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8 Strategies for Coping with MS Fatigue

By Lisa Marie Basile
Reviewed by Dana Cooper, M.D.
October 20, 2023
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If you’re like an estimated 80% of people with multiple sclerosis (MS), fatigue may be a frequent struggle. This feeling of having little physical or mental energy can make it hard to take care of your home or family, prioritize self-care, or perform your job duties. In fact, fatigue is one of the main reasons some people with MS leave their jobs, according to the National Multiple Sclerosis Society (NMSS).

MS fatigue is more than just being tired—a feeling that can occur when you don’t get enough sleep or when you push yourself a little too hard during the week. Rather, fatigue is a severe, chronic, overwhelming sense of exhaustion that can dramatically impact daily life even when you’re well rested.

“It’s honestly one of the hardest symptoms for people without MS to understand. People will say, ‘Well, I’m tired too…’ but they don’t understand how fatigue differs,” says Andrew L. Smith, M.D., a board-certified neurologist at OhioHealth in Columbus.

Managing your fatigue can help you find a better quality of life, and it can give you the energy to get back to the things you love. Here are some strategies you can try to help prevent or cope with MS fatigue.

Rule Out Other Health Concerns

“There’s no straight line to fatigue,” says Barbara Giesser, M.D., board-certified neurologist and MS specialist at Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, California. While fatigue is common among people with MS, there can be other explanations, too, so it can be hard to pinpoint the exact cause. Giesser recommends first ruling out additional medical conditions and other factors that could be contributing to your fatigue.

“If you have fatigue, [your doctor] will want to rule out hypothyroidism or anemia,” Giesser says. “The goal is to identify and address any secondary causes of fatigue.”

In addition, fatigue may be due to side effects from medication, co-occurring sleep disorders, or depression. In those cases, your doctor may want to adjust your dosage, diagnose and treat the sleep issue, or refer you to a mental health professional.

Take Your Disease-Modifying Therapy

After addressing other potential underlying causes, your doctor can also determine whether physiological changes due to MS could be at play, as well. According to Giesser, inflammation-related nerve damage may be one of the main causes of fatigue in MS, although it’s not yet entirely clear how.

For this reason, it’s important you take your prescription medication, such as disease-modifying therapies or corticosteroids, as prescribed.

Keep Cool and Comfortable

In people with MS, fatigue may also be worsened by heat exposure, Smith says. According to the NMSS, MS symptoms worsen in general when your core temperature gets a bit too high: just a quarter- or a half-degree rise in body temperature.

Try to stay cool and comfortable by wearing breathable clothing, eating cold foods, avoiding peak sunlight hours, and exercising indoors on warmer days.

Get Some Exercise

When you’re fatigued, it may seem like exercising would drain your energy further. But exercise can offer a host of benefits, including improving fatigue, research findings suggest. Exercise may also help reduce rates of disease relapse and progression, which may also help reduce MS fatigue in the long term.

The NMSS recommends getting about 150 minutes of exercise per week, which equates to 30 minutes five times per week. Aim to do four different kinds of movement regularly—depending on your ability—Giesser suggests:

  • Aerobic exercise, which increases your heart rate, helps keep your lungs and heart healthy, and helps reduce fatigue in people with MS, according to some research
  • Resistance exercise with weight or bands, which can also improve movement, mobility, and fatigue, says the same research
  • Stretching, which can help reduce spasticity, a symptom that may also contribute to fatigue
  • Neuromotor exercise (like dancing or tai chi), which studies have found can help improve balance, gait, quality of life, and pain

You can change up which type of activity you do each day. Not sure where to start? Follow a YouTube video of exercises from MS experts, take a walk around your neighborhood, or simply stay busy around the house. “House cleaning, walking your dog, or playing frisbee with your kids all count,” Giesser says.

It’s also a good idea to consult with an occupational therapist or physical therapist who can work with you to develop an exercise plan that’s right for your abilities. Besides helping you find the right exercise routine, an occupational therapist can also work with you to create strategies for conserving your energy.

Tend to Your Mental Health

Stress can trigger flare-ups and worsen MS fatigue, suggests research published in the Journal of Behavioral Medicine. Fortunately, certain strategies have been shown to help some people cope with stress.

Mindfulness training and cognitive behavioral therapy, or CBT [a form of therapy that focuses on thinking and behavior], can help with stress,” Smith says. “CBT helps you better recognize a symptom and address it. It helps you pick up on your own internal cues.” For example, you may learn to be more aware and able to acknowledge when fatigue is coming on, which can allow you to change plans or find a way to conserve energy, he explains.

A mental health professional trained in CBT and mindfulness approaches can help get you started in learning the skills and tools that can help you cope better with stress. Your doctor may be able to make a referral, or you can search for an in-person or telehealth provider online. The American Psychological Association and Psychology Today both offer directories that may be helpful.

Track Your Symptoms

Keeping a fatigue diary can help you take note of any patterns or triggers, according to the Multiple Sclerosis Society (UK). For example, tracking your fatigue could help you notice that it gets worse after certain activities, or better with certain dietary changes. You may want to take note of:

  • Your mood
  • When and how you’ve exercised
  • What you ate and when
  • Any medications you’ve taken
  • What time of day it is

You can show your fatigue diary to your doctor during checkups. They may be able to share further insights about what habits or triggers could be making your MS fatigue worse (or better).

Eat for Energy

Certain foods can tank your energy levels, Giesser says, which is why she suggests smart eating and snacking.

Avoid sugary foods—even juices, which can masquerade as healthy but are often high in sugar—or refined foods (like potato chips) when you’re in the mood for a snack. “When people eat food with a high glycemic load (like sugary snacks or refined carbs), it can cause a spike and a crash,” Giesser says. That post-snack crash is what doubles down on your fatigue.

There isn’t one “best” diet for MS, but researchers suggest keeping your plate full of colorful, nutritious foods. “It’s an old cliché, but healthy foods are better and less inflammatory. You can’t go wrong with things like nuts, fruits, veggies, and [other] foods that aren’t inflammatory,” Smith says. A healthy snack might look like a veggie with hummus, a banana with a spoonful of nut butter, or tuna with a green pepper.

Talk to Your Doctor About Medication

Your doctor may suggest prescription treatment for your fatigue, Giesser says. “There are some off-label medications, like amantadine and modafinil, that are helpful with fatigue.” However, evidence on their efficacy is mixed. For instance, one trial found that these drugs were no more effective than a placebo in decreasing fatigue. If you’re interested, ask your doctor whether these medications may be right for you.

Ultimately, fatigue is a complex symptom, and it may take some trial and error to find an approach or combination of approaches that can help you regain some of your energy. Your doctor may be your best partner in these efforts, so be sure to keep them in the loop about what you’re experiencing and follow their guidance.

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