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Stroke Smart Magazine

November/December 2007
Q & A

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Managing Post-Stroke Fatigue During the Holidays

with Nancy A. Flynn, Ph.D., OTR/L

What's different about fatigue than regular tiredness after a stroke?
When people experience regular fatigue, they have warnings; they start to get tired. Also, the tiredness is related to some activity they are doing, and it improves after rest. Stroke survivors describe post-stroke fatigue as something that comes on without warning, like “hitting a wall,” and rest doesn't always make it better. In addition, post-stroke fatigue can take different forms, including physical fatigue, being too tired to think clearly, and being unable to be social with others. Some people find that their ability to concentrate or remember things is unpredictable, which may be an indication that you have problems with “cognitive” fatigue.

Why do stroke survivors have fatigue?
The reasons for post-stroke fatigue aren't understood, but it is quite common. In studies, about 40 to 70 percent of stroke survivors experience it.

Why are there more problems with post-stroke fatigue over the holidays?
Stroke survivors have more post-stroke fatigue during the holidays for the same reasons everybody else has problems with tiredness over the holidays, except that for stroke survivors, it's much bigger. There are family expectations to meet, traditions to maintain, there may be extra visitors, you may be staying in an unfamiliar space, sleep and eating routines are disrupted, and there is just so much to be done! There are increased physical demands, and often, increased social demands as well, which can be exhausting. Stroke survivors who manage their post-stroke fatigue well the rest of the year may have a hard time continuing the same strategies that usually work for them.

What are some strategies that can be used for post-stroke fatigue?
There are strategies you can use all the time, and then there are special strategies to manage fatigue during the holidays.

Some general techniques are:

Rest before you feel tired. Think of your energy as a bank account: once you feel tired, you're probably already “overdrawn” and you have to pay the “penalties” to make it up. That means you will need extra rest to get back to zero! Resting for 20 to 30 minutes once in the morning and once in the afternoon before you are tired can make an “energy deposit” in your account, and extend your day!

Try different kinds of rest. You don't have to sleep; sitting quietly, reading, watching TV— all of these things will help. If you are afraid you'll fall asleep, use a timer so that you can really relax while you are resting.

Regular exercise can help build up your tolerance for activity.

What special strategies should be used during the holidays?
The first step is to communicate with others about your fatigue. It may help to use a different language. Instead of saying that you are “tired” or “fatigued” use the language “pathological fatigue” or “post-stroke fatigue.” This can help make it clear that what you are experiencing is different from “just being tired.”

Find an ally who can help you take a rest or bow out of an activity. In some families, there is real resistance to changing tradition, and if someone else will help you negotiate those changes, it can be easier.

If you are staying somewhere else, be sure to ask your host to help you make a plan to manage your fatigue. Because fatigue is invisible, your host may not be aware of the problem. Explain that you need a quiet place to go in the morning and the afternoon, and find a quiet room to retreat to for rests during the day.

And, finally, try to spread out the events of the holidays. If someone calls to get together and there's just too much going on, ask that person if you could set a date in January when things settle down! It will make that long month after the holidays much more fun!


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