Multiple Sclerosis Self-Care: Everyday Strategies

If you’ve been diagnosed with multiple sclerosis (MS), an autoimmune disease that attacks the protective coating (called myelin) around the nerves in your central nervous system (CNS), it means the brain signaling to different parts of your body has been disrupted, leading to various physical and cognitive challenges.

Treatment for MS almost always requires working with a neurologist and taking medication, but there are still ways to manage symptoms and preserve your quality of life through the self-care actions you take every day, says Daniel Gratch, M.D., a neuroimmunologist at Northwell Health’s Lenox Hill Hospital in New York City.

Building an MS Self-Care Plan

Symptoms caused by MS are broad and varied. They can include vision loss and eye pain, walking and balance problems, numbness, and/or muscle weakness, according to the Mayo Clinic. Compounding matters, multiple sclerosis symptoms may worsen if you’re under too much emotional or physical stress, fighting an infection, or not exercising regularly, sleeping enough, or eating well, Dr. Gratch adds.

While you cannot control whether or not you receive a diagnosis of multiple sclerosis, you can play an active role in creating an MS self-care plan to help you best manage the symptoms you are facing. It starts with setting realistic, personally meaningful goals, tracking your progress, and staying on top of your health, so you can continue living your life to the fullest with this condition.

Managing MS Fatigue

About 80% of people with multiple sclerosis live with chronic fatigue, according to the National MS Society. There are multiple reasons for this, says Dr. Gratch. “Fatigue is difficult to understand on a biological basis,” he says. “When patients report fatigue, I think it’s very important to do another, holistic review of why. Often, it’s related to sleep habits, diet habits, and mood disorders that might not be well-managed, like anxiety, which can spend a lot of your budget for energy.”

In MS, your “energy budget” can be depleted in several ways: Primary fatigue is thought to be caused by nerve damage from the disease, which forces your brain to reroute its signaling to create new pathways, per the MS Society UK, using up precious energy to do so. Inflammation can also release immune proteins called cytokines that slow processing speed and cause feelings of exhaustion, research shows.

What’s more, people with MS are very sensitive to heat, notes Daniel Giang, M.D., a neurologist at Loma Linda University Medical Center in California. When your core body temperature rises, your body exerts energy to cool itself down, even as nerve conduction is slowed in already damaged pathways from MS, triggering fatigue.

In addition, secondary fatigue can result from other effects of multiple sclerosis, including pain, loss of sleep, stress and worry, and/or certain medications, Dr. Gratch points out.

Self-care can help you address fatigue—especially when it is secondarily caused by the condition. Start with these strategies from the National MS Society:

• Avoid overheating. Demyelination makes the body expend more energy to keep cool. Stay hydrated, wear loose clothing, and avoid the outdoors during extreme heat and humidity.
• Eat a healthy diet. While there is no “MS diet,” Dr. Gratch says a Mediterranean diet may help you avoid gaining excess weight for better energy, lower inflammation levels, and fewer flares.
• Follow consistent sleep hygiene. Aim to log seven to nine hours each night and seek treatment for other multiple sclerosis symptoms that can interfere with sleep, such as spasticity and urinary dysfunction.
• Try physical therapy. Physical therapy can teach you energy-saving ways of walking, with or without assistive devices, and how to perform other everyday tasks with less effort.
• Seek psychological support if needed. This might include joining a support group, stress management, relaxation training, and/or psychotherapy.

Exercising With Multiple Sclerosis

No self-care plan for multiple sclerosis is complete without an exercise routine. “Many MS patients find that it’s best to exercise early in the morning—they can actually get in more cardiovascular exercise at 5 a.m. or 6 a.m. than they would at 5 p.m. or 6 p.m.,” says Dr. Giang, explaining that body temperature is lowest in the morning and highest late in the afternoon. “For MS patients who have demyelinated nerve segments, you run out of energy faster when your body temperature’s higher.”

Dr. Gratch notes that exercise intensity may change depending on someone’s stage of disease. For those who are capable, he likes to see “high-intensity aerobic exercise at least three times per week.” That can mean anything from a brisk, 30-minute walk outdoors, using stationary exercise equipment at the gym, or even swimming laps at a pace that works for you.

The benefits of exercise are clear when it comes to your self-care plan, both experts agree. In fact, research shows that staying active with MS can improve bladder and bowel function, bone density, cardiovascular fitness, cognitive function, energy levels, flexibility, mood, and strength, per the National MS Society. “It’s also good for reducing stress,” notes Dr. Gratch.

Tips for exercising safely with MS include:

• Clear it with your healthcare team. Before starting any new exercise routine, get the green light from your doctors.
• Don’t push too hard. “You should be able to have a conversation while exercising—that level of intensity is ideal,” says Dr. Gratch, adding “huffing and puffing a bit while talking is fine.”
• Manage body heat. People with multiple sclerosis are especially sensitive to higher temperatures. Exercise in a cool room, or at cooler times of the day when you’re outside.
• Stay hydrated. Drinking plenty of cold water can help keep your body temperature low.

