Fatigue in multiple sclerosis is more than everyday tiredness. It’s an overwhelming feeling of exhaustion that can stop you being able to continue with your usual daily activities. The level of exhaustion you feel is often completely out of proportion to any activity you may have been doing.
Fatigue is one of the most common symptoms of MS. Managing it involves taking steps to increase your energy levels and then learning how to use that energy in the most efficient way.
On this page we explore what fatigue feels like, the causes, and the lifestyle changes that can reduce the impact of MS fatigue on your everyday life.
MS fatigue is very different from the tiredness that people without MS may experience following day-to-day activities such as heavy exercise, a busy day at work or after a bad night’s sleep. It involves a sudden loss of energy and being unable to continue what you were doing.
Fatigue can be experienced physically and mentally. Simple tasks, such as showering, getting dressed or even getting out of bed, may leave you feeling physically exhausted for hours.
Cognitive fatigue can include problems with short term memory, concentration or word finding. Fatigue can make it harder to think clearly and keep your mind focused.
You may find that your MS symptoms get worse when you’re experiencing fatigue but reduce again after rest.
MS fatigue is different from everyday tiredness in several ways.
MS fatigue feels different for everyone and can be hard to describe. Some people with MS told us what it's like for them.
Fatigue feels as if I am an inflatable, and someone has pulled the air stopper out! My brain goes fuzzy, I can't think clearly, my speech slurs and my eyesight goes. Swallowing becomes more difficult, my balance gets worse and my legs feel heavy and clumsy.
Fatigue feels like being weighed down, as if you’re trying to walk up to your neck in a deep, muddy river in heavy, wet clothes carrying shopping bags full of rocks.
Fatigue leaves me feeling dulled and tired. I find it hard to concentrate and to absorb new ideas, and I’m often confused, searching for the right word, and forgetting things.
The causes of fatigue in MS are not well understood. It’s thought to result from several different factors. Some are caused by multiple sclerosis itself (primary fatigue). But often there are other contributing factors that can cause fatigue or make it worse (secondary fatigue).
Primary fatigue is directly caused by MS. It may be due to nerve messages from your brain and spinal cord having to navigate the areas of damage caused by your MS. It takes more effort and energy to send and deliver messages to other parts of the body, like the muscles in your arms and legs. This can cause a build-up of fatigue.
Secondary fatigue is not caused by MS itself, but factors related to having the condition.
For example, other MS symptoms can contribute to fatigue and make it worse, such as:
Other things that cause or contribute to fatigue are your lifestyle, medications you're taking and other health conditions.
Lifestyle factors that can add to fatigue include:
Fatigue may occur as a side effect of some medications or be caused by an infection or MS relapse.
There are also other health conditions that can cause fatigue, such as anaemia (NHS.UK) and thyroid problems (NHS.UK).
For many people, fatigue is the result of a combination of factors which can leave you feeling tired and lacking in energy. Once you’re aware of these factors, you can see which ones apply to you and begin making changes.
Although fatigue is one of the most common symptoms of MS, it is not clear how many people are affected. Levels reported in research vary widely. Some research suggests around 6 in 10 people with MS may experience fatigue. Other research suggests it could be higher, with up to 8 in 10 people with MS affected.
You may not be able to get rid of your fatigue completely, but there are techniques that can be used to reduce the impact it has on your life.
There are two main aspects of managing fatigue.
Although the key person in fatigue management is you, health professionals, such as an occupational therapist, physiotherapist or MS nurse, can support you through this process and help you develop strategies to manage your fatigue.
Do reach out to them if fatigue is an issue and you need some advice and support – you don't have to manage fatigue on your own.
The sections below encourage you to address the areas in your own life that may be adding to your fatigue. By reflecting on different aspects of your life, you can begin to identify where you might make small changes that could increase your energy levels.
Sleep is a very important part of healthy living. Whilst you're asleep, there are many complex processes going on in your body that allow you to wake up the next day feeling refreshed. Sleep helps to regulate your mood, memory and metabolism.
There's no set rule on how much sleep you need. Most adults need six to nine hours to function at their best, although some people operate perfectly well on four or five hours while others need much more.
You may not be getting good quality sleep for a variety of reasons, such as MS symptoms, concerns and worries making it difficult to switch off, family responsibilities and being less active.
There are many steps you can take to improve your sleep.
If you can't sleep, lying in bed thinking about not being able to sleep will make dropping off even less likely. Try to focus on something else and distract your mind rather than trying to force sleep. You could try a relaxation technique or get out of bed and do a mundane task.
Read more tips on how to improve your sleep.
Low mood can lead to reduced energy levels (and vice versa). Often it's not clear which symptom came first so it can become a vicious cycle.
Sometimes when you’re feeling down it can be difficult to see the positives in your life. This can lead to a negative spiral that is hard to break. Here are a few suggestions you can try if you’re struggling with your mood.
