This is Part One of a three-part series on managing the symptoms of multiple sclerosis. The text has been excerpted from Dr. Schapiro's book, Managing the Symptoms of MS, 6th Edition, which came out this month.

To those who do not have MS, it may come as a surprise that fatigue is the most disabling symptom of MS. For those who have MS, this is not at all surprising. Part of the reason that fatigue is so common and potentially disabling relates to the fact that many different kinds of fatigue are experienced by people with MS, and it is possible to have none or all of the forms at the same time.

Fatigue may result from a whole host of factors, including sleep disturbances. Bladder frequency during the night results in a poor night’s sleep and fatigue the next day. Breathing problems that may be unrelated to MS may do the same. Restless legs are more common in MS and may result in not getting to the deeper stage of sleep to allow for a restful night. Medications taken for other symptoms or for other problems may have fatigue as a side effect which becomes a magnifier. Thus, it is important to be watchful for contributions from sources other than MS and to have them evaluated and treated as needed. Appropriate studies and consultations may lead to a dramatic alleviation of fatigue.

Occupational therapists may be helpful in teaching the concept of energy conservation to those who have moderate or severe fatigue of differing varieties. Efficiency in performing activities of daily living, which include dressing, grooming, toileting, eating, and so forth, may increase the energy available for other activities.

Principles of Energy Conservation

  • Balance activity with rest and learn to allow time to rest when planning a day’s activities. Rest means doing nothing at all. There is a fine line between pushing to fatigue and stopping before it sets in. Rest improves overall endurance and leaves strength for enjoyable activities.
  • Plan ahead. Make a daily or weekly schedule of activities to be done, and spread heavy and light tasks throughout the day.
  • Pace activity. Rest before you become exhausted. Taking time out for five- or ten-minute rest periods during an activity may be difficult at first, but it may significantly increase overall functional endurance.
  • Learn “activity tolerance.” See if a given activity can be broken down into a series of smaller tasks or if others can assist in its performance.
    Set priorities. Focus on items that are priorities or that must be done, and learn to let go of any guilt that may be associated with not finishing tasks as the result of fatigue.