Fatigue is a common symptom of many neurologic disorders, and multiple sclerosis (MS) is no exception. Unlike weariness and a sense of exhaustion from exercise, manual labor, and stress, MS-related fatigue consistently interferes with your ability to do everyday activities such as cooking, cleaning, socializing, and working.

Although many patients describe their fatigue vividly—“It’s like swimming with a fur coat on,” or “I feel like I’m wearing a lead coat”—it’s invisible. Since no one can tell by looking at you how tired you are, friends and family may be puzzled that you can’t do the things you once did. Coworkers or supervisors may mistakenly and unfairly assume you are lazy or unmotivated. Reactions like these contribute to difficulties at home and at work.

Two Kinds of Fatigue

MS patients experience two types of fatigue. One, called primary, is a symptom of the disease itself. The other, called secondary, is due to factors such as sleep disturbances, medication side effects, and the increased effort it takes to get through each day. Primary fatigue is further subdivided into lassitude and nerve fiber fatigue. Lassitude is an overwhelming sense of tiredness that comes on suddenly and without warning. It isn’t typically related to exercise or being overheated, but it can be exacerbated by those things as well as stress, poor sleep, and medication.

While fatigue is a reality of MS, it can be managed with consistent self-care. Here are some expert-recommended strategies to consider.

1. Make Time for Exercise
   It sounds counterintuitive to tell a fatigued person to exercise. In fact, until about 20 or 30 years ago, doctors discouraged people with MS from exercising, fearing it would deplete what little energy they had. Today, a large and growing body of research shows that people with MS tolerate exercise well and it improves their quality of life. It also builds strength, tones muscles, improves balance and coordination, and deters depression. Even people with advanced disability benefit from exercise. By contrast, those with lassitude who don’t exercise may spiral down into increased fatigue, deconditioning, and depression.
   
   
2. Choose Your Activity Carefully
   There is no single best kind of exercise program for people with MS. It depends on what type of MS you have, your level of ability, and whether you are vulnerable to overheating or overexertion. For people with nerve fiber fatigue, exercise can temporarily intensify symptoms. These temporary symptoms are neither relapses nor signs of damage. And often they can be resolved by rest and cooling off. Experiment with different types of activity—swimming, cycling, yoga, tai chi, strength training—to determine which one works the best and which one you like the best.
   
   
3. Talk to Your Doctor About Medication 
   Several drugs have proved useful in combatting fatigue. Amantadine (Symmetrel), an anti-viral drug used to treat influenza, reduces fatigue in about 50 percent of patients. For some people, the drug’s effectiveness wears off over time, but if you take a several-days’ break, it may become more effective again. In general, the risk of side effects is low. If you take it late in the day, it may cause insomnia.
   
   

   In several studies, modafinil (Provigil), a prescription drug that promotes wakefulness and alertness, has been shown to reduce fatigue. Like amantadine, it can cause sleep problems if taken too late in the day. Other side effects include jitteriness, headache, nausea, and rapid heart rate.

   Stimulants such as methylphenidate (Ritalin) and the mixture of amphetamine and dextroamphetamine (Adderall) are also prescribed to treat fatigue. Both are potentially addictive, but a 2009 study by the National Institute of Drug Abuse found a low potential for tolerance or addiction when methylphenidate was used for medical purposes.

   Antidepressants are also helpful in reducing fatigue, especially if it’s associated with depression. They may boost energy and improve mood and concentration. None of these medications are approved by the US Food and Drug Administration to treat fatigue, so prescriptions for them are considered off-label.

4. Stay Cool
   Nerve fiber fatigue is related to damage to myelin, the fatty insulation that protects nerve fibers and helps them transmit signals from the central nervous system to the rest of the body. When nerve fibers are damaged, they can still send signals, but not as well as undamaged fibers. When these damaged nerve fibers are overused or become overheated due to sustained exertion or heat exposure, the nerves are less and less able to send signals. Once the body cools off, the nerve fibers start working again. Anything you can do to lower your body temperature, especially during exercise or in hot weather, will delay or prevent nerve fiber fatigue. Cooling vests, hats, and neck wraps, icy drinks, or even a splash of cold water on the hands and face can help forestall nerve fiber fatigue.
   
   
5. Ask About Physical and Occupational Therapy
   Certain medication used to treat MS such as antidepressants, drugs used to treat spasticity, and pain relievers, can cause sleepiness or fatigue. In addition, if muscles grow weak or tire quickly, it becomes harder to perform normal daily activities, and the extra exertion leads to more fatigue. Physical and occupational therapy can help by teaching you to work smarter rather than harder. Planning activities in ways that conserve energy helps with pacing and may result in more consistent energy levels.
   
   
6. Address Sleep Problems

Poor sleep contributes to low daytime energy. Work with your doctor to identify what’s disrupting your sleep whether it’s sleep apnea, restless legs syndrome, depression, muscles spasms, or problems with bladder control. Treating the particular problem will also likely reduce sleep disruptions. If you simply have a hard time getting to sleep, staying asleep, or both, talk to your doctor about how to maintain good sleep habits.

Adapted from Navigating Life with Multiple Sclerosis by Kathleen Costello, MS; Ben W. Thrower, MD; and Barbara S. Giesser, MD, FAAN. The book, part of the American Academy of Neurology’s Neurology Now™  Books series published in 2015 by Oxford University Press, is available to purchase in English from all major booksellers.