Research has also shown that sleep disorders such as sleep apnea and restless legs syndrome are more common in people with MS. In fact, one Spanish study published in June 2021 in the journal Neurología showed that people who were older than 55, were more disabled, or had secondary-progressive MS had an especially increased risk for a sleep disorder. But not all sleep problems in people with MS are directly or even indirectly caused by MS. Pain or anxiety from any source, or just poor sleep habits, can interfere with sleep quantity and quality. Since getting adequate sleep improves your quality of life generally and can help you live better with the effects of MS, “Speak with your medical care provider about sleep issues,” recommends Kathy Costello, NP, an adult nurse practitioner and vice president of programs at Can Do MS, a nonprofit organization that provides health and wellness services to people with MS and their families. Don’t rely on over-the-counter medication or figure it’s something you just have to live with, Costello advises. “Self-management is important, but asking for help is equally important," Costello says. A medical evaluation can help determine what’s causing your sleep problems and the best way to resolve them. Here are some of the most common underlying sleep issues in people with MS. RELATED: 12 Ways to Fight MS Fatigue
Pain of Any Type Can Awaken You
“Any type of pain can interrupt sleep — whether MS-related or other pain,” says Costello. “MS pain that commonly interferes with sleep is neuropathic pain — often described as burning, shooting, searing, or deeply aching. This pain can be relentless and is often worse at night.” Musculoskeletal pain can occur from a compensatory gait pattern (due to leg weakness or foot drop). Sometimes a change in gait can produce back or hip pain that may interfere with sleep, says Costello. “Poor seating for those people with MS who spend a lot of time seated can produce pain in the back, hips, neck, and legs that can be more bothersome at night,” she adds. Spasticity — which can cause chronic muscle tightness or sudden, sporadic contractions of a muscle or muscle group — will cause pain, and the pain from sporadic spasms can cause multiple interruptions to your sleep cycle, frequently waking you. This type of fragmented sleep can leave you feeling exhausted in the morning. “Nighttime or nocturnal spasms are common in MS, and it is important to let your MS provider know if you are experiencing this symptom, as it is treatable,” says Costello. Your MS doctor may prescribe medication, rehabilitation exercises, or a combination of both to help get a handle on spasticity so that you can sleep more soundly. According to Costello, “An evaluation of the bladder by a MS-knowledgeable urologist can be very helpful, as there are different types of bladder problems in MS that can produce symptoms, including some that are more disruptive at night.” If overactive bladder is determined to be the cause of your nocturia, your urologist can recommend a number of treatments for it, including various types of medication, Botox injections, or electrical nerve stimulation, also known as neuromodulation therapy. Also ask your doctor how much fluid you should be drinking and when. Don’t limit fluids so much that you become dehydrated, but do create a plan to taper off fluid intake before bedtime. RELATED: Pelvic Floor Physical Therapy for MS: Help for Bladder, Bowel, and Sexual Function
Restless Legs Syndrome a Common Cause of Sleep Problems
Restless legs syndrome (RLS) is one of the most common sleep disorders for people with MS. The urge to move the legs and the unpleasant sensations that accompany this urge typically occur at night or when legs are at rest. “RLS may be related to abnormalities in neurotransmitters that help regulate muscle movements or in the part of the central nervous system that controls automatic movements,” says Michelle Drerup, PsyD, a sleep psychologist and director of behavioral sleep medicine at the Cleveland Clinic’s Sleep Disorders Center in Ohio. Dr. Drerup adds, “According to research, people with MS who have a more severe disease course and lesions in their cervical spinal cord are at a higher risk for having restless legs syndrome. In addition, medication used to treat MS may also cause or worsen these problems.” Your MS doctor may prescribe medication to help ease RLS symptoms so that you’re able to sleep without frequent interruption. Lifestyle approaches, including stretching exercises before bedtime and avoidance of caffeine, nicotine, and alcohol, may also help to reduce symptoms, says Drerup. RELATED: 8 Health Problems Linked to Not Getting Enough Sleep
