10 Ways to Combat MS Fatigue

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Fatigue is the one of the most (if not the most) debilitating symptom in Multiple Sclerosis (MS), and its root cause is usually challenging to tease apart. Often the physically crushing and mind-numbing exhaustion of MS fatigue stems from a combination of the disease itself and other factors like medications, poor sleep habits, depression, or inactivity.

The good news is that while the unpredictable burden of MS fatigue may seem overwhelming, there are things you can do to lessen it.

Here are 10 strategies you can engage in to fight your fatigue and feel good - you deserve it.

Staying Cool to Combat MS Fatigue

Fatigue can be worsened when a person's core body temperature rises - this is called the Uhthoff phenomenon. For instance, you may notice that your MS fatigue worsens during a hot bath, a summer stroll outside, or a fever. This worsening of your MS fatigue can be quite dramatic, some people even fear they are experiencing a new MS relapse. The good news is that with a resolution of the heat, the symptoms resolve - so your fatigue should go away (or back to its baseline) once you cool down.

Preventing this phenomenon from occurring in the first place is your best bet. Tips include:

  • Keeping your home air conditioned
  • Carrying a mini fan around with you or ice packs that you can stick in your clothing
  • Drinking cold water throughout the day
  • Seeking out shade when outside
  • Considering a cooling vest
  • Exercising in the morning or evening when temperatures outside are cooler
  • Wearing loose, light-colored cotton clothing when outside

Conserve Energy

The idea behind energy conservation is that the bodies of people with MS need to work harder to do anything - move, think, and feel - because nerve communication is impaired and slowed.

This is often why experts think MS fatigue is more than just physical exhaustion. It often encompasses a mental fatigue too, commonly known as "brain fog." Everything is just run down more easily.

You may need to think ahead as to how you can conserve your energy each day. This can be tricky, but once you get into the flow of your routine, energy conservation 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
  • Planning energy-draining activities like shopping, cleaning or paying bills for the morning when you are less fatigued
  • Asking your partner to take on more of the heavy duty household chores
  • Using your scooter or wheelchair to get around throughout the day

Keeping it Simple

Minimize the chaos in your life as much as possible. Declutter your house and work space and make your home an inviting, warm, and usable space - an occupational therapist can be especially helpful in devising an efficient home and work environment based on your limitations and MS needs.

In addition, seek out the help and support of your loved ones. Most want to help, but do not know how or do not want to step on your toes. Hire a cleaning lady or ask a friend to help you with tidying the house or grocery shopping once a week. If you have children, ask friends to carpool and consider cutting back on the number of their extracurricular activities - they will likely enjoy spending more time at home with you anyway.

Make Time for Yourself to De-stress

With the humdrum of life, it can be difficult for anyone to find time for themselves. This may be especially difficult for those with MS who struggle to meet everyday basic needs, which varies depending on your level of disability. But please try to engage in an activity that you enjoy once a week. A good distraction can do wonders for your fatigue.

If you find that stress is really impacting your fatigue, you can also seek professional help. Cognitive-behavioral therapy by a licensed psychologist or psychiatrist can be very useful in helping you manage your stress in a healthier, adaptive way.

Devise Your Own Exercise Program

Exercise has been found in scientific studies to improve MS fatigue, in addition to other symptoms like bladder and bowel problems and depression. Exercise is also important for a person's heart health.

The good news is that there are a number of ways to exercise. With your doctor or physical therapist, devise an exercise plan that works for you based on your needs, limitations, and interests. A program may include daily walks, gardening, ballroom dancing, swimming, or arm exercises and stretches while you lounge with your partner in the evenings.

You may be surprised by how creative you can get while still getting your heart rate up. Still, be sure to take care of yourself - don't push too hard, too quickly. Remember to also stay cool - carry a water bottle with you during your exercise excursion, run cool water over your wrists when you get warm, and wear lightweight, breathable clothing.

