My fatigue is severely impacting my life!

Here is My Question:
The fatigue I have is terrible and severely impacting my life! I don't sleep well so I'm sure that isn't helping. What can I do?

Answer:
One of the biggest impediments to getting out and about for persons with Multiple Sclerosis is fatigue.  Yes, fatigue, that bone weary, heavy, melt into the floor feeling that makes you want to stop doing what you’re doing and sit (or sleep).  It affects everyone differently.  It makes anything requiring thought or motion more difficult (which is everything). It doesn’t matter if you are on your own or you have family and friends to help- fatigue is something that needs to be managed for you to be at your best. So let me ask you …

When you go to your medical professional and make this statement they are going to try to tease out whether it is truly MS related fatigue, or something else.  They are going to ask how well you are sleeping, and how many hours you are sleeping.  They may ask about your sleep schedule- some people who are no longer working can get their sleep cycles turned around. So even if they are getting enough sleep, but on an odd schedule, it can leave them feeling tired.  They may ask about what you are doing before you try to go to sleep.  They may ask if you have sleep apnea.  They will ask if you have a history of depression.  They will ask if pain is keeping you up at night.  You see where I am going with this. Just because you are feeling exhausted during the day does not automatically mean it is MS related fatigue, it could just mean you are not getting enough sleep. 

Getting to sleep can be a challenge for many of us- MS or not.  We worry, we think, and we plan.  We just lay there. Here are some ideas…

1. Go to bed at the same time, all the time, even on weekends.  It will help regulate your sleep/wake cycle.
2. Avoid lying down and dozing after dinner.  Dozing will make it harder to go to sleep later. Get up and do some stretching after dinner. Get up and go outside. Get up and get a puzzle out. Play cards or a board game.
3. Develop a ritual or routine.  Do the same things in the same order every evening.  This will help your body know it is time to sleep.
4. Don’t go to sleep with the TV on.  This is for two reasons.  The first reason is that your bedroom should be dark while you are trying to sleep- so no additional lights.  The second reason is (and this is just a theory of mine), beginning at about 1 o’clock in the morning, the television is trying to wake you up.  All of those telemarketers selling stuff are literally shouting at you in the middle of the night to wake you up and get you to buy their stuff.  Don’t fall victim to telemarketers- turn the TV off before you go to bed.
5. Avoid liquids after 6:00 PM.  This is tricky.  You need to drink fluids for your body to function optimally.  Yet I know some of you are not drinking as much as you probably need to due to bladder urgency. If this is you, remember you should optimally be drinking 64 ounces of fluid (8 almost full coffee mugs) per day.  If you are worried about liquid intake and sleep, load those fluids early in the day- the first 32 ounces by noon, the second 32 ounces by 5:00.  Then you have the chance of getting all of the fluid out of your system before you try to go to sleep.
6. Try to not be really busy before bed.  Being really productive can make it harder to relax when the time comes to go to bed.

Here are some sites that I think have good information about going to sleep…
http://www.helpguide.org/articles/sleep/how-to-sleep-better.htm 
http://www.nhs.uk/Livewell/insomnia/Pages/bedtimeritual.aspx 

And if you are losing sleep because your kids can’t go to sleep…
http://www.parenting.com/article/how-to-get-your-child-to-sleep-really 

Lori Kostich M.S. CCC-SLP, MSCS
Mandell Center for Multiple Sclerosis Treatment and Research