Living with NMOSD means learning how to combat decision fatigue
I've learned that decision fatigue can be just as exhausting as physical symptoms
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After a long and exhausting day at work, I drove in silence, first picking up my daughter from camp and then my husband from his office. I knew the inevitable question was coming: “What should we do for dinner?”
When it did, I felt overwhelmed. It wasn’t that I didn’t want dinner. It was that I no longer had the mental energy to make another decision. After a day spent constantly weighing options, assessing my symptoms, and managing responsibilities, just choosing a meal felt like too much.
As someone living with neuromyelitis optica spectrum disorder (NMOSD), I’ve learned that decision fatigue can be just as exhausting as physical symptoms. In fact, some days the hardest part isn’t dealing with pain, numbness, fatigue, or uncertainty — it’s all the decision-making that occurs throughout the day.
The stress of decision fatigue
Every morning starts with a series of calculations. Which symptoms need attention and which can be ignored? Should I push through my plans or cancel them? Do I need to conserve energy now for something important later? And those are just the first decisions of my day.
From there come dozens more. Every choice requires an assessment of risk, energy, symptoms, and consequences. What many people don’t see is that living with NMOSD means constantly monitoring and managing an unpredictable condition. There is no autopilot. Even on good days, part of my mind is evaluating, adapting, and planning around what my body may or may not do next. The mental load is relentless.
By the time evening arrives, I’m not simply tired from work, family responsibilities, and the normal demands of daily life. I’m mentally exhausted from making hundreds of decisions, both big and small. The cumulative weight of those choices depletes the same cognitive resources I need to answer even the simplest question.
This is why, by the end of the day, being asked what to have for dinner feels like a crushing burden.
Decision-making impacts our emotional well-being
Each decision carries emotional weight because the consequences can feel significant. Making the wrong choice can mean worsening symptoms, unnecessary anxiety, and a difficult day. Over time, this creates mental exhaustion that I rarely share with others.
NMOSD treatment can add another layer of complexity. Medications such as high-dose steroids are well known for affecting mood, irritability, and emotional regulation, earning the nickname “‘roid rage.” When I find myself feeling impatient, emotional, or overwhelmed, it can be tempting to blame my medication alone. But the reality is often more complicated.
There is also another layer that people don’t often recognize: the emotional decisions. How much of my illness should I share with others? Do I explain why I am tired today? These are not medical decisions, but they consume my energy just the same.
Decision fatigue can make me feel irritable, anxious, emotionally drained, and less resilient to everyday stress. While medications may contribute to those feelings, the invisible burden of constantly managing a chronic illness is often an equally important factor.
Recognizing this has helped me be more compassionate with myself and understand that sometimes what I need is not a medication adjustment, but rest from the relentless task of making decisions.
Hitting pause throughout my day
Over the years, I’ve learned that reducing decisions can be a form of self-care. Establishing routines, such as planning meals in advance, helps reduce the number of decisions I need to make each day. The fewer nonessential decisions I must make, the more energy I can dedicate to the ones that truly matter.
I’ve also learned the importance of giving myself permission not to decide immediately. Not every choice requires an instant answer. Sometimes the healthiest response is to pause, gather information, and revisit the decision when my mind is clearer.
Decision fatigue is not a personal weakness. It’s a natural response to carrying a level of responsibility that most people don’t see. Managing a chronic illness requires constant awareness, adaptation, and judgment. That work is real, even when it is invisible.
Living with NMOSD has taught me that strength is not just about enduring symptoms. It’s also about navigating uncertainty every day and continuing to make thoughtful decisions despite limited energy. Some days that may mean making big choices about treatment or health. Other days it may simply mean deciding to rest without guilt.
And sometimes, the bravest decision of all is recognizing that it’s another pizza night.
Note: Neuromyelitis News 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 providers 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. The opinions expressed in this column are not those of Neuromyelitis News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to neuromyelitis optica spectrum disorder.
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