Heat Complicates Both MS Symptoms and Sleep
MS symptoms can temporarily worsen if you’re overheated. In fact, the National Multiple Sclerosis Society says even a one-quarter or one-half-degree elevation in core body temperature can cause symptoms like Uhthoff’s phenomenon, or temporarily blurry vision associated with overheating. Heat can hamper a good night’s sleep as well, the Sleep Foundation says. If you’re sleeping in an environment that’s too hot, this can affect your body’s ability to regulate its internal temperature — which has consequences for both sleep and MS symptoms. “People with MS could have pain. They could have bladder issues. There’s a higher incidence of restless leg–type symptoms or restless leg syndrome, and that affects sleep in and of itself. So if you’re overheated, all those symptoms are going to be heightened, and that’s going to impact sleep potentially significantly,” explains Martin I. Belkin, DO, a neurologist at the Michigan Institute for Neurological Disorders in the Detroit metro area. How can you stay cool while getting some shut-eye? Dr. Belkin recommends sleeping in an air-conditioned environment and staying hydrated, as well as using cooling devices like neck wraps and cooling vests. And if you don’t have traditional air conditioning, he adds, using a fan can help. But when it comes to preventing heat from hampering your sleep, Belkin advises addressing underlying MS symptoms that can be worsened by heat. “The key is treating a lot of those underlying symptoms — making sure the pain is adequately treated, that coexisting restless leg syndrome or other sleep disorders are being treated, and that the bladder dysfunction is being treated. If you can treat those underlying symptoms that are worsened by the heat, then you can get better sleep,” he says. RELATED: Cooling Products for Multiple Sclerosis
Periodic Limb Movements in Sleep Can Also Affect Sleep Quality
People who have RLS frequently also have periodic leg movements in sleep (PLMS), sometimes called periodic limb movement disorder, but having PLMS does not automatically mean a diagnosis of RLS. PLMS is a rhythmic movement of the lower extremities, bending at the hips, knees, or toes during sleep. The constant movement can result in a less-than-ideal sleep cycle. Costello suggests working with your doctor to make sure that what you’re experiencing is in fact PLMS and not spasticity. PLMS is diagnosed by a full-night sleep study, or polysomnogram, which monitors your movement while you sleep, among other things, according to the Sleep Foundation. If you do have PLMS, there are drugs that can effectively treat the condition.
Sleep Apnea Is Serious but Treatable
Sleep apnea is characterized by snoring at night and excessive sleepiness during the day, and can be diagnosed by doing a sleep study. Sleep apnea can cause serious strain on the heart when untreated, so it is very important to be evaluated by a doctor if you’re experiencing symptoms associated with this condition. Treatment with a continuous positive airway pressure (CPAP) machine (a special breathing device and mask used while sleeping) or surgery may be necessary for moderate to severe cases. For people who snore but don’t have sleep apnea, or for those who have very mild sleep apnea, there are a few things you can do on your own to improve the flow of air to your lungs while sleeping, including the following:
Sleep on your side to keep your airways open.Avoid alcohol close to bedtime.Try over-the-counter nose strips to help keep the nostrils more open.Lose weight if you’re overweight.
RELATED: Could Sleep Apnea Be Causing Your Excessive Daytime Sleepiness?
