Sleep Problems and Multiple Sclerosis
Sleep plays an important role in your physical health and well-being. It supports healthy brain function, helps with healing and repair, regulates mood, reduces stress, and supports your immune system. The average adult needs seven to nine hours of sleep each day to function well. Yet many people - especially those with multiple sclerosis (MS) - do not get enough quality sleep.
People with MS often report sleeping poorly at night and feeling tired during the day. In the general population, the three most common sleep problems are insomnia, sleep apnea, and restless leg syndrome. Research shows that people with MS are even more likely to have all three.
Insomnia
Insomnia means having trouble falling asleep, staying asleep, or waking up too early. It is a significant problem for nearly 50 percent of people with MS at some point. In MS, insomnia can be caused by symptoms that happen at night, such as pain, muscle spasms, and the need to urinate frequently. Some medications can also contribute, including certain antidepressants (SSRIs), stimulants used to treat daytime fatigue, and corticosteroids used during MS relapses. Depression, which is common in MS, is also linked to insomnia.
Over-the-counter sleep medications may help occasionally, but if used often they tend to stop working and can leave you feeling foggy during the day. More effective approaches include adjusting your current medications, treating the MS symptoms that are disrupting your sleep, cognitive behavioral therapy for insomnia (a non-medication approach), and in some cases, prescribed sleep medications.
Sleep Apnea
Sleep apnea affects at least one in five Americans and likely an even greater number of people with MS. It causes you to repeatedly stop breathing during sleep. These pauses lead to broken sleep and low blood oxygen levels. If left untreated, sleep apnea is linked to poor daytime functioning, mood and memory problems, and serious heart and vascular conditions. It may also worsen fatigue, low energy, and daytime tiredness - all of which are already common in MS. Treating sleep apnea can reduce these risks and improve energy and alertness.
Restless Leg Syndrome
Restless leg syndrome (RLS) causes an uncomfortable urge to move your legs, usually in the evening or at night. Moving the legs temporarily relieves the feeling. RLS may affect up to one third of people with MS - about three times the rate seen in the general population. It is more common in those who are older, have had MS longer, have primary progressive MS, or have greater disability.
The exact cause of RLS is not fully understood, but it appears to be connected to how the brain uses iron. A blood test to check iron levels is a good first step, since replacing low iron can improve symptoms. Reducing caffeine, nicotine, and alcohol, massaging your legs, and taking warm baths before bed may also help. When these steps are not enough, medications are available.
Tips for Better Sleep
Good sleep habits - sometimes called sleep hygiene - can make a real difference in sleep quality. These tips are helpful for anyone, including caregivers:
- Keep a consistent schedule. Go to bed and wake up at the same time every day, including weekends.
- Use your bed only for sleep. Avoid watching TV, using your phone or computer, or eating in bed. This trains your brain to associate the bed with sleep.
- Create a relaxing routine before bed. Reading, taking a warm bath, or listening to calm music can help signal your body that it is time to wind down.
- Avoid stimulants. Cut off caffeine three to four hours before bedtime. If you smoke, avoid cigarettes and alcohol in the six hours before bed.
- Limit food and liquids before bed. Avoid large meals and reduce fluid intake three to four hours before sleep to cut down on nighttime bathroom trips. (See also: [Bladder Problems and MS] for more on managing urinary symptoms at night.)
- Keep your bedroom cool. A cooler room supports better sleep.
- Be careful with naps. If you nap, try to do so before 3 p.m. so it does not interfere with nighttime sleep.
- Limit screens before bed. Avoid computer and TV screens in the time before you go to sleep.
These habits can take practice. Give yourself time to adjust, and if you are still struggling after a few weeks, talk to your health care provider.
When to Talk to Your Provider
If you are experiencing poor or unrefreshing sleep, discuss your symptoms with your provider so they can arrange appropriate testing and treatment. While sleep problems may not resolve completely, most people experience real improvements in daytime functioning and well-being with the right treatment.
Based on articles by Eilis Boudreau, MD, PhD; Michelle Cameron, MD, PT, MCR; and Jason Malcom, MSW.
