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| Part of the Relapsing MS Playbook series |
Tips for Managing MS Sleep Problems
Dr. Jacqueline Nicholas provides some tips for managing sleep problems for those living with MS. Sponsored content appears before this video.
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Dr. Jacqueline Nicholas
In my experience, my patients will commonly tell me that either their sleep is a major issue or they're just not getting good sleep.
00:00:13:07 - 00:00:42:00
Dr. Jacqueline Nicholas
A common question is: How can sleep be affected by MS? Sometimes if they have anxiety, muscle spasms that can occur at night that wake somebody up, or bladder difficulties, there are many things that can be done for this to help somebody get excellent rest at night. A few tips for managing sleep problems include shutting off screens and phones, and trying to have a routine before bed.
00:00:42:00 - 00:01:05:04
Dr. Jacqueline Nicholas
It can be very helpful to do some brief stretching exercises before falling asleep to help minimize spasms, or interruptions, and some people may need to take a medication that relaxes muscles at nighttime to help prevent those spasms. As far as bladder issues that could wake somebody up at night, making sure to empty your bladder right before you go to bed,
00:01:05:06 - 00:01:28:02
Dr. Jacqueline Nicholas
minimizing caffeine or alcohol use because that can make you need to go to the bathroom more frequently, and then some people will need to take medications to help keep their bladder from being overactive at night. So it's very dependent on the individual and their own problems, but the great news is there are lots of things we can do to help.
Living with multiple sclerosis (MS) can make getting a good night’s sleep a nightly challenge. Many MyMSTeam members report having insomnia, making sleep disturbances a common and frustrating aspect of MS. One member added, “Between leg cramps, muscle twitches, and neuropathic pain, it’s no wonder I don’t sleep well.”
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 rest. A neurologist specializing in neuroimmunology and MS, Dr. Nicholas is the 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 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.”
This article explains why sleep disturbances are common symptoms of MS and offers tips to help improve your sleep quality.
Why Sleep Problems Occur in MS
Sleep disruptions are not just an inconvenience — they’re a significant issue for people with MS. Research shows that about 60 percent of people with MS experience sleep problems, including:
These sleep challenges can stem from MS-related symptoms such as muscle spasms, neuropathic pain, and neurological changes. Researchers believe that lesions caused by MS attacks on the brain or spinal cord may contribute to sleep issues, which would help explain why sleep disorders are so common in people with MS.
Sleep disturbances also cause daytime sleepiness, feelings of confusion, and reduced problem-solving abilities.
Tips for Better Sleep With MS
Because MS can affect sleep in so many ways, Dr. Nicholas recommended finding effective strategies to manage symptoms and get better sleep.
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 boost cognitive function (thinking and memory) and quality of life in people with MS.
You can also try a few tips to get better sleep. Always discuss your sleep concerns with your doctor, and consult them before making any significant changes to your sleep routine, treatment plan, or lifestyle.
Although it might seem like the last thing you want to do when you’re tired, being physically active can improve sleep and reduce MS-related fatigue.
“The most impactful thing we can do for fatigue is to make sure someone is exercising,” Dr. Nicholas 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.”
There’s no one-size-fits-all approach to movement — physical activity can take many forms. “Exercise doesn’t have to mean going to the gym or running several miles,” Dr. Nicholas said. “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.”
Stay active throughout the day, but avoid too much movement right before bed. Ask your doctor about safe exercises you can try.
Another tip for overall better sleep is to improve your sleep hygiene by establishing a bedtime routine and maintaining a consistent sleep schedule — try to fall asleep and wake up around the same time each day.
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.”
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. “I’m sweating at night and freezing all day,” a member shared.
In addition to keeping your bedroom cool, choosing the proper pillows and blankets may provide more comfort, especially for those with MS-related pain in the shoulders or neck and jaw. Firm, supportive pillows can help keep your neck and back properly aligned. Many MyMSTeam members also recommend weighted blankets, which sometimes have cooling features to prevent overheating at night: “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.”
MyMSTeam members have also offered these suggestions:
Medications and nonpharmacological treatments may be available to help. The U.S. Food and Drug Administration (FDA) hasn’t approved any therapies specifically for sleep disorders related to MS, but your doctor will choose the medication based on your symptoms and sleep problem. Talk with your doctor about your options.
Research has shown that melatonin can act as an antioxidant and improve sleep quality in people with MS. A MyMSTeam member whose mother has MS mentioned using this supplement: “Melatonin really helps my mom fall asleep.”
Again, ask your healthcare team before taking supplements or OTC medications. Some may cause interactions with other drugs or make side effects worse.
Although some medications may help you sleep, 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.”
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.
Talk with your doctor if you’re unsure about the side effects of your current treatment regimen. They may recommend changing your dosing schedule to help you sleep better.
Sleep problems associated with MS may be a symptom of chronic depression or anxiety. “Sometimes anxiety or stress can impact someone’s ability to fall asleep or stay asleep,” Dr. Nicholas said. “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 contributes to your sleep issues, talk with your doctor. They can discuss options such as antidepressants or cognitive behavioral therapy, which has been shown to treat sleep disturbances linked to insomnia.
Nocturia, or the need to urinate frequently during the night, can also cause sleep disturbances in people with MS. Dr. Nicholas noted, “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 we can minimize those wake-ups. Some people have spasms in their muscles, and so we want to focus on treating that so they sleep better.”
If you go to the bathroom a lot throughout the night, tell your healthcare provider. They can help you explore treatment options and may refer you to a continence adviser.
If you’re having a hard time falling asleep in the first place, don’t force it. It may be helpful to get up and try a relaxing activity that isn’t too stimulating, like sitting in a quiet room or reading. You could also try relaxation or meditation techniques.
The Multiple Sclerosis Association of America recommends getting out of bed if you haven’t fallen asleep in the first 20 minutes. Once you feel sleepier and ready for bed again, try thinking about enjoyable memories or doing parts of your bedtime routine.
It may be beneficial to track your sleep patterns and habits in a sleep diary. Each day, note:
A sleep diary can help you remember more details and make it easier to describe your sleep patterns to your doctor. To help you remember everything you need to discuss, you can get customized questions to ask at your next appointment.
Sleep doesn’t have to be a constant struggle with MS. By implementing a few strategies and working closely with healthcare professionals, you can improve your sleep quality and overall well-being.
On MyMSTeam, people share their experiences with multiple sclerosis, get advice, and find support from others who understand.
What strategies do you use for a better night’s rest? Let others know in the comments below.
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I just completed two 2, sleep studies, and found out I suffer from both forms of sleep apnea. My brain won’t tell my body to breath, nor will my body do so on it’s own. So, I am waiting for the doctor… read more
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