Fatigue and MS

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Fatigue is one of the most common symptoms in multiple sclerosis (MS), occurring in 65-95% of people with MS. Fatigue is described as the “most bothersome” symptom by up to 60% of people with MS.

While fatigue with MS may be unpredictable from day-to-day and is experienced differently by each person, it generally occurs on a daily basis and tends to worsen as the day progresses. Fatigue is also often aggravated by heat and humidity.

Fortunately, there are treatments and strategies to reduce your experience of fatigue, and how it impacts your life.

What is fatigue?

Everyone has low-energy days or days when they are not up for doing anything but fatigue associated with MS is different than just feeling tired. Fatigue is defined as a feeling of exhaustion, tiredness, weariness or lack of energy that significantly interferes with what you want to do. Fatigue can be:

  • Physical: feeling tired, like you’re “dragging” or just need to rest. Some people with MS report their ‘legs feeling heavy like lead’ when physically fatigued.
  • Psychological/emotional: lack of motivation to do anything, feeling depressed or emotionally “spent”.
  • Mental: difficulty concentrating or staying focused, feeling like your mind “goes blank”, or you forget your train of thought. 

Fatigue in MS can be categorized as primary (related directly to the MS disease process) or secondary (fatigue due to other reasons, which may or may not be related to MS).

What are the different types of fatigue?

Primary vs. Secondary Fatigue

Fatigue in MS can be categorized as primary (related directly to the MS disease process) or secondary (fatigue due to other reasons, which may or may not be related to MS).

Primary MS fatigue is caused by direct damage to the central nervous system that slows down reactions and connections in the brain, causing fatigue. There are three types of primary MS fatigue:

  • Lassitude (extreme tiredness): An overwhelming feeling of tiredness that is not directly related to how active you’ve been, or how much you’ve exercised.
  • “Short-circuiting” fatigue: Occurs in specific muscle groups. Examples of this are tiredness in your hand after writing for a short time, or leg weakness after walking.
  • Heat sensitivity fatigue: A rise in body temperature can cause fatigue. This kind of fatigue can occur due to hot or humid weather, but may also be triggered by things like taking a hot bath or eating hot meals. Some people find that dry heat causes less fatigue than humid heat.

Secondary fatigue can be caused by physical or emotional stress, or external factors in the environment such as:

  • Other medical conditions such as infection or injury
  • Side effects from your medications
  • Poor diet
  • Inactivity (causing muscle weakness)
  • Stress or depression
  • Sleep problems
  • Environmental causes such as lighting or temperature
  • "Super Hero Syndrome" such as over scheduling or doing too much physical activity
  • Disorganization of physical surroundings such as clutter

How can fatigue affect your daily life?

  • Fatigue can interfere with your ability to work, do daily activities, and take care of yourself and others.
  • You may have less energy to do things you enjoy. 
  • Fatigue can have a negative effect on your mood, physical functioning, attention, memory and communication.
  • You may be less able to think clearly.
  • Fatigue can cause falls and make driving dangerous.

Why is fatigue such a problem for people with MS?

The exact reasons for high rates of fatigue in MS aren’t entirely known. Ongoing research suggests three possible causes:

Changes to the central nervous system

There are many potential changes to your nervous system due to MS, including damage to neurons (demyelination of neurons), damage to brain cells, or reduced ability for the brain to convert food into energy (reduced glucose metabolism). If any of these changes have happened, your nervous system may have to work harder to function on a daily basis.

Changes to the immune system

MS may cause chronic inflammation (an immune response), resulting in increased feelings of fatigue and sluggishness. This “sickness syndrome” is similar to the inflammation response that happens when you are getting a cold or flu, and might feel achy and tired.

Changes to the endocrine system (also called hormonal changes)

Low levels of cortisol (a hormone that responds to stress) or other hormonal changes might contribute to the experience of fatigue.

What can you do to reduce your fatigue?

Exercise Regularly

  • Exercise has been shown to be one of the most effective ways to fight fatigue in people with MS (see factsheet on MS and Exercise).
  • Staying fit can help you maintain muscle strength, boost your energy, improve your mood, and help you sleep better.
  • Exercise can be done safely by people with MS but you may need some guidance. Talk to your health care provider before beginning a new exercise program.
  • You can also talk to a physical therapist before you get started. He or she can evaluate your current level of fitness, and give you exercise ideas.
  • Include both aerobic exercise (activity that gets your heart pumping a bit) and muscle-building exercises (weights or resistance training) in your routine. It’s also important to include some stretching and flexibility type exercises. 
  • Think about exercising with a partner (like walking with a neighbor) or joining a group exercise class at a gym, community center, or senior center. Working out with other people can really help you stay motivated.
  • Some places like the YMCA may offer exercise classes specifically for people with MS such as water aerobics.

