The MS Employment Support Service (ESS) is a specialist Disability Employment Service available for people affected by MS. The service is currently available in the Melbourne and Sydney metropolitan regions, and the Geelong/Bellarine region of Victoria. The MS ESS is a team of Occupational Therapists and Physiotherapists that work with clients in managing their symptoms at work, and maintaining their capacity for work. If you are experiencing MS symptoms that are making it difficult to do your work, and want further details about our service, phone 1800 042 138 or read their brochure.
Ready for a Nap, but the desk is in the way?
How to manage fatigue for better work, rest and play
Fatigue is one of the most common symptoms of MS, occurring in approximately 80% of cases. It can interfere with participation in all aspects of life, particularly a person’s ability to work.
The good news is that you can take steps to lessen its impact on your daily function and participation in work. Having a good understanding of your fatigue – what causes it; how it works; what strategies work for you to manage and lessen it is a good place to start.
Understanding your fatigue is helpful when developing strategies to overcome it, or if you need to explain it to others.
MS Fatigue is experienced as a direct result of damage to the Central Nervous System. It usually occurs more rapidly, lasts longer and takes more time to recover from than ordinary fatigue.
Neuromuscular Fatigue is a failure of damaged nerves to conduct messages to muscles during repetitive or prolonged activity and can usually be resolved with a short rest break. For example, your hands may tire during typing, but function will recover after a rest break.
Lassitude Fatigue is an overwhelming sense of tiredness that can occur any time without warning, and sometimes with no apparent reason. It does not necessarily resolve after rest.
In addition to these types of fatigue that are a direct result of MS, there are also the secondary causes of fatigue. This may be sleep disturbance due to pain; muscle spasms; low mood; and as a response to temperature insensitivity.
Through our work in supporting people with MS to remain employed, we have found that managing fatigue is usually dependent upon the person making some small changes to routines, priorities and activities. Small lifestyle changes enable a person to do more, not less.
Many of the changes that work for a person to manage their MS Fatigue are good lifestyle practices that also contribute to managing other MS symptoms and improve general wellbeing too. So – what is there to lose? Why not think about how some of these strategies could fit into your life?
The first step in making changes to lessen your fatigue can be understanding your own experience of it better. Keep a fatigue and symptom diary for a week or two, and see what patterns emerge. Write down your activities; symptoms; what time you have gone to bed/sleep; what time you get up and if you have had rest breaks or naps during the day. This can give you valuable information to use in planning when you carry out activities, when you need to rest or what activities particularly contribute to fatigue.
Once you have this information, think about how you may be able to use some strategies to target your fatigue.
To get the most out of of your energy throughout the work day, consider your duties from these perspectives:
Task – how can you change the way you complete work tasks to make them less fatiguing? Can a heavier task be done earlier in the day when you have more energy? Are there tools or equipment that can make the task easier to perform? Can a task be broken into smaller components and done ‘a bit at a time’?
Environment – How can you change or adapt your work environment to make it less fatiguing?
Consider body mechanics – an ergonomically sound workstation will reduce energy that is lost due to poor posture or poor muscle efficiency. Limit exposure to high or low temperatures – if the air conditioning isn’t adequate, think about personal cooling aids that may assist. From small desk top fans to cooling attire (such as cooling vests) there are a range of products that can reduce the impact of fatigue caused by temperature insensitivity.
Consider energy conservation techniques – for example, doing all of the printing in one go and collecting it all together; or choosing a desk position that limits how far you need to walk to the printer/staff room/bathroom; sitting to perform tasks such as dressing or showering in the morning.
Person – How can you change your personal practices for any normal daily activities to maximise energy levels for your work day? For example, sitting whilst showering or dressing before work may leave you with more energy. Implementing strategies that improve your energy levels, or reduce the energy required to perform normal activities, will all contribute to how much energy you have available during the day.
REST AND SLEEP
You may have heard the term ‘sleep hygiene’? This refers to the routine we have around going to bed and sleeping. Practising good sleep hygiene helps to improve the quality of the sleep and rest that you get, and contributes to you waking feeling refreshed. A good sleep hygiene routine includes:
- Avoiding caffeine, alcohol and other stimulants prior to bedtime;
- Having a regular sleep/wake pattern – eg going to bed and getting up at a similar time each day;
- Participating in calming activities before bedtime. You may consider using mindfulness techniques or meditation to achieve a state of calmness.
- Make your bedroom a comfortable and calm place for sleep. Have the room at a comfortable temperature.
Build small rest breaks into your daily routine. A rest break can be simply having a small break in the task that you are doing. Take a few minutes to stretch; go for a walk around the office (or block); go to fill your water bottle; use headphones at your desk to eliminate distraction. Find a quiet place (unused office/meeting room; car) that you can spend a few minutes recharging. Changing your posture and taking a cognitive break from a task can provide some rejuvenation.
If you can, build rest breaks into your week. If you work part-time, it may be good to have a day off in the middle of the week, then you can participate in rejuvenating activities to build up your energy for the rest of the week.
THE THREE P’s
Plan, Pace and Prioritise.
Consider all of the things you do in a day/week, and apply this principle. Think about what is most important to achieve, and when best to do it (when you have the highest levels of energy). Delegate tasks when you can, and ‘dump’ those of low priority.
EXERCISE and LIFESTYLE
It is easy to give up on exercise when you are feeling constantly tired and fatigued. But, participating in regular exercise actually improves endurance and increases energy levels. It also improves your mood and helps to manage stress – and low mood or anxiety can contribute to fatigue, so it has a double effect on increasing your energy levels.
Keeping hydrated and eating healthily will also improve your energy levels.
Visualise that you have 10 spoons of energy per day, and every task uses one spoon. This helps you to prioritise and plan activities each day. This helps to consider the impact of each task, and which are the most important to you.
By implementing small changes (even just one or two) in home and work activities, you will be saving your energy for the tasks that you consider the most important for you to do.
MS Employment Support Services Authors:
Renee O’Donnell – Senior Employment Support Consultant, Bach. Occ Therapy; Occupational Therapist
Elizabeth Stenhouse - Employment Support Consultant, Bach. Occ Therapy, Occupational Therapist
Imogen Oliver - Employment Support Consultant, Bach Occ Therapy, MErg, Occupational Therapist
Li Li - Employment Support Consultant, B.App Sc, Occupational Therapist