People with multiple sclerosis (MS) often spend their nights dealing with sleep disturbances. Inadequate sleep can worsen fatigue, another common symptom of MS.

MyMSTeam talked with Dr. Jacqueline Nicholas to find out what causes problems with sleep in people with MS and which strategies can help them get a better night’s sleep. Dr. Nicholas is a neurologist specializing in neuroimmunology and MS. She’s currently director of MS research at the OhioHealth Multiple Sclerosis Clinic in Columbus, Ohio.

“My patients will commonly tell me that either their sleep is a major issue or they’re just not getting good sleep,” Dr. Nicholas said. “The good news is that there are things that we can do to help when we know about it. It’s very dependent on the individual and their problems, but we can work with our patients to help them get good rest at night.”

MS is a chronic disease of the brain and spinal cord, which make up the central nervous system (CNS). Symptoms vary among people with MS, but motor and cognitive problems are among the most common, along with sleep disturbances. “Between leg cramps, muscle twitches, and neuropathic pain, it’s no wonder I don’t sleep well,” one MyMSTeam member said.

Sleep disturbances also cause daytime sleepiness, feelings of confusion, and reduced problem-solving abilities. Finding ways to improve sleep is important for your overall quality of life.

People with MS can also have problems with heat and cold sensitivity as well as sweating, which may manifest as night sweats. “I’m sweating at night and freezing all day,” a member shared. Another asked, “Do you wake up in the night sweating and having to pee? Then after you relieve yourself, the sweating subsides?”

Since MS can affect sleep in so many ways, Dr. Nicholas recommended finding effective strategies to manage those symptoms and get better sleep.

“If somebody tells me they’re getting up five times a night to empty their bladder and then they can’t fall back asleep, we want to focus on bladder management so that we can minimize those wake-ups,” she said. “Some people have spasms in their muscles, and so we want to focus on treating that so they sleep better.”

Make your MS specialist your partner in managing your symptoms. Start by getting customized questions to take with you to your next doctor visit.

About 60 percent of people with MS have a sleep disorder, such as:

• Insomnia
• Nocturia (frequent urination at night)
• Sleep-disordered breathing (also known as sleep apnea)
• Rapid eye movement (REM) sleep behavior disorder
• Narcolepsy
• Circadian rhythm disorder
• Restless legs syndrome

Researchers believe it’s possible that when MS attacks cause lesions on specific parts of the brain or spinal cord, the damage may contribute to the development of sleep disorders. This would help explain why sleep disorders are so common in those with MS.

Standard treatments for sleep disorders can improve fatigue and other clinical outcomes in people with MS. Interventions that focus on improving sleep may also help improve cognitive function (thinking and memory) and quality of life in people with MS.

The following strategies may help people with MS reduce sleep issues.

Get More Physical Activity During the Day

Although she admits it might sound odd, Dr. Nicholas highly recommends exercise as a way to improve sleep and fatigue.

“The most impactful thing we can do for fatigue is to make sure someone is exercising,” she said. “I know that sounds crazy when somebody says that they feel tired, and then your doctor tells you to exercise. But exercise is important. Exercise doesn’t have to mean going to the gym or running several miles. It could be chair exercises for five minutes while watching a TV show or taking a break from work and walking a short distance. It really is dependent on the person, but there are many ways to incorporate that in somebody’s life and help impact fatigue.”

Adopt Good Sleep-Hygiene Practices

Another tip for getting overall better sleep is to improve your sleep hygiene by establishing a bedtime routine and maintaining a consistent sleep schedule. Dr. Nicholas shared a few good habits to adopt.

“Shutting off screens and phones and trying to have a routine before bed can give you an easier time falling asleep at night,” she said. “It can be very helpful to do some brief stretching exercises before falling asleep to help minimize spasms.”

Think About Which Drugs You Take at Night

While some medications may help you sleep at night, others can make it harder to get a good night’s rest.

“Some people may need to take medication that relaxes muscles at nighttime to help prevent spasms,” explained Dr. Nicholas. “Some people will need to take medications to help keep their bladder from being overactive at night.”

On the other hand, Dr. Nicholas recommended avoiding caffeine, alcohol, and nicotine around bedtime. These substances make it more likely that you’ll need to get up to urinate during the night.

If you take prescribed medications at night, consider whether any of them might have side effects that contribute to poor sleep. Talk to your doctor if you’re unsure about the side effects of your current treatment regimen. They may also change your dosing schedule to help you sleep better.

Keep Your Bedroom Comfortable

Sometimes, it may be difficult to get comfortable at night. Finding the right position while lying down can be complicated by mattresses, pillows, and blankets that don’t suit your needs. Many people with MS are also sensitive to temperature, especially heat.

In addition to keeping your bedroom cool, choosing the proper pillows and blankets may provide more comfort. Firm, supportive pillows can help keep your neck and back aligned. Many MyMSTeam members also recommend weighted blankets, which sometimes have cooling features to prevent overheating at night.

MyMSTeam members have also offered these suggestions:

• “Memory foam pillows work for me.”
• “I use a heating pad on my lower back, with a pillow under my knees. For my head, I use a pillow that helps my neck and back align.”
• “I’ve been using a bamboo pillow for years, and I love it. It’s just enough firmness and softness at the same time.”
• “Update — got my cooling weighted blanket. I not only tolerate it very well, but I really like it. It prevents me from overheating and helps a bit with the spasticity.”

Read about causes of pain in the shoulders or neck and jaw with MS.

Find Ways To Boost Mood and Reduce Stress

Sleep problems associated with MS are sometimes a symptom of chronic depression or anxiety. Depression frequently occurs with MS, and the symptoms may seem to blur together, especially when you’re under stress. Luckily, you can take steps to manage mental health symptoms, too.

“Sometimes anxiety or stress can impact someone’s ability to fall asleep or stay asleep,” Dr. Nicholas pointed out. “Managing mood and stress can really help somebody to get better sleep, and then they feel so much better during the day.”

If you believe that depression, anxiety, or stress is contributing to your sleep issues, talk to your doctor. They can discuss options including antidepressants or cognitive behavioral therapy (CBT), which has been shown to treat sleep disturbances associated with insomnia.

Try Sleep Medications or Supplements

Sleep medicines are another possible remedy for sleep disturbances. Although the U.S. Food and Drug Administration (FDA) hasn’t approved any therapies specifically for treating insomnia related to MS, your doctor may prescribe a medication off-label (not for its stated use). Talk to your doctor about your options and whether they’re a good choice for you.

Over-the-counter (OTC) medications can also be taken for their sedating effects. Antihistamines such as Benadryl (diphenhydramine) are often used by people with MS.

“It’s almost midnight here … and I have trouble falling asleep,” wrote a MyMSTeam member. “To help me fall asleep, I take diphenhydramine or some other kind of sleep aid.”

Research has shown that melatonin can act as an antioxidant and improve sleep quality in people with MS. “Melatonin really helps my mom fall asleep,” a MyMSTeam member shared about their mother, who has MS.

Again, ask your health care team before taking supplements or OTC medications, some of which may cause interactions with other drugs or worsen side effects.

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 211,000 members come together to ask questions, give advice, and share their stories with others who understand life with MS.

How has MS affected your sleep? What strategies do you use for a better night’s rest? Share your experience in the comments below, or start a conversation by posting on MyMSTeam.