Fatigue & Daily Living
At least at the beginning, it's important to listen to your body and do what it tells you. Over time you will recognize the signs that your body is telling you and you will know what the appropriate coarse of action should be. It may seem obvious, but many people with multiple sclerosis (MS) keep going even when they know they shouldn't. Instead of trying to push through, take a break or simply slow down at the first sign of fatigue. There’s no shame in respecting your limits.

It’s important to evaluate your level of energy at all times. Think of your personal energy stores as a "battery bank." Deposits and withdrawals have to be made over the course of the day or the week to balance energy conservation, restoration, and expenditure. Keep a diary for one week to identify the time of day when you are either most fatigued or have the most energy. Note what you think may be contributing factors.

Be alert to your personal warning signs of fatigue. Fatigue warning signs may include tired eyes, tired legs, whole-body tiredness, stiff shoulders, decreased energy or a lack of energy, inability to concentrate, weakness or malaise, boredom or lack of motivation, sleepiness, increased irritability, nervousness, anxiety, or impatience.

Overcome fatigue

Fatigue is one of the most common symptoms of MS. With about 80% of people with MS having fatigue, about half of those say it’s their worst symptom. Fatigue can be caused by many things, from trouble sleeping, to depression, to lack of muscular strength.

People with MS are also affected by something called "MS fatigue." This is different from other kinds of fatigue. It doesn’t happen just because you're tired. It can come on at any time, even in the morning after a good night’s sleep.

To help overcome fatigue it's important to plan ahead and organize your day or tasks. For example, change where items are stored to reduce trips or reaching, delegate tasks when needed, and combine activities and simplify details. Be sure to schedule rest in your day since frequent periods of short rests are beneficial to avoid becoming fatigued. Be sure to pace yourself since a moderate pace is better than rushing through activities. Reduce sudden or prolonged strains and alternate sitting and standing.

It's important to talk to your doctor about your MS and fatigue. Let your neurologist know as soon as possible that fatigue has become a problem for you. The best thing for you to do is try to stop fatigue before it starts. Next are a few things that you can do to try to help:

● MS fatigue tends to get worse as the day goes on, so try to do things in the morning while still rested.
● Heat and humidity can make MS fatigue worse, so think about the weather when making plans and try to stay cool.
● Focus on one task at a time to conserve energy so not to over task yourself.
● Ask your doctor about physical therapy that can help simplify daily tasks.
● Ask your doctor if there are any medicines can that help reduce fatigue.

Be sure to get enough sleep

Trouble sleeping is also common in MS, and is one of the things that can lead to fatigue. Symptoms that can disrupt sleep include painful muscle spasms (spasticity), the need to make frequent trips to the bathroom (nocturia), and involuntary twitching and kicking or periodic limb movements in sleep (PLMS). They occur because of secondary factors such as stress, spasticity, inactivity, or depression that people with MS often have.

There are also several things you can do yourself to relax and start a sound sleeping habit:

● Repetitive mental exercises like the classic "counting sheep" can help some.
● Visualization or seeing yourself going to sleep in a peaceful setting. Find your "happy place".
● Progressive relaxation — mentally putting your body to sleep one part at a time.

You can also try listening to music or meditating. If nocturia isn’t a problem, try a relaxing cup of decaf tea or warm milk.

Don’t rely on sleep medicines and remember that just because something is available over-the-counter doesn’t mean it’s harmless. When you can control your MS symptoms, you should find that it becomes a little bit easier to sleep. If it doesn’t, then talk to your doctor or see a sleep specialist. If you are having trouble sleeping, it won’t be a permanent problem.
Keeping Cool
Heat or high humidity can make many people with MS experience a temporary worsening of their symptoms. It's felt that this occurs because heat causes the nerves whose myelin has been destroyed to conduct electrical signals even less efficiently. So as your external temperature rises, the more noticeable it becomes. Now on the other side of the spectrum, extremely cold temperatures and changes in temperature can also cause MS symptoms, like spasticity, to flare.

