The Decision Fatigue of Living with Chronic Illness — and How to Manage It

It’s easy to feel overwhelmed by the sheer number of decisions we have to make daily. Creating routines and preserving your energy can help.

What should I wear today? What should I make for breakfast? What should I pack for the kids’ lunch? What route should I take to the office? Should I make those phone calls in the morning or the afternoon? Should I stop for gas today or tomorrow? When should I work out? What should I make for the potluck? What color should I paint the living room?

If you’re exhausted just reading this list, consider this: These are just a small fraction of the decisions adults face in their everyday lives. In fact, adults make an average of 35,000 decisions a day.

Throw a chronic illness into the mix, and you’re sure to be making many more — and feeling the burden even more acutely. I’ve been making health-related decisions daily for the last 20 years, ever since I experienced my first symptom of multiple sclerosis (MS). It worsens my fatigue and leaves me feeling burnt out.

No wonder so many of us feel the weight of what experts call decision fatigue.

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Defining decision fatigue

According to the American Medical Association (AMA), decision fatigue is “a state of mental overload that can impede a person’s ability to continue making decisions.” The more choices someone has to make, the more likely they’ll take shortcuts in their decision making.

In a review of literature, researchers compared decision fatigue to muscle fatigue after exertion; in both cases, an individual depletes internal resources with repeated use.

As someone with MS, I have experienced my cognitive resources being depleted after making many back-to-back decisions. When this happens, I take a break before making further choices — just as someone working out needs to rest between sets.

Decisions come in many varieties

While I was searching for a diagnosis, I had to continuously decide which doctor to see next and which testing to undergo. After my diagnosis, I had to weigh the risks and benefits of the various available treatments and decide which was best for me.

I had to determine which lifestyle changes to adopt. Should I change my diet? Should I switch up my exercise routine? Should I modify when, where, and with whom I socialize?

Now, 7 years later, I continue making health-related choices that affect my everyday life because very few, if any, of these are one-and-done.

When I’m faced with a difficult decision, I weigh the pros and cons and often talk through my thought process with a trusted family member or friend.

Some decisions are easier to make than others. When decisions have the potential to affect my safety — like whether a distance is too far to drive independently due to leg fatigue — I err on the side of caution and ask for help. When safety plays a role, it’s easier to feel confident in my decision.

With any decision, though, I try not to second-guess myself, as that only adds another layer to my process and to my overall decision fatigue.

Flares complicate decisions

When I’m in an MS flare, my ability to make decisions diminishes further because I feel more pressure to make good choices.

Knowing that my decisions may affect the coming days or my disease process can create additional stress. I worry that a poor choice could lead to further physical worsening or an inability to return to my baseline.

Furthermore, when I’m overly fatigued, making decisions can feel impossible — in these moments, I feel stuck. But there’s more than one way out.

Simplify decisions for less fatigue

Abbey Sangmeister, MS, Ed., LPC, a counselor and burnout coach experienced in helping people with chronic illness, noted that decision fatigue can result from attempting to complete everything on a to-do list at once. The resulting stress can also lead to a disease flare.

Sangmeister recommends simplifying choices when you can by creating routines for such everyday tasks as wardrobe and meal planning.

For example, I find that choosing an outfit the night before is less complicated (and less rushed) than trying to decide in the morning. And it’s almost always easier to make a decision without time constraints.

Some people may even want to designate specific outfits for certain days of the week, to reduce the need for decision making even further.

Similarly, you may want to create a meal routine: Meatless Monday, Taco Tuesday, or whatever your family likes. That way, you won’t have to decide on seven new meals every week.

Pace yourself

Sangmeister also suggests thinking about your future self: How will you feel later if you make too many decisions repeatedly?

To avoid the stress of making multiple decisions at once, save the less important ones for later. Spreading decisions out this way can prevent you from becoming burnt out and unable to decide at all.

And rather than attempting to complete everything on your to-do list, give yourself permission to rest — even on days when you feel your best — so that you can recharge.

Additional tips for reducing decision fatigue

Sangmeister also recommends the following strategies to prevent decision fatigue:

• Create lists of food you’ll need for upcoming meals. Doing this ahead of time eliminates the pressure of having to decide at the grocery store.
• Create lists of anything you need to remember to do; this leaves more cognitive space for you to make decisions smoothly.
• Delegate decisions to other family members as much as possible so you can preserve your energy and keep fatigue at bay.
• Limit how much time you spend with social media, news, and even other people. Consuming too much, comparing yourself to others, and having negative energy around you can use up mental and emotional energy. This can deplete your cognitive resources and add to the stress of making decisions — and even make you question your decision making capabilities.
• Set reminders on your phone for self-care, as this can help prevent feeling overwhelmed when the need to make decisions arises.

Mental health matters, too

Sangmeister recommends having a mental health provider in addition to your physical health team.

“I’d suggest not waiting for signs of decision fatigue [before you] start working with a mental health professional to help you build a strong foundation,” she says. Having a plan in place can prevent you from falling into the depths of decision fatigue in the first place.

The takeaway

Those of us with MS may feel the burden of having to make many decisions. Taking time for self-care, planning, and creating routines can help. Mental health providers can also help with reducing decision fatigue.

I make the best decisions I can with the information I have. I ask family for help when I’m struggling to decide on my own, and I remind myself that decisions aren’t permanent — treatments can be changed, and diet and exercise routines can be altered as needed.