The Best Diet for Multiple Sclerosis

There is no one “magic diet for MS” that will prevent MS symptoms or cure the disease, says Dr. Giang. Many of his patients ask if they should go vegan, an eating approach that avoids all animal products, including eggs, dairy products, and even honey. While he points out that veganism has been touted in the MS community “since the 1940s or 1950s, what’s most important is that you eat healthy foods and not gain weight.”

Still, that can be a tall order. Heat sensitivity, fatigue, and mobility issues with multiple sclerosis make exercising and therefore weight maintenance more challenging. Yet obesity can worsen common MS symptoms like balance problems, muscle weakness, and low energy, and can take a toll on cardiovascular health, notes Dr. Giang.

As part of your MS self-care plan, lean into healthy proteins like chicken or fish, colorful vegetables and fruits, and unsaturated fats such as avocado and olive oil, while limiting processed foods, sugar, and alcohol. In fact, research shows that following this dietary approach can help boost energy reserves, assist with weight management, and improve cholesterol and insulin levels.

Get Better Sleep With MS

Sleep problems affect up to 70% of people with multiple sclerosis, according to the National MS Society. Reasons range from insomnia to restless legs and/or body syndrome, sleep apnea, acting out your dreams in sleep, and even narcolepsy, all of which can be tied to the brain damage caused by demyelination, specific MS symptoms, and medications that are prescribed for curbing those symptoms.

Yet getting consistent quality sleep is fundamental for maintaining good health and mood. So, what’s a person with MS supposed to do? Maximizing quality sleep starts with these self-care strategies:

• Assess your pain. Meet with your healthcare team to treat MS-related muscle stiffness, pain, or spasming with the right medications or therapies, advises MS Trust.
• Address your stress. “Meeting with a physician, a counselor, or even a pastor can help” improve mood, lower stress, and lead to better sleep, says Dr. Giang. “It doesn’t have to be a psychologist.”
• Commit to the rules of good sleep hygiene. Stay off screens a few hours before bedtime, keep your bedroom dark and cool, go to bed and wake up at the same time each day, limit caffeine and alcohol, and reserve your bed for sleep and sex.
• Limit naps to 30 minutes. Sleeping longer during the day interferes with quality sleep at night. Dr. Giang says some of his patients “hit a wall” at two o’clock in the afternoon. Rest briefly if you need to when your energy levels dip—just not for too long.
• Manage bathroom issues. Limit how much you eat and drink in the hours before you go to bed to help you avoid getting up frequently in the night, recommends the U.S. Department of Veterans Affairs.
• Review medications. Some hypnotic medications can induce sleep and treat insomnia, per the National MS Society. But other drugs that treat restlessness or spasticity can actually lead to poor sleep. Consult with your care team for the right Rx.
• Test for sleep apnea. People with multiple sclerosis are at higher risk for this condition, which interrupts regular breathing and limits oxygen and blood flow to the brain, per the Multiple Sclerosis Foundation. Ask your healthcare team for a sleep assessment.

Managing Heat Sensitivity

Up to 80% of people with multiple sclerosis experience heat sensitivity, which can manifest in many ways, including blurred vision, cognitive issues, fatigue, muscle weakness, numbness, slowed reaction times, spasticity, and tremors, according to the National MS Society.

Smart strategies for keeping your body core cool include:

• Crank the AC. During hot and humid weather, stay indoors and protect your health.
• Choose the right clothing. “Light” and “breathable” are the two adjectives you should apply to anything you wear during warmer months.
• Cool down after exercising. Get into a bathtub of lukewarm water and continue adding cooler water over a period of 20 to 30 minutes.
• Drink cold water and eat popsicles. Staying hydrated can help bring down body temps, and if you like sweet treats, ice-cold popsicles can help, too.
• Exercise outdoors when the sun is low in the sky. Think about taking that brisk walk in the morning or early evening when temps are likely to be less taxing.
• Stay indoors in hot and humid weather. Extreme heat means sticking to an air-conditioned gym or cool basement.

Reducing Stress With Multiple Sclerosis

Feeling stressed, anxious, or even depressed is common in people with multiple sclerosis, says Dr. Gratch. Diagnostic worry, a sense of losing control, having an illness with invisible symptoms, and even financial pressures can make things worse, adds the National MS Society.

“People with MS have a higher risk for mood disorders,” says Dr. Giang, noting that studies have compared people with multiple sclerosis to those with another chronic condition, rheumatoid arthritis. “You’d think people with rheumatoid arthritis would be worse off in terms of depression because every one of them has pain. But MS patients have a 70% lifetime risk of having a mood disorder, whereas a rheumatoid arthritis patient only has a 10% risk.” The explanation, he says, stems from the fact that rheumatoid arthritis does not affect the brain in the majority of cases, while MS does.