Engage in a Complementary Therapy

Complementary therapies are therapies that are used in addition to disease-modifying therapies to manage symptoms of MS. They are not scientifically proven to slow the progression of MS, but are generally safe, allow a person to take an active role in their MS health, and have been found in some studies to improve a number of MS symptoms, like fatigue.

Therapies that have been found to improve MS-related fatigue include yoga, meditation, prayer, and reflexology - a form of massage in which pressure is applied to the feet (or other parts of the body like the hands) in order to promote healing within the brain and spinal cord. Yoga, which combines meditation, breathing techniques, and exercise, is often a good alternative for people with MS who cannot engage in an exercise program.

Consider a Prescription Medication

Sometimes your doctor will recommend a medication to help you cope with your fatigue, with the caveat that you engage in other self-care strategies too. These medications can be very helpful for some people, but are usually not the magic answer to curing your fatigue. They also have some side effects, which may or may not be worth it to you.

Medications that are sometimes prescribed by neurologists to manage fatigue include:

Talk with 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 require Ritalin daily to manage their fatigue.

Get Your ZZZ's

Sleep is a beautiful thing, and, unfortunately, many of us do not get enough. For those with MS, symptoms like getting up in the middle of the night to use the bathroom and aching, tingling legs often plague your ability to sleep well and long. Sleep disorders too may be the root of your sleep issues, like restless leg syndrome or sleep apnea.

You can improve the quantity and quality of your sleep by practicing healthy sleep habits like:

  • Going to bed at the same time every night, regardless of the day of the week
  • Having a nighttime routine (e.g., a warm bath followed by a non-stressful TV show with your partner in the living room - avoid stressful conversations, email, TV in bed)
  • Re-evaluating your nap time, if it's interfering with your nighttime sleep
  • Avoiding or cutting back on caffeine intake, especially in the afternoon
  • Limiting or avoiding alcohol, which can negatively impact your sleep
  • Treating your MS symptoms (e.g., consider medication to treat your bladder spasms if you are waking up at night to urinate and avoid fluids at nighttime)
  • Seeing your doctor for a workup of primary sleep disorders - a sleep study may be helpful

Review Your Current Medications

It may surprise you that the very medications you are taking for your MS symptoms may be the culprit for your fatigue or at least contributing to it. For instance, anticholinergic medications used to treat your urinary incontinence can cause fatigue, as can some of the disease-modifying therapies. Muscle relaxants used to treat spasticity can also cause fatigue.

Speak with your doctor about how you can manage these medication side effects. Your doctor may suggest switching your medications or changing the time of dosing - like taking your Avonex on the weekend when you can rest, or only taking your muscle relaxant in the evening.

See Your Doctor for Your Sad Mood

Depression may not be the root cause of your fatigue, but it may be making it worse. Treating your depression, usually with a combination of medication and therapy, like cognitive-behavioral therapy, will most likely help your MS fatigue.

In fact, you may not even realize how much your mood is affecting your fatigue, or how much your fatigue is affecting your mood - it's usually a complicated cycle of one triggering the other. Besides a low mood and lack of interest in doing things you once enjoyed, other symptoms of depression include a change in appetite and sleep, irritability, and a feeling of hopelessness or guilt.

The Bottom Line

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


Cramer, H., Lauche, R., Azizi, H., Dobos, G. & Lanhhorst, J. (2014). Yoga for multiple sclerosis: a systematic review and meta-analysis. PLoS One, Nov 12/9(11):e112414.

Krupp, L.B., Serafin, D.J., & Christodoulou, C. (2010). Multiple sclerosis-associated fatigue. Expert Review of Neurotherapeutics, Sep;10(9):1437-47.

Namjooyan, F., Ghanavati, R., Majdinasab, N., Jokari, S., & Janbozorgi, M. (2014). Uses of complementary and alternative medicine in multiple sclerosis. Journal of Traditional Complementary Medicine, Jul-Sep;4(3):145-52.

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