Managing Fatigue As Your MS Worsens

Medically Reviewed by Michael W. Smith, MD on December 22, 2020
4 min read

As your multiple sclerosis (MS) progresses, you may notice more fatigue. But there’s a lot you can do to manage it. We asked experts and people living with progressive MS to share their best strategies for beating fatigue.

Pay attention to how you feel. If you’re tired, scale back on activities.

“Managing your energy and listening to your body is key,” says Mitzi Joi Williams, MD, an MS specialist in Atlanta. “When you feel like it’s time to rest, take that time to rest. If you don’t, you may wind up needing to rest for 2-3 days to compensate for 1 day of overdoing it.”

Figure out what triggers your fatigue. Many things may play a role, from stress to sleep quality, says Victoria Leavitt, PhD, assistant professor of neuropsychology at Columbia University Medical Center. When you learn your triggers, you can manage them better.

To find your triggers, keep a journal. Write down your daily habits, schedule, and symptoms. Include exercise, sleep quantity and quality, stress, hours at work or doing chores, caffeine intake, medication, pain, treatment, and fatigue level. Then look for patterns.

Some medications make fatigue worse. Others may lessen it. Talk to your doctor about which might work the best for you.

Working out can help you manage fatigue. “A good exercise program helps with strength and aerobic capacity, improves joint flexibility, elevates your mood, and helps you get back to regular activities,” says Carol Michaels, a recovery fitness trainer who works with people with MS.

Plan exercise for times when you have the most energy. If you feel tired, break up exercise sessions into smaller chunks or lower the intensity of your exercise. Try walking, even if it’s just around the house. On days when you feel a lot of fatigue, try breathing, stretching, and balance exercises.

Take small bites instead of big gulps. “It’s better to get a little bit done each day than to totally lose function for several days at a time,” says Williams.

Ask for help instead of doing everything yourself. “Prioritize your most important tasks,” says Brittany Ferri, an occupational therapist in Rochester, NY. “Delegate heavy-duty tasks to others if you can.”

“As a woman with progressive MS, I can tell you firsthand fatigue is inevitable and the only way to deal with it is head-on,” says Alexis Franklin, a patient advocate from Arlington, VA, who was diagnosed with MS in 2008.

As Franklin’s MS progressed, fatigue made walking harder and she developed “drop foot,” where her leg started dragging. She learned to use mobility aids to make getting around easier. Now, she says, it’s easier to overcome initial fatigue, go further, and feel a sense of normalcy.

Plan activities when they’re less likely to trigger fatigue. If you feel tired on hot days, choose indoor activities instead. Schedule outdoor activities for early or late in the day, when it’s cooler.

Use shortcuts. Park close to the store entrances. Consider getting a handicapped parking permit. Remember that when you go somewhere, you also need to come back.

Set yourself up for success by organizing your space to make daily tasks easier and save energy.

“Keep items you use often nearby,” Ferri says. “Use eye-level and chest-level shelves in the fridge, pantry, closet, and bathroom. Even keeping items on countertops in helpful.”

Organize your space so you know where everything is and don’t waste energy looking for things.

“While it’s imperative that you take care of yourself first and do what’s right for you, you also need a community of people who understand you,” Franklin says. She gets together with a group called “MS is BS” to talk about issues like fatigue and managing MS. “They’ve helped me overcome emotional fatigue and physical fatigue,” she says.

As MS progresses, you may prefer to stay home. But while rest is important, avoiding family and friends can take a toll on how you feel.

“Social connections are so important for our overall health and well-being,” Leavitt says. “Pace yourself, be realistic about what you can manage, but prioritize time spent with supportive friends and family,” she says.

As your MS progresses, you may feel anxiety or depression. Feeling tired, slow, and foggy can take a toll on your mental health.

Depression and fatigue are related, Leavitt says. Talk to your doctor about what you can do. Treating depression may improve your fatigue and overall sense of well-being.