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Multiple Sclerosis (MS) Fatigue

Understanding your energy levels

​​​​​​​​​​​​​​​​​​When you have MS, it is important to use your energy in the most efficient way possible, or to maximize how you use your energy. The first step to doing this is to understand how your energy levels work.

You can think of how you store, use, and refill your energy levels as a bank account:

  • In this bank account, think of energy like money. Just like a regular bank account, it is important to know how much money you have available.
  • With MS, you have less energy available. Looking at this limited amount of money in your bank account, you need to think carefully about what you spend your money on and how to get more money into your account.
  • If you spend more money than you have in your account, this is called going into overdraft, or having an overdrawn account. With a bank account, this usually means having to pay back the money later, with an additional fee or with interest. The same is true with your energy levels. When you use up more energy than you have available, it can take days to get back to your original level. You may feel like you’ve “crashed”, or “hit the wall.”

To avoid a situation where your energy bank account becomes overdrawn, leading to an energy crash, it is important to be aware of how much energy you have available and to have plans in place to budget your energy effectively. Find strategies to maximize your energy and ways to manage your fatigue.

Zones of fatigue

Thinking about your fatigue and how you are feeling in terms of zones can help you talk about your level of fatigue and decide which strategies to manage your fatigue would be most helpful.

How am I feeling? How can I manage my fatigue?

Green zone:

  • “good to go”
  • calm and focused

Manage your fatigue before it sets in (be proactive).

  • Rest before fatigue sets in.
  • Pace yourself.
  • Take short, frequent breaks (like resting for 5 minutes every 30 to 45 minutes).

Yellow zone:

  • getting a little tired
  • stress increasing or feeling more frustrated
  • difficulty concentrating
  • Sit down if possible.
  • Look for ways to make a task easier (like asking for carry-out help at the grocery store instead of packing and carrying out your own groceries).
  • Think about which tasks are most important and re-organize or re-prioritize your plans for the day.
  • Cool down if needed.
  • Remove background noises and distractions.

Red zone:

  • feeling like you have “hit the wall”
  • out of energy
  • “crashing and burning”
  • overwhelmed, brain is foggy
  • Stop and rest.
  • Ask for help or give tasks to other people (delegate).
  • Adjust plans for the day.
  • Do only what is essential.

If you are a support person for someone with MS, you can also watch for the zone of fatigue that they are in. Use this information to find the best strategy to manage fatigue at that time.

Patterns of fatigue: Daily activity diary

A daily activity diary can be a helpful tool to start to better understand the unique patterns of fatigue that you experience, where you spend your energy, and where you may be able to make changes to manage your energy levels. A daily activity diary is not something that you should do every day. Think about doing a daily activity diary for just 5 to 7 days to start to understand your fatigue. You may want to do a diary again if you notice your fatigue getting worse.​

A daily activity diary can include:

  • A description of the last night’s sleep.
  • A description of what you did every hour during the day. Include details, like “walked 100 metres and up 15 stairs carrying a backpack to get from my car to my office.”
  • Comments about your level of fatigue, how you felt doing the activity, and how important the activity is to you. Some people use numbers or a scale for this (like rating your level of fatigue from 1 to 10).

This information will help you better understand:

  • What your fatigue patterns are. Are there certain times during the day where you have high levels of fatigue? These are the times of day that you might need to plan for a rest period.
  • What your triggers are. Are there specific activities that keep making your energy levels crash? These are activities that you might need to do differently, do less often, or ask someone else to do.
  • What your restorative patterns are, or where your energy levels are at their highest. These are good times of the day to plan to do your most demanding activities.
  • What your restorative triggers are. Are there activities that tend to make your energy levels better?
  • What is the effect of overdoing it. How long does it take you to recover from one very busy day? Use this to plan ahead for future busy days and try ways to manage expected rises in fatigue levels.

This information can help you learn where to start making changes. Remember that a daily activity diary is a tool that you can use for a short time, not something to do every single day.

Download a blank daily activity diary (PDF).​

Activity analysis

Activity analysis can help you find ways to make a fatiguing activity or task easier.

Activity analysis means breaking down an activity into its smaller components. This will help you come up with ideas for small changes to make the activity easier or ways to do the activity in a way that uses less energy.

When you are doing activity analysis, think of:

  • The physical and cognitive skills that the activity uses. Activities need your body’s strength and movement (physical skills) and your brain power for things like concentration, thinking, or problem-solving (cognitive skills)
  • The different environments where activities can happen, which might make them easier or harder.
  • Expectations for how to do this activity, how often it needs to be done, and who needs to do it.
  • The smaller steps or parts that make up the full activity, because you may be able to get rid of some of these steps or make them easier.

Take the activity of cleaning the house, for example. Some people see cleaning the house as one task, meaning they plan to clean their whole house in one go. Activity analysis helps to challenge that and find ways to make cleaning easier. Before cleaning the house, take some time to break this task down into smaller, more manageable pieces. Cleaning the house is actually made up of many smaller activities like tidying clutter, washing floors, scrubbing the tub, or dusting. And each of those tasks can be made even smaller, like doing each of them 1 room at a time.

Once you have broken down the cleaning activity into small parts, decide together who should do what, what tools can help make it easier (like a mop for floors instead of cleaning by hand), what tasks can be skipped this time, and what parts of the house are the priority to be cleaned.

As this example shows, you can use many strategies together to maximize your energy and manage your fatigue. Activity analysis can break down an activity into small tasks, a to-do list can help you prioritize those tasks, planning and pacing can help you schedule those tasks at the best time, delegating can help to share tasks, using tools can make the tasks easier, and so on.

Learn more about ways to maximize your energy and manage your fatigue and use these strategies together to find what works best for you.

Current as of: September 14, 2023

Author: Calgary MS Program - Allied Health