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Sleep and Multiple Sclerosis

SCOFA-Sleep-and-Multiple-Sclerosis-1

 
Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.

 
 

Common Sleep Problems and Multiple Sclerosis | How MS Affects Sleep |
How Sleep is Managed in Multiple Sclerosis | What’s the Takeaway? 

 

Overview 

We often hear about the world of good that sound sleep can do, but as we age, the burden of yet another sleepless night becomes a worrying norm. 

Where a lack of sleep can be a significant stressor in those with otherwise “normal” physiologies, it has proven far more prevalent and demanding in those with multiple sclerosis (MS).[1,2]

When it comes to MS, lack of sleep is a given. However, how much or how little people with MS can sleep depends on the affected individual’s sleep disorder.[3]

For some, the lack of sleep can resemble a Jager-Bomb hangover, whereas, for others, it can feel like they’ve suffered a physical and mental blow to the body from their body.[4] 

Whatever the cause of your sleep issues, you need to talk to your doctor so that the most appropriate sleep management plan can be implemented.

 

Common Sleep Problems and Multiple Sclerosis 

Sleep disorders are prevalent among the general population, with figures suggesting that around 2-4 percent of men and women are likely to be diagnosed with sleep apnea at some point in their lives. 

Likewise, nearly 11 percent of people will experience restless legs syndrome, and nearly a fifth of the population will be affected by insomnia.[3]

Though these figures sound alarming, they’re far worse for those with MS. Sleep disturbances in MS continue to be clinically unrecognized and consequently undertreated by physicians.[5] 

Studies suggest that around 5 in 10 people with MS experience significant yet treatable sleep problems, such as insomnia, sleep apnea, and restless legs syndrome – the common culprits.[6] 

These sleep problems can lead to constant fatigue, a highly debilitating symptom with significant socioeconomic consequences. 

 

How MS Affects Sleep

There are several factors, psychological, physiological, and organic, that contribute to sleep problems in people with MS. The symptoms of MS are somewhat unpredictable and sporadic. One person’s symptoms may be mild; another’s may be disabling.[7] 

For example, physical symptoms such as pain, spasticity, and bladder problems can make it difficult for an individual with MS to get comfortable and fall asleep. In turn, the sufferer becomes embedded within a loop of sleeplessness, fatigue, and inevitable mental health decline.[6]

We will break down below some of the leading causes of sleeplessness in MS, hoping to shine the spotlight on symptoms that have gone beneath the radar.

 

1) Urinary Problems

Nocturia is the medical term that describes the need to empty your bladder through the night.[8] 

The condition can affect most people, particularly people with vaginas and elderly individuals, but it is far more prevalent in those with MS.[9] These factors make it increasingly difficult for an individual to get back to sleep and can lead to constant fatigue the following day.

Fortunately, many remedies to nocturia can be provided to you by a specialist urologist – a doctor who specializes in problems with the urogenital tract. They can prescribe you medications to help control your bladder or suggest lifestyle adjustments that may reduce the need to urinate at night.

 

2) Depression

While lack of sleep can cause various mental health disorders like depression and anxiety, it is now recognized as a rather significant symptom attributed to the worsening of said conditions. 

People with depression – around 50 percent of those with MS – can find it difficult to fall asleep or stay asleep or find the motivation to get up and start the day.[10] 

These symptoms often resemble MS-associated fatigue, making depression more difficult to diagnose in people with MS.[10] 

Depression can be treated using a combination of pharmacological and psychological therapies, which can be prescribed to you by the appropriate specialist.

 

3) Muscle Spasticity 

Muscle spasticity is a common MS symptom that can significantly impact a person’s sleep. Spasticity is characterized by tightness, rigidity, and involuntary muscle contractions. It can cause discomfort, pain, and functional impairment, thus making it challenging for people with MS to get comfortable and fall asleep, leading to sleep loss.[11]

Muscle spasticity can also disrupt sleep by causing restless legs syndrome (RLS), affecting approximately a quarter of those with MS.[12] 

MS patients perceive RLS as the irresistible urge to move the legs while resting, making it difficult for people with MS to fall and stay asleep.[12] 

Finally, muscle spasticity can also interfere with a person’s ability to turn and reposition while sleeping. This limitation can cause discomfort, pain, and pressure sores, making it difficult for people with MS to get comfortable while trying to sleep. Off-positioning and previous spasticity can lead to leg cramps that make for a rather unpleasant alarm clock.[13]

It’s essential to know that though sleep conditions are prevalent in those with MS, they can often be treated using a combination of therapies. If you are struggling with your sleep, discuss your symptoms with your specialist so that a tailored sleep management plan can be implemented.

