ALS and Fatigue

Amyotrophic lateral sclerosis (ALS) is a progressive disorder of the nervous system, which leads to the death of motor neurons, or nerve cells that control the voluntary muscles.

As the disease progresses, many patients experience fatigue, a symptom that can severely affect quality of life.

What causes fatigue in ALS?

Fatigue in ALS may be caused by the death of nerve cells. The muscles that no longer receive a nervous signal from the brain weaken or atrophy, which means that not only does that particular muscle not move, but all the muscles around it must work harder to try and pick up the slack. The faulty signaling from the brain can also cause muscles to spasm or cramp, which can lead to pain and fatigue.

Weakness of the muscles involved in breathing may make it difficult for patients to achieve restful sleep, which can contribute to fatigue.

Treating fatigue

There are some treatments available for fatigue, but only a few well-controlled studies to support one therapy over another. Amantadine, pemoline, and bupropion have been used to treat fatigue. Modafinil is a wakefulness-promoting agent approved for the treatment of excessive sleepiness associated with narcolepsy (a sleep disorder that causes fatigue).

Dietary supplements such as creatine may increase or preserve muscular strength, reducing fatigue.

Other therapies, such as supported treadmill walking, muscular exercise, and repetitive transcranial magnetic stimulation, have also been suggested as potential treatments for fatigue.

Strategies for managing fatigue

While some treatments may help reduce the severity of fatigue symptoms, many patients also benefit from coping strategies to reduce fatigue in their day-to-day activities. These include:

  • Learning how to make tasks easier by using assistive devices and seeing an occupational therapist to learn how to simplify daily tasks.
  • Stopping and resting often.
  • Alternating activities with rest periods.
  • Trying to establish a regular sleeping pattern.
  • Avoiding prolonged bathing in warm water, as it can make muscle fatigue worse. Be aware in extremely hot or cold weather.
  • Ensuring that enough food is eaten; it may be necessary to consult a dietitian.
  • Avoiding stress as much as possible.
  • Making living spaces as accessible as possible for daily activities; this might mean moving a bed or rearranging personal items so they require less energy to access.


ALS News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.