Management of Fatigue

Fatigue is one of the most commonly reported symptoms by people living with multiple sclerosis (MS), and it can be one of the most disabling, significantly impacting an individual’s ability to function at home and/or work. An estimated 76% to 92% of people with MS have fatigue.1 Fatigue is often described as an extreme mental or physical exhaustion that is not improved with sleep.2

Types of fatigue in MS

The exact cause of fatigue is unknown. In people with MS, there may be many contributing factors that can cause or exacerbate fatigue, such as MS symptoms that cause interrupted sleep (like nocturnal muscle spasms or bladder dysfunction), mood changes like depression, or muscle weakness or spasticity that make everyday tasks require additional effort. In addition, there is a form of fatigue that is unique to MS called lassitude. Lassitude is characterized as fatigue that generally occurs daily, tends to worsen as the day progresses, can come on suddenly or occur early in the morning, and is generally more severe than other types of fatigue, greatly interfering with daily tasks and responsibilities. Lassitude may also worsen with heat and humidity.3

Fatigue can also be a side effect of medications. Any medications that include warnings of “may cause drowsiness” or recommendations to “not operate machinery” can cause fatigue. Fatigue may be caused or worsened by other conditions, including depression, infections, or anemia.4

Fatigue, MS, and depression

People who have depression – both those who have MS and those who do not – frequently experience fatigue as a symptom of their mood disorder. Some of the fatigue experienced by those with MS may be due to undiagnosed depression. Treating depression can also help treat fatigue that is caused by the condition. Anyone who is experiencing symptoms of depression, including consistently sad or low mood, a lack of enjoyment in previously enjoyable activities, difficulty sleeping, irritability, or a sense of hopelessness, should talk to their doctor about their symptoms.4

Ways to manage MS-related fatigue

Anyone experiencing fatigue should discuss it with their doctor, explaining how frequent and how debilitating the symptom is, such as how it interferes with their daily functioning. While there are currently no FDA-approved treatments for MS-related fatigue, there are management strategies that can help lessen the symptom, including:

  • Physical or occupational therapy, which can teach ways to simplify or more easily perform daily tasks
  • Regular exercise, which can build endurance and reduce fatigue long-term
  • Sleep hygiene, including having a regular schedule for sleeping/waking and not using electronics before bed
  • Treating sleep-disrupting conditions, including spasticity and urinary problems
  • Managing heat and/or having strategies for cooling down slowly (cooling too quickly can cause constriction of blood vessels and shivering, which can exacerbate MS symptoms)
  • Stress management, which may include getting psychological support through a support group or therapist3,4

People with MS-related fatigue should talk to their doctor about their medications, as well as any supplements they are taking. While there aren’t medications that are specifically approved for MS-related fatigue, your doctor may prescribe medications off-label (when a medication is used in a manner other than that which it is officially approved).

Conserving energy to minimize the effects of fatigue

Many people with MS find ways to conserve their energy, including:

  • Planning out daily tasks, prioritizing those that are most important and pushing those that aren’t critical to later dates if energy is waning
  • Scheduling alternating times for rest and activity
  • Breaking complex tasks into smaller ones
  • Asking for help in accomplishing tasks
  • Organizing needed supplies (such as for cleaning or cooking) to have everything on-hand
  • Using online ordering and delivery services4

Invisibility of fatigue

Like other symptoms of MS, fatigue is invisible and may be discounted or misunderstood by family and friends. It can be disheartening and isolating for someone dealing with MS-related fatigue to experience the lack of understanding by those closest to them. Educating others about the realities of MS and fatigue can help increase awareness and lead to better understanding.4

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Written by Emily Downward | Last review date: March 2022.