Given the correlation between MS, stress, and mood disorders, self-care for multiple sclerosis should include some form of mental health support, experts say. “I wish more MS patients were willing to engage in counseling,” Dr. Gratch says. “Even for people who are doing well, it helps to have somebody they can talk to and who can counsel, listen, and work with them in dealing with stress because you can’t stop stress. You can only deal with it.” Regular exercise can help reduce your stress levels, too, he adds.

The National MS Society can help you find resources, MS support groups, and peer support through the National MS Society.

Using Mobility Aids to Save Energy and Stay Active

When multiple sclerosis leads to fatigue, weakness, spasticity, and/or balance issues, assistive devices can help you stay more active and independent, reports the National MS Society. Up to 60% of working adults with MS rely on some type of assistive equipment, research shows.

Mobility aids for people with multiple sclerosis include:

• Canes and walking sticks. One or both devices, which roughly 40% of people with MS rely on, can assist mobility when balance, gait, and muscle weakness are affected.
• Rollators and walkers. Rollators are wheeled walkers with handlebars, while walkers may have front wheels or no wheels at all. Walkers provide weight-bearing support and maximum stability, while rollators offer fluid, forward motion. walkers may have front wheels or no wheels at all. Walkers provide weight-bearing support and maximum stability, while rollators offer fluid, forward motion.
• Wheelchairs. Manual wheelchairs can be beneficial to someone with multiple sclerosis who has upper body strength but struggles with balance or gait. Lightweight versions can often be quickly folded to fit into the trunk of a car for easy transportation.
• Scooters and electric wheelchairs. Motorized support, including scooters and power chairs, can help get you where you’re going, both inside and outside of the home. Roughly 15% of MS patients use such an assistive device, per Hartford HealthCare. To figure out whether a mobility scooter vs. power chair is right for you, talk with your doctor.

Making Your Home More MS-Friendly

Part of your self-care plan should include a thorough assessment by an occupational therapist of your home for safety and accessibility, and that’s true whether you’re in a house with a yard, a condo, or an apartment. According to Cleveland Clinic, these tips can help make your home safer when you have mobility limitations due to multiple sclerosis:

• Adapt your kitchen. Accessible storage, wheeled carts, smooth surfaces, and large-handled utensils can make cooking with MS a whole lot easier.
• Consider a lift. Add a stair lift or utilize your first floor for sleeping and working instead.
• Install grab bars near couches and chairs. Also add them in long hallways and in bathtubs. Consider lift chairs to help you rise from a sitting position.
• Modify your bedroom. Add bed rails, ladders, or rungs to make getting in and out of bed easier.
• Prevent fall risks. Fall prevention starts with removing area rugs that can trip you up, lighting hallways and stairwells, and storing things within easy reach.
• Try tech tools. Conserve your energy. Let smart tech tools lock up at night, answer phones, search the Web, or respond to someone knocking on the front door.
• Rethink your bathroom. Install a raised toilet seat, use bathmats with strong grip only, add grab bars in the shower, and place a shower chair or bench in the tub to make bathing safer.

Finding Your MS Support System

Even with the best self-care plan, multiple sclerosis is a neurological disorder that can profoundly affect how you feel, physically and emotionally. The right support system can go a long way in helping you navigate life with this condition. In addition to your medical team, you might benefit from other forms of support, including:

• Caregiving help. From getting in and out of the shower and bed to medication dispensing and more, having friends, family, and/or a professional health aide to help when you’re flaring can ease the burden on you.
• Emotional support. Talking to someone other than a family member about how you’re feeling may be helpful with multiple sclerosis. Seek support from a counselor, psychologist, or psychiatrist if you’re battling low mood.
• Home-safety modification. An occupational therapist can assess your living quarters to help make them safe, accessible, and easier to navigate with MS. The National MS Society offers resources for how to handle home modifications.
• Housekeeping help. Whether it’s from a friend, family member, or a professional maid service, don’t shy away from asking for cleaning help if you need it.
• Meal prep and food delivery. MS symptoms can affect your hands and ability to feed yourself. Have a food plan in place for days when cooking is not an option.
• Transportation. Doctor appointments, grocery store runs, even social outings: Plan for who can drive you where you need to go when you’re not able to take yourself.

Moving Forward With Multiple Sclerosis

Managing a chronic disease like MS take a team. But it also take patience and perseverance on your part to take care of the little things, so your multiple sclerosis treatment is more effective and your symptoms remain controllable. If you feel like you are doing all the right things, but your MS symptoms are still interfering with daily life, talk with your doctor. Together, you can make changes to your treatment plan and work towards a solution.