Fatigue in MS is one of the greatest concerns that are shared by all people with MS – regardless of which type of MS an individual has. For the majority of the general public, it is also one of the most misunderstood symptom.

Often people with MS have to fight not only the symptom, but are often required to continuously explain or even defend one’s self against criticism. For example, some families or friends will accuse the person for being lazy or ‘not trying hard enough’.

Even many ‘experts’ particularly physical therapists will attempt to convince the person with MS that the fatigue they suffer is due to a lack of endurance because of insufficient exercise.

There are several types of fatigue in MS – but regardless of which type, fatigue to us feels more like complete exhaustion – unlike anything most of us have ever suffered before! It goes way beyond tired!

All people, whether they have MS or not, suffer from ‘normal’ fatigue. This is the fatigue you feel after working or playing hard, or from having a ‘late night’ or disturbed sleep.

All people, also suffer from fatigue which is caused by insufficient endurance levels. In an able bodied person this may be caused by a lack of over all general fitness – or by pushing beyond ‘normal activity’, such as working long hours, extreme physical exertion etc.

However, people with MS also suffer from two additional types of fatigue, which is not generally understood by family and friends. These are often referred to as nerve/muscle fatigue and general overwhelming fatigue with a sudden onset.

The nerve/muscle fatigue is caused by damage to the myelin sheath surrounding the nerve fibers. The impulse to move travels along and fires at the appropriate places. However, if there is any demyelination, the nerve fires, short circuits, fires, short circuits and then becomes blocked – this is what is called a conduction block. An example of this would be if you are walking fine, and then the more you walk the weaker the leg or legs become and eventually you are unable to lift your leg any further.

Lassitude is what most people are referring too, when talking about "MS Fatigue". This is generally an overwhelming, sometimes with an alarming sudden onset of ‘exhaustion’. The desire to sleep or nap may become so overwhelming that nothing else is possible except to find a quiet place and nap.

Generally, MS fatigue seems to worsen as progression continues. Neurologists believe that this type of fatigue has a neurological – neurochemical origin, maybe an imbalance of neurotransmitters.

However, if you study the causes and need for sleep in all sentient life forms you will find that the actual purpose for sleep is rejuvenation of the body cells, and redirection of energy to healing. This may be likened to a concentrated effort to repair the body rather than having to divide the body’s resources in maintaining alertness and function plus repair.

Therefore, it makes intuitive sense that a body that is diseased or damaged will require more sleep in an effort to repair itself at least at a cellular level. So that the desire to sleep is ‘induced’ in an attempt to enable repair. Personally, I believe that both theories have merit.

Another form of fatigue suffered by people with MS may be induced due to clinical depression, which is caused by a chemical imbalance within the brain. However, in clinical depression, people often report lack of sleep, insufficient nutrition due to lack of appetite and an overall general feeling of malaise.

Therefore, it is almost a ‘chicken and egg’ debate of whether the fatigue of depression is caused by a chemical imbalance or whether it is due to lack of sufficient sleep and nutrition.

Clinical depression – not to be confused with depressed mood or grief reaction to disability -–does respond well to anti-depressants, which indicates that the depression is caused by a chemical imbalance. The fatigue which accompanies, depression also lifts. The older types of anti-depressants had a sedating effect, whereas the newer drugs, such as Zoloft, Paxil and Prozac are reported to have an energizing effect.

Fatigue may also be induced by chronic pain and unrelenting stress. You will recall in the article about stress aggravating pain can cause exhaustion. Spasms and spaticity can also induce fatigue through inefficient or lack of restful sleep. As most of us know it is when we relax and finally try to sleep that many of our spasms occur.

Heat, illness causing an increase in body temperature, such as infections, can also cause fatigue.

Some medications we take for spasms are also known to have a sedating effect, such as Zanaflex, whereas Baclofen causes an increase in weakness in some people.

Whereas exercise may increase levels of endurance, in MS – particularly progressive MS, there is a widespread damage which will cause conduction blocks. There comes a point when no amount of strength in a muscle will have the slightest amount of effect if the muscles are not receiving adequate or appropriate nerve stimulation. Additionally, as previously discussed, exercise can induce further muscle/nerve fatigue.

Therefore, understanding this type of fatigue, may lead to changes in activity levels and the way an individual completes tasks. For example, if you are aware that you do suffer from this form of fatigue, then recognizing the early indicators of weakness will prompt you to rest your muscles giving your nerves a chance to recover from misfire or ‘short circuit’.

Perhaps even changing from a walker to a chair, or from a manual to an electric chair for different periods during the day – or for different activities may assist.

Understanding the need for rest, for naps may prompt a change in time management, so that naps or rest periods are automatically incorporated in a daily schedule.

While none of us want to sleep our lives away, there comes a point in progression and disability where we really are left with no choice, but to rest, so that we may go on and achieve our goals.

Understanding our limitations and pacing ourselves throughout the day is also essential. For example, most people seem to be far more alert and energized in the morning hours than they are in the afternoon. Therefore it makes logical sense to plan activities or tasks which require energy for the morning hours of peak performance.

Diet and good nutrition are factors which receive little or no attention with regard to fatigue. However, in order to effect cell repair, provide the body with the necessary ‘fuel’ to function begins with adequate intake and a balanced diet.

Amantadine, Provigil, and low levels of anti-depressants have been shown to have a positive effect on fatigue levels.

Alternatively, understanding the nature of the drugs which have a sedating effect may necessitate a change from just taking say Baclofen to a combination of Baclofen and Zanaflex.

This would help the level of spasticity management required while reducing the sedative effect of zanaflex and the weakening effect of Baclofen. Also understanding that drugs such as Valium, Xanax to name a couple are great as muscle relaxants, but are also capable of inducing further need for sleep.

Having adequate pain control, spasms control is essential to the quality of life. However, it is also essential to enable an individual to achieve an adequate number of hours of restful sleep. Lack of sleep will only compound MS fatigue.

Taking care of ourselves requires that we gather as much information as we can about the medications we take – the impact it has on our level of functioning. Understanding our need for sleep, our need to alter our environment to reduce stress caused by overload or stimulus. Understanding our need to eat well, and nap often.

While there are some nutrients and pharmaceuticals which may combat fatigue, there comes a point when nothing well help all the time. This is why it is important to understand our limitations, understand the different types of fatigue and try to work with out bodies rather than fighting against them.