MS fatigue

MS can make you feel tired. Let’s put all our energy into changing that.

Feeling tired? It could just be the stresses and strains of daily life, but it could also be your MS.¹ Tiredness (also known as fatigue) is one of the most common symptoms of MS, affecting over 90% of people living with MS.^1,2

MS fatigue can affect you both physically and mentally.^3,4 It might leave you feeling totally exhausted or you may just feel generally weak or lacking in energy.² Fatigue can also affect your ability to concentrate, think clearly and make decisions (commonly called ‘brain fog’).^2,4

Fatigue can vary widely in its intensity and may change on a daily basis. Sometimes it might seem manageable and other times it may feel overwhelming. On some days, even the simplest tasks or activities, like seeing friends, can leave you feeling exhausted.^1,4

Some days it’s fine and I can be buzzing with energy. Other days it can be a battle to get motivated and even just to move. I have fatigue every day, it just occurs on different levels. At the moment, I can kind of work around it, but there are days when I have to cancel plans because of it. Sometimes I even have to cancel trips like shopping with friends, as standing around in shops zaps too much of my energy.

Katie

Living with MS since 2016

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When I had my relapse, even the smallest task meant I needed a nap, and I would be sleeping for 14–16 hours a day during this period. I still get tired, but I find that keeping busy and mentally active helps.

Conor

Living with MS since 2003

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Fatigue used to sweep over me after working only half an hour at the computer, and I found I had to lay down after that. After my relapse, I wanted to go back to work and this led to the cycle of working and resting. On reflection, my advice to others would be to give yourself a break and recover at your own pace. Don’t try and push yourself – you will get better if you give yourself a break.

Katharina

Living with MS since 2018

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Unlike ordinary tiredness, MS fatigue can come over you quickly without warning and it can take a long time for you to recover.⁵ Your legs and arms might feel heavy and it may become harder to grab and hold things or write.⁵ It can also temporarily make other MS symptoms worse, and affect speech and your ability to think quickly and clearly.⁵

Many people living with MS get fatigue later in the day. Some people also find that stress or heat can make it worse.⁵ Fatigue can make it challenging to work, so it’s important to find ways to work around your tiredness at work.⁶ See some tips on how to do this on our work and careers page.

Although fatigue can impact you in many different ways, there are plenty of ways to reduce the impact it has on your everyday life – read on to find out more.

Fatigue falls into two main categories, depending on whether it’s caused by MS directly (primary fatigue) or if it’s an indirect effect of other MS symptoms (secondary fatigue).⁵

Primary fatigue

This is caused directly by your MS.⁵ It’s not known exactly how MS makes you feel tired but it may be a result of nerve damage that interferes with communication between your brain and your body. This is why you will often experience fatigue during a relapse.^7–9

Secondary fatigue

This is caused by the indirect effects of living with MS. Symptoms like muscle weakness, depression, pain, not enough sleep, stress and inactivity, can make you fatigued.^6,7 For example, if pain and spasticity interfere with your sleep, you can feel more tired in the day as a result.^7,8 Some medications also have side effects that can make it worse.⁵

Fatigue can also be divided into both acute and chronic fatigue.^5,7 Acute fatigue can come over you suddenly. It’s usually related to a certain task you’ve been doing but resolves soon after (e.g. resting after a walk).⁷ Chronic fatigue happens over a longer time period and is associated with illness, stress and not enough sleep.^5,7

Tired of being tired? Whatever the cause of your fatigue and whether it’s mild, moderate or severe, there are ways to manage it. Read on to find out how.

MS can zap your energy, but it doesn’t always have to stop you from living your life.⁷ There are plenty of ways to reduce the impact fatigue has on your everyday life, some of which are listed below.