Take Naps

  • Naps, or short periods of sleep or rest, can help manage fatigue. Generally, it is recommended that you keep your naps short, from 10-30 minutes and take one to three short naps per day.
  • Some people find that one longer nap per day (1-2 hours) helps them feel more energetic and doesn’t interfere with ability to get restful sleep at night. For others, longer naps interfere with sleep patterns. Try different lengths and different timing to figure out what works best for you.
  • You can nap on a sofa, recliner, a bed (on top of, not under, the bed covers). You can even nap with your head down on a desk. Here are some helpful hints for an effective nap:
    • Turn TV and music off or go to a quiet environment.
    • Loosen tight clothes (don't put on sleepwear).
    • Dim the lights; if you can't do that face a corner or use an eye mask.
    • Close curtains or blinds.
    • Use light covers or sweater or jacket to avoid getting chilled.
    • Set an alarm or timer so you don't oversleep.
    • Even if you don't fall asleep, resting can still help reduce your fatigue.

Pace Yourself and Get Enough Rest

  • Your mind and your body need rest in order to function at their best. Scheduling regular rest periods may help you manage fatigue.
  • Be patient with yourself. You may not be able to do everything in a day that you’d like to.
  • Determine what is essential to do each day so you can learn how to reduce the number of daily activities such as errands.
  • Pace your activities to reduce overdoing it, and stop BEFORE you are tired.

Other Strategies for Managing Fatigue

  • Talk to your health care provider about whether other medical conditions or medications you are taking could be contributing to your fatigue.
  • If you are depressed, get help. Depression can cause significant fatigue. Talk to your health care provider about treatment options (see factsheet on MS and Depression).
  • Manage your stress. Identify prominent life stressors and look for ways to address those at their source. Find ways to relax and to take care of yourself.
  • Modify your diet to include more nutritious foods.
  • Make sure you’re eating regularly throughout the day. You might need to change the times that you eat in order to get an energy boost when you need it most. Some people with MS have found that eating light meals every 2 to 3 hours helps manage fatigue.
  • Use of a “cool-vest” in order to help keep your body temperature down and manage fatigue due to heat.
  • Take a look at your sleep. If sleep is poor, try to figure out the causes—could it be physical discomfort, poor sleep environment, or too much caffeine? Once you identify causes, try and eliminate them in order to get better rest (see factsheet on Sleep & MS).
  • You may want to use assistive devices such as a cane, walker or scooter to help pace yourself and manage fatigue.
  • Try to make your living space more efficient. Make changes in your home to make frequently used items more accessible. For example, arrange your kitchen so that tools you frequently use to cook with are easy for you to get to.
  • Simplify and improve safety of your living space. Assess your home environment for distractions like overly cluttered areas, rooms with poor lighting, or rugs that are easy to trip on and take care of those issues. 

Learning to manage your fatigue will help you have enough energy to do activities you WANT to do (like hobbies), not just the ones you HAVE to do (like chores).

Resources and References

National MS Society. (2006). Consumer Guide to Clinical Practice Guidelines Fatigue: What You Should Know, A Guide for People with Multiple Sclerosis.

Web MD (2011). Multiple Sclerosis and Fatigue.  

Ehde, D (2010). Pain and Fatigue in MS [Video].

Bakshi, R (2003). Fatigue associated with multiple sclerosis: diagnosis, impact, and management. Multiple Sclerosis, 9, 219-227.

Disclaimer

This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment. 

Authorship

Content is based on research evidence and/or professional consensus of faculty at the University of Washington Multiple Sclerosis Rehabilitation Research and Training Center. This factsheet may be reproduced and distributed freely with the following attribution: Artherholt, S. (2013). Fatigue and MS [Factsheet]. Multiple Sclerosis Rehabilitation Research and Training Center. NIDRR/U.S. D.O.E. grant #H133B080025. University Washington. http://msrrtc.washington.edu/

 

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