Most people with multiple sclerosis experience fatigue — and many of these people often find it the most limiting MS symptom.

“No matter what stage of MS people have, they usually rank fatigue as their most troubling symptom. Other MS symptoms may come and go, but fatigue seems to be a constant,” says Jeffrey Cohen, MD, director of the Clinical Neuroimmunology Fellowship at the Cleveland Clinic in Ohio.

“About 85 to 95 percent of MS patients complain about fatigue. MS fatigue is not just being tired — it is like having the flu without the other symptoms. You can feel like fatigue is crushing you,” explains Julie Stachowiak, PhD, author of The Multiple Sclerosis Manifesto: Action To Take, Principles To Live By.

What Causes MS Fatigue?

“The exact mechanism of MS fatigue is not known, but studies suggest that changes in the brain caused by MS may require MS patients to use five times more effort to complete a simple task than a person without MS,” says Stachowiak, who was diagnosed with MS in 2003.

“There are many reasons why someone with MS experiences fatigue. Some are directly related to MS and some are not,” says Dr. Cohen.

• Indirect fatigue. Stress, trouble sleeping due to muscle spasms, side effects from medications, and depression that may go along with a chronic illness like MS can all cause fatigue. “Doctors should also rule out unrelated causes of fatigue such as anemia or thyroid disease,” adds Cohen.
• Neurologic fatigue. “MS symptoms like tremor, muscle weakness, and muscle spasm use up a lot of energy and can lead to fatigue,” explains Cohen. “Damage that has been sustained over time along nerve pathways can be aggravated by stress, activity, fever, and heat exposure. All these factors contribute to MS fatigue.”
• Autoimmune fatigue. MS is an autoimmune disease. That means that normal defense mechanisms turn against the body and mistake normal structures, such as the protective covering of nerve fibers in MS, as foreign invaders. “This type of persistent tiredness or lassitude is common in many autoimmune diseases and is probably the most common type of MS fatigue. It is very similar to the type of fatigue experienced in chronic fatigue syndrome,” explains Cohen.

How to Fight MS Fatigue

Although MS fatigue is common and frustrating, there are things you can do to fight fatigue and increase energy. “Rest may not eliminate fatigue, but it certainly helps,” says Stachowiak. You need to think of your energy level like an energy bank. Take frequent breaks and don’t use up all your energy early in the day. Try these energy-boosting tips:

• Work closely with your MS healthcare providers. MS requires constant monitoring to make sure your disease is under control. Proper treatment does help control fatigue.
• Avoid heat exposure. “Heat definitely drains energy in a person with MS. If you live in a hot climate, you might try a cooling vest. In some cases, if you can’t get away from the heat, you should consider moving to a cooler climate,” advises Stachowiak.
• Take good care of yourself. “A healthy diet and a regular exercise program can really help with fatigue. If you are physically out of shape and overweight, everything you do requires more energy,” says Cohen.
• Combine exercise with mindfulness. Exercises that include some form of meditation and mind-body connection, such as tai chi and yoga, have been shown to be helpful for MS fatigue. “I can add three to four hours of energy to my day by exercising in the morning,” says Stachowiak.
• Medications can help. Modafanil (Provigil) is a wakefulness-promoting medication that works for some people. Central nervous system stimulants assist others, and the antiviral medication amantadine (Symmetrel) can also be helpful. Dalfampridine (Ampyra) is a new drug approved for MS. “Ampyra improves nerve conduction and seems to improve MS fatigue,” says Cohen.
• Treat depression. If you are feeling down and hopeless — and you can’t seem to overcome these feelings — talk to your healthcare provider. Depression makes fatigue worse; a mental health professional can help.
• Simplify your life. “Chaos in your life makes MS symptoms, including fatigue, much worse. If your job is too stressful, find another job. Learn how to avoid stress,” advises Stachowiak. You may need to plan better, delegate some tasks to friends and family, or consider joining a support group.

Almost everyone with MS has to deal with fatigue. Medications can help, but there is also a lot you can do on your own — take care to eat right, exercise regularly, and lower your stress levels. MS fatigue and other MS symptoms can be frustrating, but most people with MS do lead full and active lives.

“I have been an MS specialist for over 20 years and I have seen tremendous progress in MS treatment. We have a whole array of new MS drugs, and for the first time we can look forward to reversing the damage caused by MS as well as halting the progression of the disease. The future has never been brighter for MS,” says Cohen.