Multiple Sclerosis Centers of Excellence
Common Sleep Disorders and Multiple Sclerosis
Eilis Boudreau, MD, PhD and Michelle Cameron, MD, PT, MCR
Sleep plays an important role in your physical health and well-being. Sleep supports healthy brain functioning, is involved in the healing and repair of your heart and blood vessels, regulates mood, reduces stress, and even helps your immune system defend your body against foreign or harmful substances. The average adult needs 7-9 hours of sleep each day to function well. Yet, many people do not get enough sleep.
People with MS often say they sleep poorly at night and are fatigued in the daytime. In the general population the three most common sleep problems reported are insomnia, sleep apnea, and restless leg syndrome (RLS). Research suggests that people with MS are even more likely to have all of these problems.
Insomnia is characterized by problems getting to sleep, problems staying asleep, or by waking up too early. Insomnia can have multiple causes and is a significant problem at some point for almost 50% of people with MS. Insomnia can be caused by MS symptoms that occur at night such as pain, muscle spasms, and urinary frequency, that then disrupt sleep. Medications, including some antidepressants (SSRIs), stimulants used to treat daytime fatigue, and corticosteroids used to treat MS relapses, can also contribute to insomnia. Depression, which is common in people with MS, is also associated with insomnia.
Although occasional self-medication of insomnia with over-the-counter sleep medications can help, if you use them often they’ll probably stop working and will also make you feel sleepy or foggy during the day. Many approaches can be effective for treating insomnia including adjusting your current medication regimen, addressing MS symptoms that are contributing to poor sleep, using non-medication cognitive behavioral therapy approaches, and, in resistant cases, using prescribed sleep enhancing medications.
Sleep apnea affects at least 1 in 5 Americans, and probably an even greater proportion of people with MS. Sleep apnea is characterized by repeatedly stopping breathing during sleep. These frequent pauses in breathing can cause fragmented sleep as well as low blood oxygen levels. Untreated, sleep apnea is associated with poor daytime functioning, mood, and memory problems and, if severe, cardiovascular disorders such as heart disease and stroke. Sleep apnea may also worsen fatigue, poor energy, and daytime tiredness, all of which are common in people with MS. Treatment of sleep apnea can reduce both the risks associated with sleep apnea and reduce fatigue, poor energy, and daytime tiredness.
Restless Leg Syndrome
Restless leg syndrome (RLS) is characterized by an uncomfortable urge to move your legs or, more rarely, other body areas, with the urge being temporarily relieved by moving the involved body area. RLS symptoms are generally worst in the evening or at night. RLS may affect up to 1/3 of individuals with MS and is three times more common in people with MS than in the general population. In people with MS, RLS is more common in those who are older, have had MS for longer, have primary progressive MS, and have greater disability. The exact cause of RLS is not known, but RLS appears to be linked with iron metabolism in the brain. Checking for low iron levels with a blood test, and replacing iron when low, can improve symptoms. Decreasing the intake of caffeine, nicotine, and alcohol, massaging your legs, and taking warm baths before bedtime may decrease RLS symptoms. When these interventions fail, medications to treat RLS symptoms are available.
In summary, sleep problems such as insomnia, sleep apnea, and RLS are common and are more common in people with MS than in the general population. These sleep problems may be troublesome on their own and may contribute to daytime fatigue, poorer quality of life, and may be associated with greater disability. Fortunately, treatments are available for the most common sleep problems. If you have poor quality, unrefreshing sleep, discuss your symptoms with your provider so they can initiate appropriate testing and treatment. Good sleep practices, such as keeping a regular bedtime and wake time, protecting your sleep time from other activities, setting up your bedroom only for sleep, and limiting caffeinated beverages can also help. While sleep related symptoms may not completely resolve with treatment, most people experience substantial improvements in daytime functioning and an improved sense of well-being with treatment.