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MS and Sleep: Strategies for Battling Sleep Disturbances

Updated on May 06, 2022
Medically reviewed by
Evelyn O. Berman, M.D.
Article written by
Brooke Dulka, Ph.D.
Article written by
Emily Wagner, M.S.

People with multiple sclerosis (MS) often need strategies for battling sleep disturbances. More than 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 — also known as REM — sleep behavior disorder
  • Narcolepsy
  • Circadian rhythm disorder
  • Restless legs syndrome

MS is a chronic disease of the brain and spinal cord (also called the central nervous system). 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 is no wonder I don’t sleep well,” one MyMSTeam member wrote.

Inadequate sleep can worsen fatigue, another common and debilitating symptom of MS. According to the National Multiple Sclerosis Society, around 80 percent of people with MS report that they experience fatigue.

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

There are some effective ways to address sleep disturbances associated with MS. Be sure to speak with your health care provider before trying any new medications or treatments.

Strategies for Battling Sleep Disturbances With MS

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

Here are several strategies that can help people with MS reduce sleep issues.

Supplementing With Melatonin

Research suggests that levels of melatonin (a hormone that synchronizes circadian rhythms, or the sleep-wake cycle) are dysregulated in people with MS. Other research has shown that melatonin can act as an antioxidant and improve sleep quality in people with MS.

One treatment for MS, Rebif (interferon beta-1a), may help to normalize melatonin levels while reducing fatigue and increasing sleep efficiency.

Another study of melatonin supplementation over six months showed that it is effective in reducing inflammation and markers of oxidative stress in those with relapsing-remitting MS.

“Melatonin really helps my mom fall asleep,” a MyMSTeam member shared about her mother, who has MS.

Melatonin is considered safe with very mild side effects (which can include dizziness, headaches, and nausea). Always consult your doctor before beginning any over-the-counter supplements, including melatonin.

Pillows and Blankets

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, some of which come with cooling features to prevent overheating at night.

Other suggestions from MyMSTeam members include:

  • “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.”

Antidepressants for Sleep Problems Related to Depression

Sometimes, sleep problems associated with MS are a symptom of chronic depression. Depression frequently occurs with MS, and the symptoms may seem to blur together.

The best thing to do is to treat the underlying condition causing the unwanted symptoms. Thus, antidepressants may be one way to help alleviate sleep problems in people living with both depression and MS. Talk to your doctor about screening if you are concerned you may have depression, and ask whether taking an antidepressant might help you get a good night’s sleep.

Cognitive Behavioral Therapy for Sleep Disorders

Cognitive behavioral therapy (CBT) is a type of psychological treatment. CBT is all about changing unhelpful thoughts and behaviors, improving emotional self-control, and developing coping strategies. It can be done in group therapy settings or one-on-one therapy.

CBT can help treat many conditions, including depression, anxiety disorders, and even sleep disturbances. For example, CBT has been shown to treat sleep disturbances associated with insomnia. In another study, those with MS who were experiencing insomnia also participated in CBT. After CBT, the participants reported improvements in their insomnia, fatigue, and depression.

Other Tips for Better Sleep

Another tip for getting overall better sleep is to improve your sleep hygiene by establishing a bedtime routine and maintaining consistency in your sleep schedule. Before bed, consider creating a calming routine with activities like taking a warm bath or reading. Try to go to sleep at about the same time every night and wake up around the same time every morning.

Avoid using electronics in the bedroom about an hour before bedtime. Additionally, dim the lights, as higher light exposure can decrease the natural melatonin secretion that you need for sleeping.

You can also try to avoid caffeine, alcohol, and nicotine, particularly around bedtime. If you take medications at night, consider whether any of them might have side effects that contribute to poor sleep. Talk to your doctor if you are unsure about the side effects of your current treatment regimen — they may also change your dosing schedule to help you sleep better.

Sleep medicines are another possible remedy for sleep disturbances. Although there are currently no FDA-approved therapies specifically for treating insomnia related to MS, your doctor may prescribe you a medication off-label. Talk to your doctor about your options and whether they’re a good choice for you.

Over-the-counter 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.”

Again, ask your doctor before taking over-the-counter medications, some of which may cause interactions with other drugs or worsen side effects.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 185,000 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, and 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.

References
  1. Sleep Disorders in Patients With Multiple Sclerosis — Sleep Medicine Reviews
  2. Multiple Sclerosis (MS) and Sleep — Sleep Foundation
  3. Fatigue and Sleep Disturbance in Multiple Sclerosis — European Journal of Neurology
  4. Quality of Life in Patients With Multiple Sclerosis — Journal of Neurological Sciences
  5. Fatigue — National Multiple Sclerosis Society
  6. Sleep Issues — Multiple Sclerosis Association of America
  7. Sleep Disorders in Multiple Sclerosis — Current Neurology and Neuroscience Reports
  8. Sleep and Its Association With Perceived and Objective Cognitive Impairment — Journal of Sleep Research
  9. Melatonin Dysregulation, Sleep Disturbances and Fatigue in Multiple Sclerosis — Journal of the Neurological Sciences
  10. Melatonin Acts as Antioxidant and Improves Sleep in MS Patients — Neurochemical Research
  11. Efficacy of Melatonin on Serum Pro-inflammatory Cytokines and Oxidative Stress Markers — Archives of Medical Research
  12. The Safety of Melatonin in Humans — Clinical Drug Investigation
  13. Keeping Cool: Use of Air Conditioning by Australians With Multiple Sclerosis — Multiple Sclerosis International
  14. Depression in Multiple Sclerosis — Multiple Sclerosis Journal
  15. Cognitive Behavioral Therapy — Mayo Clinic
  16. Effect of Digital Cognitive Behavioral Therapy for Insomnia — JAMA Psychiatry
  17. Outcomes of Cognitive-Behavioral Treatment for Insomnia — International Journal of MS Care
  18. Sleep Timing, Sleep Consistency, and Health in Adults — Applied Physiology, Nutrition, and Metabolism
  19. Hypnotic Use and Fatigue in Multiple Sclerosis — Sleep Medicine
All updates must be accompanied by text or a picture.
Evelyn O. Berman, M.D. is a neurology and pediatric specialist and treats disorders of the brain in children. Review provided by VeriMed Healthcare Network. Learn more about her here.
Brooke Dulka, Ph.D. is a freelance science writer and editor. She received her doctoral training in biological psychology at the University of Tennessee. Learn more about her here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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