Some MyMSTeam members have brought up melatonin as a possible sleep aid.

“Has anyone tried melatonin? I have, and it is wonderful. I sleep really well on it,” said one member.

“The only thing I don’t like is if I get woken up, it is hard to go back to sleep.”

How It Works

Melatonin is a natural hormone that controls your sleep cycle. Inside your body, its levels naturally rise at night before returning to normal levels during waking hours. Synthetic (human-made) melatonin is available as a dietary supplement to help you sleep.

Melatonin helps signal to your brain that it is nighttime. It acts on the body’s internal clock, which helps control when you feel awake and when you feel ready to sleep. Unlike many sleep aids, it doesn’t primarily work by making you feel drowsy, but by telling your body that it is time to go to sleep.

Light can reduce the body’s natural release of melatonin, which is one reason bright light and screens at night may make it harder to fall asleep.

“Has anyone tried melatonin? I have, and it is wonderful. I sleep really well on it. The only thing I don't like is if I get woken up, it is hard to go back to sleep.”

 

— A MyMSTeam member

How It Might Affect MS Symptoms

Early research suggests that melatonin may help some people with MS sleep, but the evidence is still limited. In a 2021 pilot study, people with MS who took melatonin for two weeks had significantly longer total sleep time, along with a trend toward better sleep efficiency.

A small randomized study of 27 people with MS also found improvements in fatigue and neuropathic pain after 12 weeks of melatonin compared with placebo. Fatigue is one of the MS symptoms that can have a major impact. Because the study was small, larger studies are needed to confirm these possible benefits.

In the U.S., melatonin is sold as a dietary supplement, not as an FDA-approved insomnia medicine. The amount in a supplement may differ from what the label says, and information about long-term safety is limited. Melatonin can also interact with medications, so ask your healthcare provider before using it.
 

Over-the-counter (OTC) sleep aids are available without a prescription, but that doesn’t mean they are risk-free. Ask your doctor before using them because they can cause unwanted side effects or interact with some MS medications and treatments. They are not usually recommended as a first approach to chronic insomnia.

How They Work

Over-the-counter sleep medications can work in different ways. Most contain antihistamines, which block histamine, a chemical involved in alertness. Many allergy medications are also antihistamines, which is why they can make you feel drowsy.

“I take sleeping pills that you just buy over the counter, and now they don’t seem to work that well.”

 

— A MyMSTeam member

How They Might Affect MS Symptoms

Your doctor might advise against taking OTC sleep medications that contain antihistamines because of their sedating effects. Daytime drowsiness or grogginess may worsen MS symptoms like fatigue and brain fog.

These medicines can also cause memory or thinking problems, dry mouth, constipation, and trouble urinating. Those effects may be especially difficult for people who already have similar MS symptoms.

Sedating antihistamines are generally not a good choice for regular treatment of chronic insomnia. Their effects may wear off as tolerance develops, while next-day drowsiness and other side effects can continue. As one MyMSTeam member shared, “I take sleeping pills that you just buy over the counter, and now they don’t seem to work that well.”
 

If OTC options, supplements, or other sleep aids haven’t worked well for you, your doctor may decide to prescribe a sleep medication to help you sleep.

How long a prescription sleep medicine is used depends on the type of insomnia, the specific drug, and the person taking it. Some can cause dependence and are generally used short term, while others may be prescribed for longer periods under medical supervision.

How They Work

Prescription sleep aids can work in different ways depending on their active ingredients. Common types include:

• Benzodiazepines — These drugs enhance the activity of GABA, a chemical that slows activity in the brain. They may reduce anxiety and help with sleep but can cause dependence, falls, and next-day drowsiness.
• Dual orexin receptor antagonists — These drugs block signals that promote wakefulness.
• Melatonin receptor agonists — These drugs act on melatonin receptors to help regulate sleep.
• Z-drugs — These drugs slow brain activity and can help people fall asleep or stay asleep.
• Certain antidepressants — These drugs may sometimes be prescribed when insomnia occurs with depression or another condition, although not all are FDA-approved specifically for insomnia.

How They Might Affect MS Symptoms

The safety of a prescription sleep medicine depends on the specific drug, your MS symptoms, your other health conditions, and all the medicines you take. Your doctor should check for possible interactions with MS treatments and other medications.

Prescription sleep medicines can cause side effects such as next-day drowsiness, dizziness, poor balance, memory problems, muscle weakness, or headaches. These effects may worsen similar MS symptoms or increase the risk of falls. Work closely with your doctor while taking a prescription sleep medication so you can review your symptoms and side effects.

Some Z-drugs can rarely cause complex sleep behaviors, such as sleepwalking, eating, or driving while not fully awake. These events can cause serious injury, so contact a healthcare professional right away if one occurs.