Exacerbation, flare, relapse: the real deal or just a "pseudo"?

It took  me several years to learn the difference between a real exacerbation (aka flare or relapse) and a "pseudo" exacerbation. In case you are in the dark, here you go [according the the National MS Society]:

Exacerbation
The appearance of new symptoms or the aggravation of old ones, lasting at least twenty-four hours (synonymous with attack, relapse, flare-up, or worsening); usually associated with inflammation and demyelination in the brain or spinal cord.

Pseudo-exacerbation
A temporary aggravation of disease symptoms, resulting from an elevation in body temperature or other stressor (e.g., an infection, severe fatigue, constipation), that disappears once the stressor is removed. A pseudo-exacerbation involves symptom flare-up rather than new disease activity or progression.

My thoughts: I believe stress and lack of sleep should be added to the "pseudo stressor" list. I guess lack of sleep could be lumped in with 'severe fatigue' however now that I have MS I see fatigue in a whole new way. There is a huge difference between 'lack of sleep' (aka tired or even extremely tired) and 'severe fatigue'. I can still function when I am tired or even extremely tired but I cannot function when I have what I would consider severe fatigue. I can hardly close my mouth to stop from drooling when I'm sitting on the couch trying to look alive.

Here are some good resources that better explain this topic. If you know of any others, please share.

This is a podcast where doctors discuss the differences between an exacerbation and a pseudo-exacerbation.

This is a PDF chart with guidance from one clinic about what to do when you think you're having an exacerbation.