Fatigue is a common symptom of many neurologic disorders, and multiple sclerosis (MS) is no exception. Unlike weariness and a sense of exhaustion from exercise, manual labor, or stress, MS-related fatigue consistently interferes with your ability to do everyday activities such as cooking, cleaning, socializing, and working.
Although many patients describe their fatigue vividly—“It’s like swimming with a fur coat on,” or “I feel like I’m wearing a lead coat”—it’s invisible. Since no one can tell by looking at you how tired you are, friends and family may be puzzled that you can’t do the things you once did. Coworkers or supervisors may mistakenly and unfairly assume you are lazy or unmotivated. Reactions like these contribute to difficulties at home and at work.
Two Kinds of Fatigue
Patients with MS experience two types of fatigue: primary and secondary. Primary fatigue is a symptom of the disease itself due to nerve damage. Secondary fatigue is due to factors such as sleep disturbances, medication side effects, and the increased effort it takes to get through each day. It isn’t typically related to exercise or being overheated, but it can be worsened by those things as well as stress, poor sleep, and medication.
While fatigue is a reality of MS, it can be managed with consistent self-care. Here are some expert-recommended strategies to consider.
- Make Time for Exercise
It sounds counterintuitive to tell a fatigued person to exercise. In fact, until about 20 or 30 years ago, doctors discouraged people with MS from exercising, fearing it would deplete what little energy they had. Today, research shows that people with MS tolerate exercise well and it improves their quality of life and has been shown to improve fatigue. It also builds strength, tones muscles, improves balance and coordination, and can improve mood. Even people with advanced disability benefit from exercise. By contrast, those with fatigue who don’t exercise may experience increased fatigue, deconditioning, and depression. - Choose Your Activity Carefully
There is no single best kind of exercise program for people with MS. It depends on what type of MS you have, your level of ability, and whether you are vulnerable to overheating or overexertion. For people with primary fatigue, exercise can temporarily intensify symptoms. These temporary symptoms are neither relapses nor signs of damage. And often they can be resolved by resting and cooling off. Experiment with different types of activity—swimming, cycling, yoga, tai chi, strength training—to determine which one works best and which one you like best. - Talk to Your Doctor About Medication
Several drugs have proved useful in combating fatigue. Amantadine (Symmetrel), an anti-viral drug used to treat influenza, reduces fatigue in about 50 percent of patients. For some people, the drug’s effectiveness wears off over time, but if you take a break for several days, it may become more effective again. In general, the risk of side effects is low. If you take it late in the day, it may cause insomnia.
In several studies, modafinil (Provigil), a prescription drug that promotes wakefulness and alertness, has been shown to reduce fatigue. Like amantadine, it can cause sleep problems if taken too late in the day. Other side effects include jitteriness, headache, nausea, and rapid heart rate. Stimulants such as methylphenidate (Ritalin) and the mixture of amphetamine and dextroamphetamine (Adderall) are also prescribed to treat fatigue.
Antidepressants are also helpful in reducing fatigue, especially if it’s associated with depression. They may boost energy and improve mood and concentration. None of these medications are approved by the US Food and Drug Administration to treat fatigue, so prescriptions for them are considered off-label. -
Stay Cool
Primary fatigue is related to damage to myelin, the fatty insulation that protects nerve fibers and helps them transmit signals from the central nervous system to the rest of the body. When nerve fibers are damaged, they can still send signals, but not as well as undamaged fibers. When these damaged nerve fibers are overused or become overheated due to sustained exertion or heat exposure, the nerves are less and less able to send signals. Once the body cools off, the nerve fibers start working again. Anything you can do to lower your body temperature, especially during exercise or in hot weather, will delay or prevent primary fatigue. Cooling vests, hats, and neck wraps, icy drinks, or even a splash of cold water on the hands and face can help prevent primary fatigue. - Ask About Physical and Occupational Therapy
Certain medication used to treat MS such as antidepressants, drugs used to treat spasticity, and pain relievers, can cause sleepiness or fatigue. In addition, if muscles grow weak or tire quickly, it becomes harder to perform normal daily activities, and the extra exertion leads to more fatigue. Physical and occupational therapy can help by teaching you to work smarter rather than harder. Planning activities in ways that conserve energy helps with pacing and may result in more consistent energy levels. - Address Sleep Problems
Poor sleep contributes to low daytime energy. Work with your doctor to identify what’s disrupting your sleep whether it’s sleep apnea, restless legs syndrome, depression, muscles spasms, or problems with bladder control. Treating the particular problem will also likely reduce sleep disruptions. If you simply have a hard time getting to sleep, staying asleep, or both, talk to your doctor about how to maintain good sleep habits. - Consider a Diet Change
Dietary strategies can also help fight fatigue. Foods with a high glycemic index—sugary or high in starches such as white breads, white potatoes, and pastas—can cause rapid blood sugar spikes and crashes. The blood sugar spikes and crashes can also worsen fatigue. Consult a dietician or nutritionist to learn what foods will help you keep more consistent blood sugar levels. If preparing food is too tiring, pre-prepared meals and ingredients or meal delivery services can be a good option.
Adapted from Navigating Life with Multiple Sclerosis by Kathleen Costello, MS; Ben W. Thrower, MD; and Barbara S. Giesser, MD, FAAN. The book, part of the American Academy of Neurology’s Brain Health Books series published in 2015 by Oxford University Press, is available to purchase from Oxford University Press or Amazon
