1. It is very normal to feel fatigued.
Fatigue is one of the most common and misunderstood effects of stroke. It can linger for weeks, months, or even years, and it’s not always easy to explain to others. People often expect recovery to be about physical strength and mobility. But for many stroke survivors, the biggest challenge is the invisible one: energy that seems to vanish without warning.
It’s not just physical tiredness — it can feel like your whole body and mind shut down.
Even simple tasks (getting dressed, having a conversation) can take a lot of energy.
Why does fatigue occur After Stroke?
Post-stroke fatigue (and other health problems like COVID) is not the same as ordinary tiredness. It’s not just the feeling you get after a long day or a poor night’s sleep. It’s often described as:
A heavy, sinking feeling that comes over the body
A mental fog that makes it hard to think or speak
A shutdown — where the smallest task feels like too much
It can happen even when a person hasn’t “done much,” and it doesn’t always go away with rest. Some people describe it as hitting a wall — others say it feels like they’ve “run out of charge” unexpectedly.
What makes it even more difficult is that fatigue is invisible. From the outside, someone might look fine — but on the inside, they’re barely functioning. That disconnect can lead to frustration, guilt, and feeling misunderstood.
After a stroke, your brain is working harder than usual to do even the simplest tasks — like walking, talking, or getting dressed. Things that used to happen automatically now take extra effort, focus, and energy.
Even thinking takes more fuel.
In the background, your nervous system is trying to protect you while your brain rewires and heals. That protection is part of something called the cell danger response.
A quick word on the Cell Danger Response
When your brain or body goes through something serious — like a stroke — your cells enter “protect mode.” They slow down energy production and limit activity to protect themselves from further stress and to make the body rest and recover.
Imagine your house goes into lockdown after a storm — the lights are dimmed, doors are shut, and no guests are allowed in. It’s safe, but it’s not a good time to host a dinner party. That’s what your cells are doing — focusing on survival, not performance.
This protective state helps you heal — but it also contributes to the exhaustion and slower recovery. If you try to “push through” before your system is ready, it can make things worse.
It is a little bit like walking on a broken leg. You can do it if you push yourself but the broken bone will take a lot longer to heal and it will very likely get worse.
“But you look fine.”
You probably have been on the receiving end of this sentence. And it has probably caused you some unnecessary suffering in the shape of shame, guilt, being accused of lying or pretending to be ill, feeling misunderstood to name a few.
Most people say this not because they are nasty and they want to make you feel bad but because they are well… ignorant. They have no clue what fatigue is let alone how it is to battle through the simplest activities after a stroke.
So be forgiving if you have strength but definitely try to explain and educate them. This way you might be able to create a supportive environment abound you and you might be able to take a break without a huge friction.
The problem with taking a break.
We live in a society which is constantly on the go. Fast-paced, non-stop, high performance, high-achieving. In one word: UNSUSTAINABLE.
Even machines need a break from time to time and we are not machines. We need time to rest — and I mean real rest, not just sitting in front of the TV or scrolling on the phone. And we certainly need time to recover after a huge event such as stroke.
The problem is we ourselves and everybody around us were programmed to believe that we need to keep going and push through.
Luckily it is not true. We can slow down. We have to look after ourselves.
This next sentence is one that every single one of my patients hears often:
BE KIND TO YOURSELF!
It is not an option. We have to look after ourselves.
🔁 The Boom and Bust Cycle
One of the most common patterns we see in recovery is the boom and bust cycle.
It looks like this:
You wake up with a bit more energy (a “boom” day)
You try to catch up on everything — cleaning, errands, exercise, social events.
The next day (or two) you crash — barely able to get out of bed (“bust”)
You rest a lot, start to feel a little better… then it repeats
This cycle can keep you stuck and frustrated. The harder you push, the harder the crash.
And this cycle doesn’t help you recover. In fact, over time, it can slow healing or even cause more issues for your body.
So what helps?
The key to managing fatigue is not to fight it — but to work with it.
And that starts with something called pacing.
2. The 3 Ps:
Pacing: Managing Energy Instead of Burning It
Pacing means:
Taking planned breaks before you're tired
Breaking activities into smaller chunks
Doing a bit, resting, then doing a bit more
Try:
15–20 minutes of activity, then 10 minutes of rest (or 30 minutes rest if you need to)
Using a timer or alarm to remind yourself to pause
Alternating high- and low-effort tasks
Think of your energy like a phone battery — don’t wait until it’s at 1% to recharge.
If you have a Garmin watch use The Body Battery function.
I tend to recommend The Visible App to almost everyone – this app can really help you with managing and understanding your levels of energy.
3. Prioritise:
What’s essential today?
What can wait?
What can someone help with?
Do I have to do more if the essentials have been done?
4 .Plan:
Spread out your tasks and include rest breaks between them.
Plan when to do each task — ideally during the time of day when you have the most energy.
Be kind to yourself: don’t push through—stop and rest before the fatigue builds up.
5. Keep an Energy Diary
Write down:
What you did each day
When fatigue showed up
What helped or made it worse
This helps you spot patterns and avoid future “busts.” You might discover that certain times of day or types of activity affect your energy more than others.
6. Rest Is More Than Just Sleep
Rest can be:
Sitting in silence with your eyes closed
Breathing slowly and deeply
Listening to soft music
A short walk in nature
Gentle stretching or lying down with legs up
Try different kinds of rest to see what helps you feel most recharged.
7. Breathing
It is not as easy as it sounds. We all breathe and most of us assume we do it well. Unfortunately, it is not the case.
I must have seen more than 300 people in my practice and so far, I have only met five people whom I hadn’t had to teach correct breathing technique.
Slow, calm, soft diaphragmatic breathing is what we need.
The fast pace of our lives, stress and health issues make us switch to so-called upper-chest breathing which is associated by our nervous systems with stress. So in a way we cause more stress by breathing incorrectly. Fortunately simple, daily practice can reverse this habit and calm our minds and bodies.
🧡 Final Thoughts
Post-stroke fatigue is real, and it’s not your fault.
It’s not laziness. It’s your body’s way of healing and protecting itself.
But with pacing, the 3 Ps, smart planning, and self-awareness, it’s possible to live a fuller life — one step at a time.
Recovery isn’t about doing more — it’s about doing what matters, in a way that works for you.
Help Others Understand
Because fatigue isn’t always visible, friends and family might not understand what you're going through.
You could say:
“It’s not just tiredness — it’s my brain using extra energy to heal. I need to pace myself so I don’t crash.”
Sharing this can lead to better support and fewer misunderstandings.
Breathe well and most of all… have you guessed it? Yes! Be kind to yourselves!
#PostStrokeFatigue
#StrokeRecovery
#FatigueAwareness
#BeKindToYourself