DMSRU Education Series 2012

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1 DMSRU Education Series 2012

2 Why Am I So Tired?? Fatigue is one of the most commonly reported symptoms of MS Affects 70-90% of those living with MS and many report it as their most disabling symptom Experienced differently by different people Often referred to as the invisible symptom of MS

3 Types of Fatigue Generalized fatigue: an overwhelming sense of tiredness (e.g. unable to stay awake despite periods of rest) Muscle fatigue: muscles that easily tire after minimal activity (e.g. your legs feel weak after a short walk) Fatigue may be caused by many different things and can be unrelated to your MS. Lack of sleep, medications, anemia, inactivity, other medical conditions and depression can all cause fatigue.

4 What is MS-related Fatigue? Everyone experiences fatigue in their daily lives so it may hard to distinguish what is normal, and what is not MS-related fatigue is often described as an overwhelming sense of tiredness and exhaustion Can be debilitating and may interfere with physical, social, emotional and cognitive functioning

5 MS-Related Fatigue MS-related fatigue differs from normal fatigue as it: Worsens with heat Prevents sustained activity Interferes with functioning Does not improve with sleep Comes on suddenly and may be disproportionate to activity

6 Symptoms of Fatigue: Physical tiredness Mental tiredness Lack of motivation Difficulty concentrating Inability to complete tasks Feelings of depression Feelings of anxiety Failure to feel refreshed after sleep Muscle weakness Poor performance at home or work Pain/physical discomfort Sleep difficulties

7 Causes Unsure of the exact cause, most likely a combination of different factors May be due to the disease itself, or may result from symptoms of the disease (e.g. pain), or due to other medical problems (e.g. sleep apnea) May result from medication side effects (e.g. analgesics & interferon) Affects everyone living with MS and is often unrelated to degree of disability

8 Fatigue & Mental Health Mental health status, coping style & personality can also influence a individual s experience of fatigue Depression is common in the MS population and the symptoms of depression aggravate fatigue Focusing frequently on bodily sensations can increase fatigue

9 What Can I Do? Some common strategies include: Energy Conservation Exercise Healthy Eating Medications Rest

10 The 4 P s of Managing Fatigue PACING pace yourself and take 5-10 minute breaks as needed. Alternate between high & low energy tasks PRIORITIZING focus on what s important PLANNING Plan ahead to ensure you have enough time to complete tasks. Spread out tasks throughout the day, week or month POSITIONING Postural supports help save energy (e.g. sitting while cooking)

11 In the Kitchen. Keep heavy appliances (such as toasters & blenders) in a convenient spot where you don t have to move them Store items that you use frequently where they are easily accessible Sit while preparing meals Prepare double recipes and freeze half for later Use electrical appliances Use paper plates & paper towels to minimize cleanup

12 Other tips Explore what changes you can make at home to make life easier for yourself. Occupational therapists are a great source of ideas and resources!

13 Exercise Regular exercise is important for everyone, regardless of disease state, and can help decrease fatigue Exercise is appropriate for those living with MS and will not have a negative effect on your disease course Helps build muscle and aerobic capacity Helps to avoid deconditioning and muscle weakness

14 Exercise Tips: Exercise at a time you feel more energetic (typically fatigue increases as the day progresses, so exercising in the morning may be an idea) Take frequent rests Do what you enjoy! Involve family & friends, this may increase motivation and make the activities more enjoyable Try new activities (many people enjoy aqua-fitness and yoga)

15 Healthy Eating! Maintaining a healthy and balanced diet can help decrease fatigue. Here are some tips: Avoid refined sugars & sweets Drink lots of water! Limit caffeine Enjoy a balanced diet Eat frequent smaller meals Limit alcohol

16 Medications! Medications may be used to treat persistent MSrelated fatigue. Three commonly prescribed medications are: Amantadine (Symmetrel) Modafinil (Alertec) If fatigue is having a negative effect on your life, ask your health care team about these medications

17 Rest Schedule time to rest and relax this means doing nothing!! Relaxing helps reduce stress, which can contribute to fatigue Ask for help! It may be hard for you, and for others, to understand your fatigue. Explain to your family & friends how you feel, they are often happy to help out

18 References Adelson, R. (2012). The three faces of fatigue: Physical, mental and emotional. Momentum, 5(3), Burks, J., & Johnson, K. (2000). Multiple sclerosis: Diagnosis, medical management, and rehabilitation. New York, NY: Demos Medical Publishing Krupp, L. (2004). Fatigue in multiple sclerosis: A guide to diagnosis and management. New York, NY: Demos Medical Publishing Matthews, B., & Rice-Oxley, M. (2001). Multiple sclerosis: The facts (4 th ed.). New York, NY: Oxford University Press Murray, J., Saunders, C., & Holland, N. (2013). Multiple sclerosis: A guide for the newly diagnosed. New York, NY: Demos Medical Publishing

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