You can keep yourself more comfortable and cooler by avoiding extreme temperatures which can worsen your MS symptoms and by using air conditioning. If hot and humid conditions worsen your MS, try to stay in cool and dry areas as much as possible. It's important to remember that while climate may worsen the symptoms of MS, climate changes don't produce more actual nerve damage. The adverse effects of temperature and humidity are generally short-term or until you are able to cool down.

One way to cool down quickly is to take a cold shower or bath. It doesn't have to be an extremely cold temperature, but rather anything that is lower than your body temperature. The colder the water is, the faster the results will become visible, just don't go to the extreme of adding ice to your bath. A cold shower does, in fact, have another purpose other than shrinking your libido.
Less Stress
The prolonged stress of living with a chronic illness like MS can lead to frustration, anger, hopelessness, and depression. Stress can keep you up at night and can lead to fatigue. Many people with MS feel that there is a definite connection between stress and MS. For many, they feel that stress makes their symptoms worse, or even leads to an MS relapse. Stress can’t be avoided completely, but it can be reduced if an effort is made. Don't stress out over the little things, taking care of yourself is much more important.

Some of the warning signs that should be looked for are emotional, physical, and behavioral changes. These can range from anger to sadness, fatigue to weight change, and impulsive acts to withdrawing from others. By being honest with yourself, one can usually notice these changes even if they are too subtle from others to notice. Others will usually notice when they become more significant.

Warning signs of stress:
Emotional
Signs include anger, an inability to concentrate, unproductive worry, sadness, and frequent mood swings.
Physical
Signs include stooped posture, sweaty palms, chronic fatigue, and weight gain or loss.
Behavioral
Signs include overreacting, acting on impulse, using alcohol or drugs, and withdrawing from relationships.

Ways to reduce or manage stress:
Simplify your life
Try to focus on the big picture. Don’t use up all your energy worrying about little things that may not matter in the long run.
Learn to relax
Find a quiet location without distractions and sit in a comfortable seat. Find a "happy place" for your mind to focus on and put all of your worries away.
Learn to say no
If you can’t or don’t want to do something, don’t. Make a list of the things that are most important to you and will make you the happiest and focus your time and energy on them.
Share your stress
Sometimes it can help to talk to about your stress. Ask your doctor about support groups in your area. Other MS patients will understand what you're going through and be able to offer advice and encouragement.
Get enough sleep
Life is always more stressful when you are tired. If you are well rested, you'll be better able to deal with your daily activities.
Exercise
Regular physical activity can also help reduce stress. It can also help reduce the depression and fatigue that can make stress worse.
Get Organized
One of the most effective ways to make life easier is to get organized and stay that way. The simple act of staying organized can eliminate stress build-up. It will help you from forgetting to do things and save you time in finding things.

Get a calendar or notebook, it will contain your future plans so you don't have to attempt to remember it. It should include:
● Appointments
● Your daily action plan or to-do list
● Daily lists
● Important contact information
● Personal information

It's always good to use something that's small and portable enough to keep on you at all times. You might also keep a larger one where you keep everything organized at home, like a study or home office.

Make a daily to-do list, this way you are able to see they extra thing you could or should do from day to day. Digital PDAs and some cell phones include calendar features that can synchronize with your home computer.

Filing all of your paperwork (bills, receipts, bank statements, insurance papers, and such) in one spot is a great way to keep it all organized so you can easily access them as needed. Go one step further and have folders for each category like "Medical," "Insurance," "Bank," "Taxes," or "Utilities." You can even go an additional step further and alphabetize them to make filing and retrieving that much easier.

Clear the clutter and get rid of anything you know you won't use every again. Keep what you know is important or that relates to anything current. Old magazines or a grocery store receipt from 2 years ago will most likely never be used again. If you can't use it, then loose it.

Make checklists so you know what you have accomplished and what still needs to be tackled. Keep your calendar up-to-date and remember that it's alright to make changes in it. Erasing is allowed and even encouraged.

Plan out your day so you can accomplish it in the least number of steps as possible. Along with this would be a list of what you need at every stop, chances are that if you don't write it down - you will probably forget it. Try to make the route you take to get from each location the shortest and/or most direct path to one another. It’s a great way to conserve energy and maybe remember everything you have to do.