I remind myself frequently of all the plus points in my life, including spending time with family and friends. It's not always easy to do this, but I do try!
If living with MS is affecting your mood, seek help and support from your GP or MS nurse. They can talk through suitable treatment options such as talking therapies or medication.
Read more about psychological therapies such as cognitive behavioural therapy and mindfulness.
Stress is a normal and unavoidable part of life. It occurs when there's an imbalance between the demands made on you and your ability to meet those demands.
You might experience stress because of deadlines at work, family issues or if you need to adapt to new life circumstances.
Excessive stress can have negative effects on both your physical and emotional health, and directly impact on your fatigue levels.
When it comes to managing stress, there are three main stages.
There are a variety of steps you can take to try and control your stress levels. This can include keeping things in perspective, doing things you enjoy and planning ahead.
I try not to worry too much about the things that I can’t change. Not always possible, I know! There are usually ways around problems and I’m lucky, I have a supportive husband and really good friends.
Read more about the ways you can reduce your stress levels.
Relaxation techniques are activities that leave you with a feeling of complete peace and calm, allowing you to shut off from everyday pressures and routines.
Regular relaxation can help with fatigue as it promotes good sleep patterns, increases the benefit of rest breaks during the day and can be used to reduce your stress levels.
Here are a few techniques you could try:
Read more about these relaxation techniques.
You might find that changes in temperature contribute to your fatigue. It might be triggered by the weather, hot baths or showers, hot drinks or meals, exercising or feeling feverish because of an infection.
These effects are usually reversed when you take steps to cool down and your temperature returns to normal.
I wear cooling scarves and bandanas. Marvellous! I also use an electric fan – especially when ironing.
Although less common, some people with MS find that cold temperatures can trigger their fatigue. If this is the case for you, taking steps to warm up – such as wearing additional layers – will help to increase your body temperature and ease your fatigue.
Read more about temperature sensitivity.
Some form of physical activity as part of your daily routine is important for a healthy lifestyle. Low activity levels cause under-used muscles to become weaker (deconditioning). This can reduce your stamina and fitness levels. It also means your body has to work harder when carrying out everyday activities, so it consumes more energy and increases fatigue.
Once I worked out what was going on (less activity, leading to more fatigue, leading to less activity) I found exercising at the gym a HUGE benefit!
People sometimes think physical activity means high energy exercise, which can be off-putting. However, any activity that increases your heart rate and your breathing is beneficial.
Research shows that becoming more active can significantly reduce fatigue. Aerobic, resistance and balance exercises are especially recommended for fatigue.
If other MS symptoms are making exercise difficult, or you’re not sure what type of exercise would work for you, speak to a physiotherapist. They’ll be able to advise on exercises that will best suit you and your ability. Your GP or MS nurse can refer you to a physiotherapist in your area.
NHS guidelines recommended that you aim to do at least two and half hours of moderate intensity activity each week. You can do this in sessions of any length. Muscle strengthening activities are also recommended at least twice a week. Learn more about NHS guidelines on physical activity (NHS.UK).
One way to meet this guidance is to try and do 30 minutes of activity on at least five days a week. This doesn’t have to be in one chunk – you could break it down into a few 10-minute sessions spread throughout the day.
Reducing the amount of time you spend being inactive by introducing even short bouts (5–10 minutes) of light physical activity will help to improve your fitness and fatigue levels. So, take it slow, fit it in where you can and build up gradually.
Even a little movement is better than nothing.
If physical activity seems like a chore, it’s easy to lose motivation and stop. To increase the likelihood of continuing regularly, you could try things like choosing something you enjoy, asking a friend for support, joining a local class and setting some personal goals.
Go to our exercise hub to read about becoming more active and explore our accessible exercise videos.
There's no evidence that a specific diet will improve MS fatigue. But eating a healthy, balanced diet is recommended to benefit your general health and to give you the best energy levels.
To achieve this, it’s recommended that you try to eat a variety of foods from the five main food groups.
It's also important to drink plenty of fluids, particularly water, throughout the day. Being even mildly dehydrated can cause tiredness and sluggishness, adding to your fatigue. The recommendation is to drink six to eight glasses a day.
Eating regularly and healthily definitely improves my energy levels. Bothering with breakfast is the most difficult for me, but makes the biggest difference!
There are various ways you can save energy when preparing and cooking meals. Read our tips for fatigue-friendly cooking.
Other common medical conditions and infections can drain energy and cause your fatigue to worsen. This includes things like a cold, stomach bug or urine infection.
A relapse can also make existing MS symptoms like fatigue worse.
Your GP can investigate whether there is an underlying medical cause that might be adding to your fatigue and suggest appropriate treatment options or refer you on to other services. Your MS nurse can provide support if you’re going through a relapse.
