Energy, thinking and mood
Fatigue
Tiredness that is out of proportion to what you have done, and that rest does not fully fix.
Still being checked
What this is
Fatigue in ALS/MND is not ordinary tiredness. Weakened muscles use more effort for the same task, so ordinary days cost more, and night-time breathing changes can add to it without you knowing. It is one of the most commonly reported symptoms and one of the least often treated, partly because it is easy to accept as inevitable. It is worth raising, because some of what drives it is treatable.
What people often describe
- Running out of energy partway through the day, earlier than you expect
- Everyday tasks costing far more than they used to
- Feeling you have to choose between the things you want to do
- Tiredness that a good night does not shift
Important distinctions
Broken sleep and fatigue are different problems that feed each other. If you wake unrested or with a headache, breathing during sleep is worth checking first.
A reduced drive to start things is a different problem from running out of energy, and the two can look alike from the outside. If that is what you or your family have noticed, it is worth raising separately.
What may help
This page lists options that are used for this problem and says where each one comes from. It is not a ranking, it is not a recommendation, and it is not personalised to you. What suits you is a decision for you and your care team.
Allied health
What a therapist can assess, teach or adjust.
Equipment
Devices and physical aids.
Procedures
Things done in a clinical setting, usually after a referral.
When to get this looked at sooner
New or unusual breathlessness, breathlessness when lying flat, disturbed sleep or daytime sleepiness should be reported to your ALS/MND team rather than treated only as a sign of having overdone it.
Who may help
Where Compass explains this
Questions
- What can help with fatigue and low energy?
- How can I plan and pace my activities?
- How do I balance activity, rest, and what matters to me?
- How can I tell if I am doing too much exercise?
Cards
Related
Other problems
Words explained
About this page
This page lists options that are used for this problem and says where each one comes from. It is not a ranking, it is not a recommendation, and it is not personalised to you. What suits you is a decision for you and your care team.
Evidence for this page
The sources behind the statements on this page, and where to find them. Compass does not decide which option is right for anyone.
Statement 1 of 5. Planning and pacing activity, prioritising what matters, resting before you are exhausted, and using equipment to save effort. This is the main approach, and an occupational therapist is who teaches it.
Supports this. Guidelines for the physiotherapy management of MND — Irish Motor Neurone Disease Association · Clinical guideline · 2014
An MND physiotherapy guideline recommends teaching energy conservation techniques, on the basis that pacing may reduce levels of fatigue.
“Teaching energy conservation techniques may encourage patients to pace themselves and reduce levels of fatigue (4).”
Section 3.4e Fatigue Management, recommendation GGLink checked August 2026
Statement 2 of 5. Some gentle activity within comfortable limits helps, guided by a physiotherapist. The balance matters: too much makes fatigue worse, and feeling weaker afterwards is the signal to ease off.
Qualifies this. NeuroPT exercise fact sheet — NeuroPT · Practical guide
A neurologic physical therapy fact sheet names fatigue and feeling weaker after exercise as signs of exercising too hard, which is the limit this option sits inside.
“Be mindful of fatigue and feeling weaker after exercising, as these are signs of exercising too hard.”
Take-AwaysLink checked August 2026
Statement 3 of 5. Where night-time breathing is part of the picture, breathing support is what changes it, and better sleep is often what people notice first.
Supports this. Guidelines for the physiotherapy management of MND — Irish Motor Neurone Disease Association · Clinical guideline · 2014
An MND physiotherapy guideline reports that breathing support improves symptoms including poor quality sleep and headaches, and quality of life with them.
“Assistive devices such as NIV have been shown to improve hypercapnic symptoms such as headaches, restlessness, nightmares and poor quality sleep, and therefore improve QOL in patients with MND (Lou et al. 2010).”
Section 3.4e.2 Evidence, FFLink checked August 2026
Statement 4 of 5. Fatigue is on the list of symptoms teams monitor for breathing changes, so it is worth checking whether night-time breathing is part of it before treating it as fatigue alone.
Supports this. NICE MND guideline — NICE · Clinical guideline
NICE tells teams to monitor a listed set of symptoms and signs to detect respiratory impairment. Fatigue is among them.
“Monitor the symptoms and signs listed in table 1 to detect potential respiratory impairment.”
1.15.7Link checked August 2026
Statement 5 of 5. New or unusual breathlessness, breathlessness when lying flat, disturbed sleep or daytime sleepiness should be reported to your ALS/MND team rather than treated only as a sign of having overdone it.
Supports this. NICE MND guideline — NICE · Clinical guideline
Republished from the Compass answer "How can I tell if I am doing too much exercise?", where this statement is already mapped to this source.
“Monitor the symptoms and signs listed in table 1 to detect potential respiratory impairment.”
1.15.7Link checked August 2026