabilities. These could include flexible or reduced hours, or allowing for a little extra rest, either at regular times each day or whenever necessary. There is similar equality legislation in Northern Ireland.

If you are a member of a trade union, they should be able to negotiate on your behalf to ask your employer to make reasonable adjustments. They should also be able to advise on other disability discrimination issues.

If fatigue or any other symptoms of Parkinson's have an impact on your daily life, you may be entitled to some benefits, such as Personal Independence Payment. This can be paid to people who are in work, as well as to people who are not.

If you have any questions about your rights under The Equality Act 2010, or you would like to speak to someone about welfare benefits, call our free confidential helpline on 0808 800 0303.