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MS Fatigue
Medically speaking, fatigue is not the same thing as tiredness. Tiredness happens to everyone and is the expected feeling after certain activities or at the end of the day. Usually you know why you are tired and a good night's sleep will solve the problem. Fatigue is a daily lack of energy that has an unusual or excessive whole-body tiredness not relieved by sleep. It can be acute (lasting a month or less) or chronic (lasting from one to six months or longer). Fatigue can prevent a person from functioning normally and affects a person's quality of life.

Fatigue is often referred to as "lassitude" or a state or feeling of weariness, diminished energy, or listlessness. For those with multiple sclerosis (MS), the characteristics of this "MS fatigue" make it different from fatigue experienced by persons without MS. It's unique in MS and is generally more severe than "normal" fatigue. It can leave you feeling a sense of tiredness at different times of the day or even all day long. It can last any duration of time and isn't predictable on its occurrence. It can also be described as an overwhelming feeling or sense of physical weakness for no apparent reason.

Fatigue is one of the most common symptoms of MS, occurring in an estimated 80% of those with MS according to the National Multiple Sclerosis Society (NMSS). MS-related fatigue tends to get worse as the day goes on, is often aggravated by heat and humidity, and comes on more easily and suddenly than normal fatigue.

There are two major types of fatigue in MS. These two types of fatigue are probably separate problems related to the MS.
• The first type is a general feeling of tiredness. It may feel as if one has not slept the night before. This feeling may be worse in the afternoons or after activity. People may feel that they are unable to do as many tasks without getting tired as they did before.
• A second type of fatigue is muscular. In this type, there is increased weakness after repeated activity. Often, this occurs with walking. People may find that they are dragging one leg or are more unsteady.

It's not unusual for people to feel guilty about being fatigued, but until it's experienced, it's difficult to understand the impact of the symptom and how debilitating it can be. In the beginning, many people with MS themselves will also underestimate the force of fatigue, then as time goes on they will know what can be expected and how best to deal with it.

Fatigue can significantly interfere with a person's ability to function at home and at work, and may be the most prominent symptom in a person who otherwise has minimal activity limitations. Fatigue and a cognitive fog are one of the primary causes of those with MS to stop working. It's another constant reminder that things are different than before you had MS.

Characteristics of MS Fatigue can be:
• Generally occurs on a daily basis
• May occur early, even after a restful night's sleep
• Tends to worsen as the day progresses
• Tends to be aggravated by heat and humidity
• Comes on easily and suddenly
• Is generally more severe than normal fatigue
• Is more likely to interfere with daily responsibilities

It's not known why this is so common in MS patients, but felt that it's caused directly by the demyelinated neurons. The "shorts" in the nervous system cause it to work that much harder to get the signal or impulse through. In addition, high temperatures seem to make these symptoms that much more noticeable if it's not bad enough already.

Treatment with modafinil is the typical medication prescribed for fatigue and has shown an improvement for most patients. Physical and occupational therapy can also work well by adjusting how much physically one has to do to accomplish a task. Caffeine also provides a bit of a boost, but that's usually typical for most people in general.

Historically, when considering the disability as a whole, fatigue is usually considered as either a sensory or other functional system and not a factor by itself, even though it has such a significant impact by itself.

At times, this could be misinterpreted as you have been working too hard, or may not rest enough. It could even be misdiagnosed as another condition and not due to MS. With the findings and a diagnosis of MS, this fits into place as one of its major symptoms. MS related fatigue tends to get worse as the day goes on, is often aggravated by heat and humidity, and comes on more easily and suddenly than normal fatigue.

Since fatigue can be a sign of many other diseases too, it's not often immediately identified as being caused by MS, thus possibly causing a delay in diagnosis. If additional symptoms are also at hand, then a diagnosis should be a bit more clear. In the Daily Living section of this site, we will discuss what you can do to combat fatigue.

