Coping With Brain Fog and Fatigue

"I just read that last chapter, why can’t I remember what happened?"
"I’ve never missed a deadline and I just forgot a major one!"
"I feel like I’m slogging through thick pudding. I just can’t focus."

Do those thoughts sound familiar? Brain fog and fatigue are two very common symptoms of neuromyelitis optica spectrum disorder (NMOSD). Brain fog is the feeling of being unable to concentrate and access words or thoughts. It is when you are not able to maintain your typical level of organization because of a dense mental fog. Fatigue is a bone-deep weariness in which you struggle to function. Both of these often occur during flares.1-3

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Why do brain fog and fatigue happen?

Research has shown that chronic inflammation can cause changes in the brain. Brain fog and fatigue are related to ongoing inflammation in the body, as inflammation disrupts communication and processing. Other reasons for brain fog and fatigue might be a lack of good, consistent sleep and poor nutrition.1,3

Pain and stiffness also can make it difficult to sleep, which can lead to increasing levels of fatigue. Exhaustion can actually make pain and inflammation worse, so the cycle of pain and fatigue keeps going.1-3

Depression is another cause of fatigue and brain fog. Depression can interfere with sleep and decrease energy levels. Those with chronic illnesses, including NMOSD, are more likely to experience depression.1-3

Talk with your doctor

When you experience brain fog and fatigue, the first thing to do is talk with your doctor. When your NMOSD is not well controlled and you are having flares, you are more likely to have symptoms of brain fog and fatigue.1-3

Your doctor may order blood work to test for low iron levels (anemia) or thyroid issues, as these can also contribute to fatigue. Next, your doctor may recommend certain medicines. If you do have anemia or a thyroid issue, your doctor will prescribe a medicine to help you regain the correct levels.1-3

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Your doctor also may recommend vitamins or changes in diet to help address any nutritional gaps. You may also be prescribed a sleeping aid to help you get better, more consistent sleep. Occasionally, medicines to treat depression that increase energy may also help.1-3

Your doctor will also look at what drugs might help to prevent flares so that your disease is better controlled overall, which can reduce brain fog and fatigue. Make sure to review your current medications with your doctor to see if any of them could be contributing to these symptoms.1-3

Tips to help manage brain fog and fatigue

There are several ways you can adapt your lifestyle to help manage brain fog and fatigue:

Sleep routine

Develop and maintain a consistent sleep routine. Wake and go to sleep at the same time every day, including weekends and holidays. Keep your bedroom as a dedicated space for sleep so your body knows that it is the space where you rest. Read, watch TV, and surf the internet from somewhere else in your living space.1-3


Make regular time for exercise so it becomes part of your routine. Exercise can help tire you out for sleeping, strengthen the muscles that support your joints, and reduce inflammation. Yoga and walking are good low-impact exercises that can give you good exercise without causing joint pain. Start slow and build up your ability and endurance.1-3

Record your patterns

When you experience brain fog or fatigue, make a note of it. Write the day, the time of day, and what you were doing to see if any patterns emerge. Share these with your doctor so that together you can brainstorm ways to manage those trouble times.3

Create an organization system

Find what works for you to help you stay organized and on top of your appointments and deadlines. This may be a planner, alarms, alerts, a white board calendar, checklist, or other method. Based on your identified patterns, schedule activities that require brain power at the times you are less likely to experience brain fog.3

Take your time

Rest when you need to. Ask for help. Say “no” or postpone plans if your body does not feel up to them. Avoid situations with lots of stimulation, as they can tax your brain and make the brain fog worse.2,3

Engage in mindfulness

Practicing meditation or taking a yoga class can help you focus and clear your mind.2,3

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