Depression Worsens Insomnia and Vice Versa
Depression is common in people with MS, and it’s well known to disrupt sleep in different ways. According to the Sleep Foundation, it can cause difficulty falling asleep, difficulty staying asleep, unrefreshing sleep, and daytime sleepiness. But insomnia can also lead to or worsen depression, underscoring the importance of speaking to your doctor if you have either depression or persistent sleep problems. Depression can be treated effectively with psychotherapy, medication, or a combination of the two. For chronic insomnia, cognitive-behavioral therapy for insomnia (CBTi) is the gold standard for treatment, according to the American Academy of Sleep Medicine. This type of therapy teaches you how to relax your body, slow your mind, and get to sleep. It also limits the amount of time you spend awake in bed. RELATED: 12 Surprising Facts About Depression
Anxiety Prevents Falling Asleep
Feeling anxious can make it difficult to fall asleep, but there are ways to learn to “turn off” your brain. “The ‘brain dump,’ or constructive worry time, is a technique to help decrease anxiety and racing thoughts at night,” says Drerup. Set aside 10 to 15 minutes earlier in the day to write out worries and concerns that are likely to interfere with sleep. “At night, if you begin to worry, you can remind yourself that you have dealt with this problem already when you were at your problem-solving best and put it aside for the time being," she says. Even if your anxiety is caused by something you can’t change, such as the unpredictability of your MS symptoms, there are strategies that can help. Your MS doctor may suggest relaxation techniques, counseling, cognitive-behavioral strategies, or a support group as possible tools for helping you gain peace of mind and get the restful sleep you need. RELATED: How Mindfulness Can Reduce Stress and Improve Quality of Life for People With MS
Nervous System Damage
“Sleep is a fairly complex activity,” Costello says. “For many people, just addressing an individual problem is not necessarily going to do the trick. There may be other factors involved.” Because MS is a neurological condition, it may not be a single symptom preventing you from sleeping soundly — and it may take time to uncover and address all of the causes of disrupted sleep. If nothing seems to be resolving your sleep problem, your doctor may refer you to a sleep specialist to try to determine the root of the problem. During a session in a sleep lab, physicians can monitor your brain waves and breathing and gather other data to get an in-depth look at what’s happening when you sleep. Identifying any abnormalities can provide useful answers that can lead to proper treatment and an improved sleep pattern. RELATED: MS Has Taken Away My Tingles
Have a Pre-Bedtime Routine
“Create a ‘buffer zone,’ or a nightly evening routine before bedtime that lasts between 30 and 60 minutes and helps you unwind for the day and prepare for sleep,” says Drerup. In addition to powering down all electronics, an evening routine can include doing some yoga or gentle stretching, reading in a dim light, meditating, or writing in a gratitude journal, says Drerup. RELATED: MS Fatigue Is Real: Obvious, but Important
Create a Dark, Comfortable Environment
Make your bedroom environment quiet, dark, and cool so it’s conducive to sleeping. “As much as possible, you want the bedroom to be reserved for sleep and intimacy,” says Costello. Take out the TV, and put in room-darkening curtains. Turn your mattress if it feels worn, and invest in comfortable pillows. Adjust the thermostat so that you’re neither too cool nor too hot.
Establish a Sleeping Pattern
Go to bed at the same time every night. Wake up at the same time every morning. Programming your body to expect a certain schedule can help regulate your sleeping pattern. To prevent problems falling asleep or disrupted sleep, avoid eating a large meal right before bed, using any kind of nicotine, or drinking alcohol or caffeinated beverages close to bedtime. “Alcohol may make you feel drowsy, but it is a depressant, and after the initial drowsiness wears off, the nervous system rebounds and can be disruptive later on during the sleep cycle,” explains Costello.
Don’t Take Long Daytime Naps
Don’t take long naps in the afternoon. Settle for a catnap if you’re feeling fatigued — just long enough to feel rested, but not so long that you aren’t able to fall asleep at bedtime. RELATED: The Many Varieties of MS Fatigue
Try a Relaxation App
Consider trying a relaxation app to help put you to sleep. Here are some options:
Pzizz ($9.99 per month), for example, plays a combination of music and voice for any length of time you choose to help put you to sleep.Relax Melodies ($59.99 per year) also plays soothing music and other sounds, with optional meditation and movement modules to induce sleep.Headspace ($12.99 per month, or $69.99 per year) has a library of more than 500 meditations, and also offers music, sounds, and wind-down exercises to help you drift off to sleep.And the free app White Noise Lite plays sounds of ocean waves, thunder, rain, and similar noises. The basic versions of these apps are free and available for both iOS and Android devices.
Additional reporting by Susan Jara and Christina Vogt.