Once the infection has cleared or you’ve recovered from the relapse, your fatigue levels should go back to their previous level.
There are no medicines licensed to treat MS fatigue, however some medicines licensed for other conditions are sometimes prescribed. This is known as off-label use.
Medicines are not a solution to fatigue on their own. They should be used in addition to the fatigue management techniques discussed on this page.
Your MS team may suggest one of the medicines listed below. The research supporting their use is limited, but they may be partially helpful for some people. These medicines don't work for everyone and they can't get rid of fatigue completely.
If you're treated with one these medicines, you'll need regular reviews to monitor safety, check how well it’s working, adjust the dose if necessary, discuss side effects, and decide whether to continue with the treatment.
Speak to your MS team if you’d like to try a medicine to support with fatigue management.
Some medications can increase drowsiness and worsen fatigue. This applies to all types of treatments – prescription, over the counter, alternative and illegal – regardless of whether they're being used to treat MS or not.
Of the medicines for MS symptoms, treatments for muscle spasms and stiffness and treatments for nerve pain are often associated with an increase in fatigue.
If you're worried that medication may be impacting on your fatigue, ask your GP or pharmacist for a medication review. They may suggest changing medicines or reducing the dose.
As well as taking steps to build up your energy levels, the other key element in managing fatigue successfully is using the energy you have in the most effective way. There are a range of techniques involved.
Planning involves taking some time to stop and think about what you need to do and what you can realistically achieve. It's a very individual process that requires you to be aware of how fatigue affects you. Planning can help you think ahead and organise your time better.
I plan my day using a notebook. Often, when I feel that I haven't had a good day or achieved all that I wanted to, I check the notebook and I've often done more than I thought.
If your energy levels are limited, it can be better to focus on a small number of essential tasks, rather than trying to do everything at once.
You could start by writing a list and then ordering the tasks by how important they are. Have a think about what's absolutely essential and whether there's anything that could wait until another day.
What you consider essential activities will be unique to you. They'll be influenced by your lifestyle, responsibilities, interests and beliefs. Priorities often change over time, so try not to get stuck doing things one way because you've always done them that way.
It's important to remember that essential activities should include things you enjoy. Household or work-related tasks may seem more important, but if all your energy is taken up on these tasks then you may not have enough energy left for the more pleasurable things in your life. Try to make social activities a priority too!
Prioritising was such a helpful idea! My energy levels are higher in the morning so I get the important tasks done then. If they're not all completed, by dealing with them on a list, I'm not so overwhelmed by them and I don't get so stressed. I'm also getting better at requesting help from family and friends when necessary.
At first, you might feel reluctant to delegate tasks. You may feel uncomfortable or guilty about asking others to do jobs that you'd normally do. You might feel like you’re giving in to fatigue or losing control. You might be worried that someone else won't do the job exactly how you like it done. But handled properly, delegation frees up time and energy for important activities and means you can achieve more.
I've reluctantly had to pass some tasks on to others. However, my experience of asking for help is a positive one.
Sometimes people are more willing to help than you might expect. However, when delegating, remember that people have their own lives and commitments and may not be able to help when you need it.
My kids help out a lot. We make supper a family job. I made a chore chart so they know who does what. It helps a lot.
Delegating tasks doesn't just mean asking family, friends or work colleagues for help. Think about whether getting some outside help might be an option. For example, someone to help with cleaning, gardening or walking the dog, or getting an online food delivery to save time and energy.
Try to do tasks using as little energy as possible. This may involve changing how you would normally do certain daily activities.
I shop online wherever possible – stuff gets delivered straight to my door!
Pacing involves taking planned breaks or rests during or between activities. Often this requires some self-discipline as it can be tempting to try to get to the end of a job without stopping. However, it may be more beneficial to take things steadily rather than continuing with an activity to the point of exhaustion and then suffering the consequences.
Doing tasks slowly or taking regular breaks can help stop fatigue from building up. You might find you can achieve more by breaking tasks down into smaller chunks with periods of rest in between, instead of working straight through until your fatigue becomes overwhelming.
A break is different from sleep, though some people do find that a short nap in the afternoon can help preserve some energy for the evening. Breaks can be a brief period of relaxation or minimal activity.
I build in rest periods. When I put the potatoes on to boil, I sit down for 10 minutes and shut my eyes while they cook! Rest, rest, rest! It's boring but it works.
As an invisible symptom of MS, fatigue is sometimes not fully understood by family, friends and work colleagues. Unless you've experienced it, it's hard to understand the impact of fatigue and just how debilitating it can be.
When explaining fatigue to others, it can be helpful to talk about how it affects you and the impact it can have on your daily life. Giving some specific examples may help them understand better. Sometimes it can help to compare fatigue to something that people might understand more easily, such as a battery losing its charge.
If you're trying to help your employer and work colleagues understand more about your fatigue, our work disclosure checklist may help you.
