7 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.

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 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 turn a good night’s sleep into a nightly challenge. More than 13,400 MyMSTeam members report struggling with 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. Dr. Nicholas is a neurologist specializing in neuroimmunology and MS. She’s currently 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.”

In this article, we’ll explore why sleep disturbances are common symptoms of MS and some tips you can try to improve your sleep quality.

Sleep disruptions are not just an inconvenience — they’re a significant issue for people with MS. Research shows that approximately 60 percent of people with MS experience sleep disorders, ranging from:

• Insomnia
• Nocturia (frequent urination at night)
• Sleep-disordered breathing (sleep apnea)
• Rapid eye movement (REM) sleep behavior disorder
• Narcolepsy
• Circadian rhythm disorder
• Restless legs syndrome and periodic limb movements

These sleep challenges can stem from MS-related symptoms like muscle spasms, neuropathic pain, and neurological changes. Researchers believe that lesions caused by MS attacks on the brain or spinal cord may contribute to these sleep disorders, which would help explain why sleep disorders are so common in those with MS.

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.

“The most impactful thing we can do for fatigue is to make sure someone is exercising.”

— Dr. Jacqueline Nicholas

People with MS can also have problems with heat and cold sensitivity as well as sweating, which may cause 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?”

Because MS can affect sleep in so many ways, Dr. Nicholas recommended finding effective strategies to manage those 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 improve cognitive function (thinking and memory) and quality of life in people with MS.

There are also a few tips you can try to get better sleep. Always discuss your sleep concerns with your doctor, and consult them before making any significant sleep routine, treatment plan, or lifestyle changes.

1. Exercise, Even if You’re Tired

Although it might seem like the last thing you want to do when you’re tired, physical activity can improve sleep and reduce MS-related fatigue.

Dr. Nicholas emphasizes, “The most impactful thing we can do for fatigue is to make sure someone is exercising.” She added, “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.”

Stay active throughout the day, but avoid too much movement right before bed. Ask your doctor about safe exercises you can try.

2. Establish a Consistent Routine

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.”

3. 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.

“Some people may need to take medication that relaxes muscles at nighttime to help prevent spasms.”

— Dr. Jacqueline Nicholas

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 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.”

4. Consider Sleep Supplements or Medications

Depending on which sleep disorder you have, there may be medicines and nonpharmacological treatments for it. Although the U.S. Food and Drug Administration (FDA) hasn’t approved any therapies specifically for treating sleep disorders related to MS, your doctor will choose the medication based on your symptoms and on which sleep disorder you have. Talk to your doctor about your options.

If you struggle with insomnia, 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 healthcare team before taking supplements or OTC medications, some of which may cause interactions with other drugs or make side effects worse.

5. Consider 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 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.”

— Dr. Jacqueline Nicholas

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.

6. Practice Stress Management

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, there are also steps you can take to manage mental health symptoms.

“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, which has been shown to treat sleep disturbances associated with insomnia.

7. Manage Bladder Issues

Nocturia, or the need to urinate frequently during the night as a result of MS, can also cause sleep disturbances. 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,” she said. “Some people have spasms in their muscles, and so we want to focus on treating that so they sleep better.”

If you find yourself getting up a lot to use the bathroom throughout the night, tell your healthcare provider. Your doctor can help you explore treatment options and may refer you to a continence advisor.

8. If You Can’t Get To Sleep, Do Something Else

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 like sitting in a quiet room or reading. You could also try some relaxation or meditation techniques. Keep in mind that these activities shouldn’t be too stimulating.

The Multiple Sclerosis Society 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.

9. Keep a Sleep Diary

It may be beneficial to keep a sleep diary to track your sleep patterns and habits. In a sleep diary, you can note:

• Bedtime and wake-up times
• Any symptoms, interruptions, or awakenings throughout the night
• Factors that seem to improve or worsen sleep

A sleep diary can help you remember more details and can make it easier to remember and share your sleep patterns with your doctor so that together you can address any of your concerns. To help you remember everything you need to discuss with your doctor, you can get customized questions to bring up at your next appointment.

Remember, 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.

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 218,000 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 your Activities page.