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MS and Sleep: Managing Night Sweats, Insomnia, and More (VIDEO)

Medically reviewed by Federica Polidoro, M.D.
Updated on May 15, 2024
Part of the Relapsing MS Playbook series

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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.”

7 Tips for Managing MS Sleep Problems
1:28
Dr. Jacqueline Nicholas provides some tips for managing sleep problems for those living with MS. Sponsored content appears before this video.

Transcript

00:00:00:00 - 00:00:13:05
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 includes 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.

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MS Muscle Cramps and Night Sweats Can Interrupt Sleep

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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?”

Managing MS Symptoms May Help Improve Sleep

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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.

Does MS Cause Insomnia or Sleep Apnea?

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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.

Certain Strategies May Ward Off Sleep Disturbances With MS

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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.

    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: The Impact of Fatigue and Depression — Journal of Neurological Sciences
    5. Fatigue and Multiple Sclerosis — National Multiple Sclerosis Society
    6. Sleep Issues — Multiple Sclerosis Association of America
    7. Autonomic Dysfunctions in Multiple Sclerosis: Challenges of Clinical Practice (Review) — Experimental and Therapeutic Medicine
    8. Sleep Disorders in Multiple Sclerosis — Current Neurology and Neuroscience Reports
    9. Sleep and Its Association With Perceived and Objective Cognitive Impairment in Individuals With Multiple Sclerosis — Journal of Sleep Research
    10. Melatonin Dysregulation, Sleep Disturbances and Fatigue in Multiple Sclerosis — Journal of the Neurological Sciences
    11. Melatonin Acts as Antioxidant and Improves Sleep in MS Patients — Neurochemical Research
    12. Efficacy of Melatonin on Serum Pro-inflammatory Cytokines and Oxidative Stress Markers in Relapsing Remitting Multiple Sclerosis — Archives of Medical Research
    13. The Safety of Melatonin in Humans — Clinical Drug Investigation
    14. Keeping Cool: Use of Air Conditioning by Australians With Multiple Sclerosis — Multiple Sclerosis International
    15. Depression in Multiple Sclerosis: A Long-Term Longitudinal Study — Multiple Sclerosis Journal
    16. Cognitive Behavioral Therapy — Mayo Clinic
    17. Effect of Digital Cognitive Behavioral Therapy for Insomnia on Health, Psychological Well-Being, and Sleep-Related Quality of Life: A Randomized Controlled Clinical Trial — JAMA Psychiatry
    18. Outcomes of Cognitive-Behavioral Treatment for Insomnia on Insomnia, Depression, and Fatigue for Individuals With Multiple Sclerosis: A Case Series — International Journal of MS Care
    19. Sleep Timing, Sleep Consistency, and Health in Adults: A Systematic Review — Applied Physiology, Nutrition, and Metabolism
    20. Hypnotic Use and Fatigue in Multiple Sclerosis — Sleep Medicine
      Updated on May 15, 2024

      A MyMSTeam Subscriber

      While I was reading this article on having problems it seemed that I could have written it. I have trouble staying asleep and have night sweats. In my case it could be stress, anxiety and depression… read more

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      How Can I Get Rid Of Chronic Back Pain Behind My Shoulder Blades?
      October 28, 2023 by A MyMSTeam Member 6 answers
      What Kind Of Mattress And Pillow Should I Have?
      March 16, 2024 by A MyMSTeam Member 2 answers
      Federica Polidoro, M.D. a graduate of medical school and neurology residency in Italy, furthered her expertise through a research fellowship in multiple sclerosis at Imperial College London. 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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