Fatigue and MS

Make the most of the energy you have People with MS experience normal muscle fatigue like everyone else, but this is compounded by the other effects of MS.

As a general rule, fatigue is not harmful but it can be disabling if it is not managed.

It requires more mental and physical effort to carry out everyday activities with weak or stiff limbs.

Weakened muscles put an extra workload on stronger muscles, causing them to tire more rapidly.

Depression and frustration at having a chronic disease such as MS can result in stress-related fatigue, partly because normal patterns of sleep may be disturbed.

Demyelinated nerve fibres need more energy to conduct impulses than healthy fibres and, as a result, they fatigue quickly.

Causes of fatigue

Fatigue can be brought on by exertion, but it can occur for other reasons, including eating a heavy meal, smoking, or a rise in body temperature.

When the body temperature is raised, demyelinated nerve fibres are more likely to fail to conduct nerve impulses properly.

Sensitivity to temperature can also reflect the body's normal daily temperature cycle, which varies by as much as one degree Celsius. Body temperature is generally lowest about 2 to 3am and highest in the afternoon. Fatigue resulting from the normal rise in body temperature combined with tiredness from the day's activities can leave a person with MS feeling particularly weak in the late afternoon.

A raised temperature caused by an infection will also cause fatigue.

If you have been exercising or having a hot bath you may find that symptoms experienced during a previous relapse come back. Electrical conduction in nerve fibres that have been repaired after an attack of MS is less stable than in healthy fibres. Even a small rise in body temperature can lead to temporary disruption of nerve impulses in some fibres.

At times it may be difficult to distinguish whether you are experiencing fatigue-related symptoms or having a relapse. Symptoms due to fatigue, often caused by a raised body temperature, usually subside quickly when the temperature returns to normal. Many people learn to recognise symptoms occuring under these circumstances as they tend to be similar on each occasion.

Managing Fatigue

Managing fatigue means finding ways to live with the problem to minimise its effects on your life.

Decide on priorities

This is the first challenge in reducing fatigue as a disabling symptom. Because your energy level is low, you will want to ensure that you make the most of the energy you do have. Decide what is most important to you.

It could be that holding down your demanding job is important enough for you to forgo other activities such as nights out during the week. Spending time with your family may be a more important way of using your energy than doing housework. If so, you could either accept a less-than-immaculate house, or hire someone to help with the cleaning, if possible.

Balance rest and activity

Moderation must be the word, so that you don't overdo things, but don't miss out on events that are important or fun. Try to plan your work routine, and your social occasions and late nights, so they don't all come in a row.

Plan ahead, exercise willpower, and be able to say "no."

Find a daily routine that suits you

Experiment. If you find that you are most affected in the late afternoon, try to do jobs that need concentration and effort in the mornings, when your mind and body work best. Plan a rest in the afternoons.

Make the most of your energy

Perform activities in the most energy-efficient manner. An occupational therapist can help you with this, perhaps by visiting your home or place of work and assessing possible adaptations. For instance, you may use less energy by simply reorganising your work area.

Using Your Energy Efficiently

At Home

Store items that are used most often within easy reach, to reduce stretching and bending.

Gather all items needed to do a particular job, such as preparing a meal, then sit down while doing the job.

Use a trolley to transport heavy items.

Use an electrical appliance whenever possible - for instance, a food processor.

Spread cleaning tasks over a period of time, rather than trying to do the whole house at once.

Plan menus before going to the supermarket, and take a list.

Alternate heavy and light tasks. Incorporate rest periods.

Personal Care

Use a seat while showering or washing.

Sit while dressing, whenever possible.

Use assistive devices, such as long-handled shoehorns, electric toothbrushes, etc., whenever possible.

For suggestions on using your energy efficiently on-the-job, see Working with MS.

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