Describing MS-Related Fatigue

One way to look at a person's daily energy needs can be by comparing it to a battery. Now if this battery can't be recharged till the next day, then once the stored power is used up, that's it. So if you run yourself too hard and fast early on in the day, you won't have any energy for the remainder of the day. One important item to remember is that with MS, sometimes the "battery charger" doesn't work that well.

If your energy is gone and you tend to push beyond your current limits, then you end up paying for it in the form of fatigue that could last up to several days. Sometimes it's a difficult thing to change, but it's very important to ration your daily energy. You may be accustomed to pushing yourself hard every day, but it's important to modify that behavior or the consequences could be harsh. As an "invisible" symptom, fatigue is often misinterpreted or misunderstood. This lack of understanding of the symptom may lead others to believe that the person is just lazy or didn't get enough sleep. Most people with MS find that if someone doesn't have fatigue from MS, then they really don't have any idea what it's like.

It has also been described as having 10 pound weights strapped around each leg, each arm, your head, and on your back. At any random time, the amount of the weights may change and not always in an even way. The left side of the body may have 5 pound weights and the right may have 10 pound, then it can change yet again depending of so many factors. It's unpredictable and can be a very frustrating issue to deal with.

Dealing With MS-Related Fatigue

The best way to deal with fatigue related to your MS is to treat the underlying medical cause. Unfortunately, the exact cause of MS-related fatigue is often unknown, or there may be multiple causes. However, there are steps you can take that may help to control fatigue.

1. Assess your personal situation.
• Evaluate your level of energy. Think of your personal energy stores as a "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.
2. Conserve your energy.
• Plan ahead and organize your work. For example, change storage of items to reduce trips or reaching, delegate tasks when needed, and combine activities and simplify details.
• Schedule rest. For example, balance periods of rest and work and rest before you become fatigued. Frequent, short rests are beneficial.
• Pace yourself. A moderate pace is better than rushing through activities. Reduce sudden or prolonged strains. Alternate sitting and standing.
• Practice proper body mechanics. When sitting, use a chair with good back support. Sit up with your back straight and your shoulders back. Adjust the level of your work. Work without bending over. When bending to lift something, bend your knees and use your leg muscles to lift, not your back. Don't bend forward at the waist with your knees straight. Also, try carrying several small loads instead of one large one, or use a cart.
• Limit work that requires reaching over your head. For example, use long-handled tools, store items lower, and delegate activities whenever possible.
• Limit work that increases muscle tension.
• Identify environmental situations that cause fatigue. For example, avoid extremes of temperature, eliminate smoke or harmful fumes, and avoid long hot showers or baths.
• Prioritize your activities. Decide what activities are important to you, and what could be delegated. Use your energy on important tasks.
3. Eat Right
• Fatigue is often made worse if you are not eating enough of or any of the right foods. Maintaining good nutrition can help you feel better and have more energy.
• On the flip side, avoid the bad foods and sugars that might taste great but it will have a bad long term effect on your energy.
4. Exercise
• Decreased physical activity, which may be the result of illness or medication, can lead to tiredness and lack of energy. Even healthy individuals forced to spend extended periods in bed or sitting in chairs develop feelings of anxiety, depression, weakness, fatigue, and nausea. Regular, moderate exercise can decrease these feelings, help you stay active, and increase your energy.
• Decreased physical activity will make you want to rest more. In turn, by resting more you will be less active and loose more strength and since you have less strength you will tend to be even less active which will cause an even greater loss of strength. The only way to stop or reverse this downward spiral is to do all you can to stay active and strong.
5. Learn to manage stress
• Adjust your expectations, so if you have a list of 10 things you want to accomplish today, maybe 2 or 3 is more realistic and leave the rest for another day. A sense of accomplishment goes a long way to reducing stress.
• Help others understand and support you. Family and friends can be helpful if they can "put themselves in your shoes" and understand what fatigue means to you. For some people, MS support groups can be a source of comfort as well since they understand what you are going through.
• Relaxation techniques, such as yoga or audiotapes can teach deep breathing or visualization can help reduce stress.
• Participate in activities that divert your attention away from fatigue, such as knitting, reading, or listening to music require little physical energy but require attention.