Treating and managing fatigue
By rating your fatigue levels at different times of the day, and in relation to different activities, you might start to see patterns. There is a fatigue diary in the MS Society booklet on fatigue for you to use.
This could help you identify changes you can make which minimise your levels of fatigue. This might include looking at how you approach:
- prioritise tasks
- organise living and work spaces
- healthy eating
- fatigue management programmes
- drugs for MS fatigue
- getting help
For more detailed information, see our booklet on Fatigue.
For some people, rest helps relieve fatigue and is an important part of fatigue management. Resting can prevent you getting to a point of complete exhaustion and coming to a sudden halt, mid task.
A few small breaks are best for some people; or you might feel better after just one longer rest at a particular time.
- try taking a few short rests or ‘power naps’, through the day
- try just one longer rest, at the same time each day
- take a break between coming home from work and getting ready for an evening out
When you rest, try to make your rest as complete as possible. Doing smaller jobs around the house, talking to the family or watching TV might be more relaxing than work or chores, but it is not really resting. It can be tricky, but the aim should be to switch off both the mind and the body.
You might want to have a short sleep, or use relaxing music to help you clear your mind. Some people find yoga or meditation useful.
If worries disturb time set aside for rest, try writing down these concerns and 'shelving' them while you are resting. You will have more energy to tackle them once your energy levels are up again.
If resting helps you manage your fatigue, it is important that other people realise how valuable this quiet, undisturbed time is.
Prioritising activities can mean you save energy for the things you really want or need to do. It can help you plan your activities and your time to rest and recuperate.
You might find it useful to make a list of all the activities you do in a typical day or week. Can they be done in a more energy-efficient way, or at different times of the day, to make them easier? Can you get help with any of these tasks?
Whatever your priorities are, try to be realistic about how much you can get done - don't try to take on too much.
You could save energy on a lot of everyday tasks if you have a good, relaxed posture. Keeping a good posture takes practice, but with time it can become easier, as your body re-aligns itself, and it can help you save energy.
A physiotherapist can help you identify any problems you might have with posture and suggest suitable exercises to help.
You might find there are practical changes that can be made to the places you work and live. Maybe re-organising desks or cupboards, or adjusting the temperature or lighting to suit you better.
Sometimes, the simplest of changes can make the workplace or home more energy efficient for you.
An occupational therapist can help you assess the spaces you use – at work and at home – and may suggest adaptations or equipment that could help. For more information about the support that occupational therapists (OTs) can offer, and how to find one, see the leaflet Occupational therapy and MS.
Combining sensible exercise with a balanced diet can help you maintain a healthy weight and get the energy you need. Weight loss and weight gain can both be issues for people with MS and can make coping with fatigue more difficult. A dietitian can work with you to plan a suitable diet to maintain a healthy weight.
What you eat can also make a difference. For example, large, hot meals can make fatigue worse and caffeine or sugary snacks might have an initial 'pick-me-up' effect, but leave you feeling more tired later.
It seems to go against common sense to exert yourself if you experience fatigue. However, there is strong evidence that exercise helps keep your body working at its best and can improve strength, fitness and mood.
It’s possible to do too much exercise, so balance the exercise with rest, and keep cool while you exercise, especially if heat makes your fatigue worse.
You might want to plan your exercise and avoid long sessions to prevent overheating. Some people find water-based exercise helpful for maintaining a steady temperature.
Fatigue management programmes are often based on the kind of strategies outlined above, and can help with making changes to your habits, behaviour and routines. They are sometimes done in group settings, sometimes individually, and might involve family members, friends and carers.
One of these programmes, called FACETS, has been shown to be effective in helping people with MS manage their fatigue. Read more about FACETS.
Some people find that drug treatments help them manage their fatigue.
Although there are currently no drugs licensed in the UK specifically for MS fatigue, certain drugs licensed for other conditions are sometimes prescribed:
Amantadine (Symmetrel or Lysovir)
This drug is licensed to treat Parkinson's disease, as well as some viral infections. Unfortunately, research regarding its use in treating fatigue in MS is not conclusive. However, the NICE Guideline for MS states that a small benefit might be gained from taking a dose of 200mg daily. Side effects can include insomnia and vivid dreams.
This drug is used to treat narcolepsy, a sleep disorder which causes people to sleep excessively during the day. It is sometimes prescribed off-label for treating MS fatigue. There have been several small studies looking at modafinil to treat fatigue in MS, but they have had conflicting results and have not proved the benefits of taking modafinil.
In 2010, the European Medicines Agency recommended that modafinil should only be used for treating narcolepsy. As a result, many specialists are unwilling to prescribe it for MS fatigue. However, it is sometimes still prescribed and some people who take it say it helps. Side effects can include insomnia and headaches.
Prokarin (sometimes spelt Procarin)
Prokarin is a skin patch that contains caffeine and histamine. It is not available on prescription and can be expensive.
Some consider it a complementary or alternative medicine. In one study, people who took it reported less fatigue, but trials of this drug have not proved benefits for treating MS fatigue.
People might say to you 'If there’s anything you need...' or 'If there's anything I can do...', but it is not always easy to ask for help, even when it is offered.
It can be useful to prepare a list of tasks that you’d like help with.
That way, if someone does offer to help, you can easily tell them how they could help.
At work, you may need to ask your employer to make some changes – perhaps more flexible hours would help, or arranging a parking space closer to the entrance. Find out more about adjustments at work.
Health and social care professionals might be able to help in all kinds of ways. An occupational therapist, for example, might suggest energy–saving gadgets at work or around the home. Or an MS nurse or psychologist might talk with you about cognitive behaviour therapy (CBT) or mindfulness training – approaches which some people find helpful when making changes to habits or routines.
Help fund research to beat MS fatigue
We're doing vital reasearch into the causes of MS fatigue and things people affected by it can do to beat it.
My physio urged me to fill in a fatigue diary which I did ... I found that if I do more than 10-15 minutes of any physical activity I’m wrecked. Just knowing that has made a tremendous difference to the way I plan my day.