Four out of five people with multiple sclerosis live with exhaustion.
It is not a symptom that comes and goes like the others. It is there. Constantly. Whether your disease is stable or active, the fatigue remains.
“Fatigue seems to be a constant,” says neurologist Dr. Jeffrey Cohen, former director of Cleveland Clinic’s Mellen Center.
Doctors aren’t entirely sure why.
The feeling doesn’t match the word
“Tired” feels like an insult to those of us living with it.
Michael Wentink, an MS patient from San Antonio, wishes for a new vocabulary. He explains the disconnect clearly.
People hear “fatigue” and nod. They say oh, I’m tired too, from work, from running around. That is not what MS does.
Wentink recalls normal tiredness from before his diagnosis. It’s nothing like this.
Normal tiredness follows exertion. MS fatigue arrives without permission. He can wake up, shower, shave, and suddenly his body demands he lie down on the bed just to recover. It is a complete depletion of energy reserves.
Cory, another patient, describes it as an inside exhaustion. It isn’t sleepiness. You want to move, but your brain won’t let you.
Three types of drain
Dr. Cohen breaks it down. Not all fatigue is created equal.
First, there is Indirect Fatigue. This stems from things that aren’t strictly MS lesions, though they often accompany the condition. Stress, bad sleep from muscle spasms, medication side effects, or depression can sap your energy. Anemia and thyroid issues are also suspects. Doctors rule these out first.
Second, Neurologic Fatigue. The symptoms themselves—tremors, spasms, weakness—are energy-expensive. The damage along nerve pathways gets worse with heat, stress, fever, or physical activity. Moving costs more because the signal path is damaged.
Third, Autoimmune Fatigue. Often called lassitude, this is common across autoimmune diseases. It mirrors Chronic Fatigue Syndrome. It’s persistent, deep, and stubborn.
12 Ways to survive
There are strategies. They don’t cure the disease, but they help preserve the day.
1. Stay close to your medical team
Control the disease. Manage the relapses.
“If MS is well-controlled, fatigue levels often drop,” says Dr. Devon Conway at Cleveland Clinic. Keep those appointments. Ensure your treatment is optimized.
2. Audit your sleep
Good sleep hygiene matters. Wake and bed times should be consistent.
But sleeping more doesn’t always mean feeling better. If you are exhausted after eight hours, check for disorders.
People with MS are at higher risk for insomnia and restless legs. These are often overlooked. Fixing them helps.
3. Run from the heat
Heat is a trigger. When body temperature rises, so does fatigue.
Wentink lives in Texas. He plans accordingly.
“Activities happen before sunrise or after sunset,” he says.
At kids’ sports games? He brings water. He seeks shade. He wears ice packs around his neck.
4. Basic health basics
Weight, blood pressure, cholesterol, diabetes. Managing these reduces the load on your system.
If you are out of shape, everything takes more energy. Dr. Conway emphasizes this. Dr. Cohen agrees. Health maintenance is a fatigue fighter.
5. Eat to stabilize blood sugar
There is no “MS Diet,” but there is sensible eating. The National Multiple Sclerosis Society suggests colorful vegetables, lean proteins, whole grains, healthy fats. Avoid processed sugar and refined grains.
Dr. Barbara Giesser, a neurologist in Santa Monica, explains the mechanism.
Simple carbs cause a spike. Then a crash. That crash exacerbates fatigue.
High-quality options:
- Proteins: Beans, nuts, lean meat
- Fiber: Oatmeal, brown rice
- Greens: Fresh fruits, leafy veggies
- Yogurt: Low-fat or fat-free
- Omega-3s: Salmon, walnuts
6. Try mind-body movement
Yoga. Tai Chi.
These practices link meditation with motion. A research review showed they reduce fatigue more than other exercises for MS patients.
7. Pace or die trying
Wentink warns against pushing through.
“I try to slow down before severe fatigue sets in,” he says. “I don’t want to bring on a leave a relapse.”
Breaks aren’t lazy. They are protective.
8. Ask about meds
Drugs exist, though the science is messy.
Modafinil (Provigil) promotes wakefulness. Amantadine (Symmetrel), an antiviral, is sometimes used off-label. Dalfampridine (Ampyra), approved for walking issues, is also tried for fatigue.
Studies conflict. Some say these help. Others say they are no better than placebos. Research is ongoing. Talk to your doctor.
9. Treat depression
Sadness hurts the body. Depression is common in MS. Untreated, it worsens fatigue.
If you have lost interest in things you love, speak up. Depression is treatable.
10. Move regularly
Dr. Conway pushes patients to exercise.
It feels harder at first. There is a “hump.” But crossing it often leads to less fatigue overall.
If you need help starting, find a physical therapist or trainer who understands MS. Occupational therapists can also suggest energy conservation strategies.
11. Say no
Simplify.
Wentink admits the holidays are hard. “Beautiful chaos,” he calls it, with family and friends. But that chaos has a cost. He’s had relapses in January and February after overexertion in December.
Letting things go isn’t giving up. It’s protecting your future health. He wants to feel okay in 20 or 3 years.
12. Kill the stress
Unresolved stress leads to anxiety, depression, and poor sleep. It makes MS symptoms worse.
Dr. Giesser suggests restorative sleep, exercise, meditation, or yoga. Mindfulness shows promise for lowering both stress and fatigue.
There are apps. There are free meditations. Start there.
This content is based on reporting by Becky Upham, Christina Vogt, and expert input from Dr. Cohen, Dr. Etienne, Dr. Conway, Dr. Giesser, and patient advocates like Michael Wentink. Always consult your healthcare provider for medical advice.