Ways to boost your energy

Give these tips and tricks a try to help you boost your energy levels:

• Eat for energy – have a balanced, healthy diet and if eating a big meal makes you tired, try eating smaller meals throughout the day¹⁰
• Stay active – try to keep moving, even if it’s just a short walk or a few yoga stretches. Even though it might not seem it at first, exercise is one of the best ways to beat fatigue, help you sleep better and is generally good for your wellbeing^6,7,10
• Sleep well – avoid long naps during the day and try to get a good night’s sleep. A comfy bed, minimal noise and light and reducing caffeine and alcohol intake can help, too^8,10,11
• Improve your emotional wellbeing – studies have shown that mindfulness has a positive impact on fatigue and on MS-related anxiety and depression.¹² Try tocreate time to rest and relax. Try a massage, yoga, meditation or aromatherapy¹³
• Keep your temperature comfortable for you – try not to get too warm or cold if changes in temperature brings on your fatigue. If you feel sensitive to heat, you could try putting ice packs in your pocket, or in a neckband or headband, if you need to cool off.^7,10 Your MS is unique to you, so experiment and do what works best for you
• Adopt and maintain good posture – a good posture during daily activities may help save energy.⁷

When I experience tiredness and fatigue, I find that gentle exercise is really helpful. The hardest thing is getting off the sofa but when you do you’ll usually feel a lot better for it.

Conor

Living with MS since 2003

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Tips and tricks to help deal with fatigue

As well as finding ways to manage your energy levels, there are also steps you can take to help work around your tiredness and fatigue:

Keep a fatigue diary – keep notes of what makes you feel tired or low in energy, so you can be prepared and find ways to work around those¹³

Plan in advance – schedule your day so you can do more involved activities when you feel more energetic. Don’t forget to plan regular breaks^6,14

Work around your tiredness at work – in some cases, it may help to talk to your employer about any accommodations to help make working easier, like flexible working hours, working from home, scheduling regular breaks, or having a parking space closer to work.^7,13 Read more about this on our work and careers page

Ask for help – your healthcare team can advise you on changes to help make regular tasks at work and home a little easier⁶

Address other health conditions – it might be something other than your MS that’s making you feel tired. Other conditions like anaemia, depression, sleep problems or thyroid issues could also be a factor, so talk to your healthcare team for more advice, if you think these could be relevant to you^8,15

Try talking therapies – these involve modifying your thoughts and behaviours to help mentally overcome your fatigue.⁶ Some studies have shown this technique to be useful.^14,16

Sometimes the tiredness can come in like a wave sweeping over you and you can’t fight it. You have to accept it and rest. Take yourself off for 5–10 minutes to quickly re-charge your batteries. Like you plug your phone into a charger, you need to do the same for yourself. Give yourself that 10 minutes and then you can get back in the game.

Grace

Living with MS since 2017

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Don’t be too harsh on yourself. Fatigue is one of the major symptoms of MS and it can take over the whole of your body. Explain to people this is a symptom of MS and try and make them understand how it feels. This is not something you need to apologise for.

Katie

Living with MS since 2016

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Drug treatments for fatigue

There aren’t any drugs currently available to specifically treat tiredness and fatigue, but your doctor may consider medications prescribed for other conditions that have also been shown to help with tiredness and fatigue⁶:

1. Induruwa I, et al. J Neurol Sci. 2012;323:9–15.
2. NCBI. Characteristics and Management of Major Symptoms. https://www.ncbi.nlm.nih.gov/books/NBK222388/ [accessed July 2020].
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4. NICE CG186. Multiple sclerosis in adults: management (updated November 2019) https://www.nice.org.uk/guidance/cg186 [accessed July 2020].
5. Gümüş, H. Arch Neuropsychiatry 2018;55(Suppl 1):S76−79.
6. NICE CKS. Multiple Sclerosis (updated Oct 2019). https://cks.nice.org.uk/multiple-sclerosis [accessed July 2020].
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9. Manjaly ZA, et al. J Neurol Neurosurg Psychiatry. 2019;90:642–51.
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11. Irish LA, et al. Sleep Med Rev 2016;22:23–36.
12. Simpson R, et al. BMC Neurol. 2014;14:15.
13. MS International Federation. Fatigue: an invisible symptom of MS. http://www.msif.org/wp-content/uploads/2020/04/MS-FATIGUE-BOOKLET-WEB.pdf [accessed July 2020].
14. Mulligan H, et al. Int J MS Care 2016;18:27–32.
15. Tur C, et al. Curr Treat Options Neurol. 2016;18:26.
16. van Kessel K, et al. Psychosom Med. 2008;70:205–13.
17. Shaygannejad V, et al. Neurol Res. 2012;34:854–8.
18. Dobryakova E, et al. Front Neurol. 2015;6:52.