Managing and Preventing MS Fatigue

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Fatigue is very common in multiple sclerosis (MS). While it is not as debilitating as vision loss or the inability to walk, fatigue in MS can be quite severe—a physically crushing and mind-numbing exhaustion. It stems from a combination of the disease itself (primary fatigue) and other factors like medications, poor sleep habits, depression, or inactivity (secondary fatigue).

Many of the same factors that cause fatigue for anyone are even more likely to make you feel tired and worn out when you have MS. And there are additional MS-specific issues, such as warm temperatures and MS medications, that you might not realize are contributing to your fatigue.

Overwhelming exhaustion can still settle in despite adopting the best fatigue-prevention habits. Still, adjusting your lifestyle to prevent MS-related fatigue is worthwhile and can have significant benefits.

Home Remedies and Lifestyle

The same lifestyle strategies that can prevent your MS-related fatigue are also useful in treating it. These practices can also help you maintain a sense of consistency, be more productive, and give you back time you might otherwise spend in bed.

Keep the Temperature Cool

MS symptoms worsen when your core body temperature rises, which is called the Uhthoff phenomenon. You may notice that your MS fatigue worsens during a hot bath, a summer stroll outside, or when you have a fever. In fact, hot temperatures are associated with worsening of many MS symptoms.

Tips for staying cool with MS include:

  • Keeping your home air-conditioned
  • Having a mini fan or ice packs handy
  • Drinking cold water throughout the day
  • Seeking shade when outside
  • Exercising in the morning or evening when temperatures are cooler
  • Wearing loose, light-colored cotton clothing
  • Wearing a cooling vest

Get Your ZZZs

Some MS symptoms, like tingling legs and the increased need to urinate, can interfere with your sleep. You can improve the quantity and quality of your sleep by practicing healthy habits, such as:

  • Going to bed at the same time every night, regardless of the day of the week
  • Having a nighttime routine like taking a bath or relaxing with your partner
  • Avoiding stressful conversations or email before bed
  • Avoiding or cutting back on caffeine, especially in the afternoon
  • Limiting or avoiding alcohol, which can negatively impact your sleep
  • Avoiding fluids at nighttime

You may also want to keep a sleep diary that tracks when you sleep, the quality of your rest, and how you feel when you wake, so you can determine if naps could be interfering with your nighttime sleep.

If you are waking up at night to urinate, consider talking to your doctor about medication to treat your bladder spasms.

De-Stress

Stress can contribute to fatigue—especially if you already have a condition that predisposes you to fatigue, like MS. Take the time to carefully think about the stress in your life and to eliminate or at least minimize some whenever you can. For example, if the traffic on your work commute is driving you crazy, consider adjusting your arrival and departure time or using public transportation. Or if dealing with your health insurance is aggravating, consider working with a patient advocate who may be able to help you with the process.

And be sure to give yourself time to relax, do things you enjoy, and spend time with friends and family. Constantly getting things done can take a toll if you don't take the time to unwind.

If you find that stress is really impacting your MS fatigue, you can also seek professional help. Counseling and cognitive-behavioral therapy with a licensed psychologist or psychiatrist can be useful in helping you manage your stress in a healthy, adaptive way.

Recognize and Manage Depression

Depression can be a major problem in MS. And depression often contributes to fatigue. Symptoms include changes in appetite or sleep, irritability, and a feeling of hopelessness or guilt.

Make sure to discuss your depression with your doctor because it is treatable. Counseling and medication can help your depression and may alleviate your depression-induced fatigue as well.

Exercise

Exercise can improve MS fatigue. You can work with your doctor or physical therapist to devise an exercise plan that works for you. A program may include daily walks, gardening, ballroom dancing, swimming, or arm exercises and stretches while you lounge with your partner in the evenings.

Muscle strengthening, toning, and cardiovascular exercises within the limits of your ability (and balance) are safe in MS.

When you exercise, remember to also stay cool by working out in a cool location, drinking cold water, and wearing light, loose-fitting clothes.

Medication

Medications can help reduce fatigue in MS. But identifying medications you're currently taking that could be causing your fatigue may be what's most helpful.

Review Your Current Medications

It may surprise you that the very medications you are taking for your MS symptoms may be contributing to your fatigue. Some include:

Some disease-modifying MS medications can add to stress, which begets fatigue, as well.

Other medications that are commonly associated with fatigue include antihistamines for treating allergies and antihypertensives for treating high blood pressure. These medications are not used more often in MS than they are otherwise, but they can add to your already existing fatigue if you take them.

Speak with your doctor about whether your medication could be adding to your fatigue or feeling of fogginess. Your doctor may suggest switching your medications or changing the time of dosing.

Medications Used to Treat MS-Related Fatigue

Medications used for the treatment of fatigue can be helpful but are usually not the magic answer to curing fatigue.

Neurologists sometimes prescribe drugs such as the following to MS patients who need to manage fatigue:

Talk to your doctor about whether one of these medications would be useful for you. It's also important to understand that there are different strategies for taking these medications. It's not an all or nothing deal.

For instance, a person with MS may only take their Provigil if they know they are going to have a long, grueling day. Another person may rely on daily Ritalin to manage fatigue.

These medications also have side effects, such as cardiovascular ones, which may not be safe for you.

Complementary Alternative Medicine (CAM)

CAM therapies are not scientifically proven to slow the progression of MS, but they are generally safe and can help with some MS symptoms, like fatigue.

Activities that have been found to improve MS-related fatigue include yoga, meditation, and prayer. Yoga, which combines meditation, breathing techniques, and exercise, is often a good way to stay active without exhausting yourself.

Reflexology, a form of massage in which pressure is applied to the feet, hands, or other parts of the body, can promote a sense of well-being.

Coping

Sometimes, no matter how hard you try, fatigue can come on suddenly. Or it may linger for months on end. If you are being treated for your MS and still experiencing fatigue, be sure to take it easy on yourself.

And don't hesitate to seek the support of your loved ones, who may be able to help.

Using Your Energy Wisely

You may need to think ahead as you budget your energy each day. This can be tricky, but once you get into the flow of your routine, conserving your energy can be a smart way to battle your fatigue. A few ways to best utilize your energy include:

  • Building rest times into your schedule, like an afternoon 20-minute power nap (as long as it doesn't keep you from sleeping at night)
  • Planning energy-draining activities for the morning when you are less fatigued
  • Asking your family to take on more of the heavy-duty household chores
  • Using your scooter or wheelchair to get around throughout the day

Keeping It Simple

Minimizing chaos in your life can prevent distraction from stealing your energy. Ideas like decluttering your house and workspace, making your home an inviting, warm, and usable space, and breaking down tasks into manageable steps can keep you from feeling overwhelmed.

Getting help from an occupational therapist can give you an extra pair of eyes as you work together to devise an efficient home and work environment based on your limitations and needs.

A Word From Verywell

When you have MS, you need to be kind to yourself and to acknowledge that your fatigue is part of your disease. MS can make it harder to do anything—move, think, and feel—because nerve communication is impaired and slowed. Experts think MS fatigue is more than just physical exhaustion. It often encompasses mental fatigue too, commonly known as "brain fog."

It usually takes a number of strategies to tackle your MS fatigue, but it can be done with dedication and daily effort. Don't lose motivation or get down if your strategies sometimes fail you, and you simply need to take a "lay on the couch and sleep" day.

If you are experiencing unusual fatigue, you should talk to your doctor or nurse. You could have an infection, another condition (such as anemia), or you may have early signs of an MS exacerbation.

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