 

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How Sleep is Managed in Multiple Sclerosis 

There’s no shame in asking for help if you can’t sleep. Sleep is fundamental to productivity, metabolism, and well-being, so caring for it should be among our top priorities. There are several strategies you can use to manage your sleep and improve the quality of your rest, including:

  1. Establish a Consistent Sleep Routine: A sleep routine can help regulate your body’s sleep-wake cycle.[14]
  2. Create a Relaxing Sleep Environment: Make sure your sleeping environment is cool, dark, and quiet. This type of bedroom can help clear your mind before you hit the hay and allow you to rest peacefully. You can also try using earplugs or a white noise machine to block out any sounds that might disturb your sleep – do this only if you find both options comfortable to apply.[14]
  3. Avoid Caffeine, Alcohol, and Nicotine: These substances can cause sleep fragmentation, making falling and staying asleep more difficult. Try to avoid them for several hours before bedtime.[15]
  4. Exercise Regularly: Exercise can enhance sleep onset, which is the time it takes to fall asleep. Try to exercise for at least 30 minutes a day, but avoid working out too close to bedtime (about an hour), as this can make it more difficult to fall asleep.[16]
  5. Talk to Your Doctor: If you are having trouble managing your sleep, talk to your doctor. They may recommend medication, therapy, or other treatments to help improve your sleep.

 

What’s the Takeaway? 

Enhancing our understanding of the potential causes of sleep conditions and how they link to MS can go a long way in ensuring symptom management and optimizing the quality of life for people with MS.

Suppose you find it difficult to fall asleep, stay asleep, or wake up without feeling groggy despite implementing appropriate lifestyle measures. In that case, it may be time for you to speak up about your symptoms and discuss with your doctor possible treatments. 

 

References:

  1. Braley, T. J., & Boudreau, E. A. (2016). Sleep Disorders in Multiple Sclerosis. Current Neurology and Neuroscience Reports, 16(5). https://doi.org/10.1007/s11910-016-0649-2 
  2. Chattu, V., Manzar, M., Kumary, S., Burman, D., Spence, D., & Pandi-Perumal, S. (2018). The Global Problem of Insufficient Sleep and Its Serious Public Health Implications. Healthcare, 7(1), 1. https://doi.org/10.3390/healthcare7010001
  3. Veauthier, C. (2015). Sleep Disorders in Multiple Sclerosis. Review. Current Neurology and Neuroscience Reports, 15(5). https://doi.org/10.1007/s11910-015-0546-0
  4. Baum, M. (2022, January 20). Sleeping with the enemy. Multiple Sclerosis Society UK. https://www.mssociety.org.uk/care-and-support/online-community/community-blog/sleeping-with-the-enemy
  5. Fleming, W. E., & Pollak, C. P. (2005). Sleep Disorders in Multiple Sclerosis. Seminars in Neurology, 25(01), 64–68. https://doi.org/10.1055/s-2005-867075
  6. Platas, M. G., & Martin, M. Y. P. (2018). Sleep Disorders in Multiple Sclerosis. Neuroplasticity – Insights of Neural Reorganization. https://doi.org/10.5772/intechopen.72831
  7. Multiple Sclerosis (MS). (n.d.). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/multiple-sclerosis-ms
  8. Appell, R. A., & Sand, P. K. (2007). Nocturia: Etiology, diagnosis, and treatment. Neurourology and Urodynamics, 27(1), 34–39. https://doi.org/10.1002/nau.20484
  9. Peyronnet, B., Krupp, L. B., Reynolds, W. S., Gamé, X., Amarenco, G., Cornu, J. N., Ryerson, L. Z., Sammarco, C. L., Howard, J. E., Charlson, R. W., Dmochowski, R. R., & Brucker, B. M. (2019). Nocturia in Patients With Multiple Sclerosis. Reviews in urology, 21(2-3), 63–73.
  10. Nagaraj, K., Taly, A. B., Gupta, A., Prasad, C., & Christopher, R. (2013). Depression and sleep disturbances in patients with multiple sclerosis and correlation with associated fatigue. Journal of Neurosciences in Rural Practice, 04(04), 387–391. https://doi.org/10.4103/0976-3147.120201
  11. Izquierdo, G. (2017). Multiple sclerosis symptoms and spasticity management: new data. Neurodegenerative Disease Management, 7(6s), 7–11. https://doi.org/10.2217/nmt-2017-0034
  12. National MS Society. (2021, March 30). People with MS Are More Likely to Have Restless Legs Syndrome, Says New Study. National Multiple Sclerosis Society. https://www.nationalmssociety.org/About-the-Society/News/People-with-MS-Are-More-Likely-to-Have-Restless-Le
  13. Solaro, C., Trabucco, E., & Messmer Uccelli, M. (2012). Pain and Multiple Sclerosis: Pathophysiology and Treatment. Current Neurology and Neuroscience Reports, 13(1). https://doi.org/10.1007/s11910-012-0320-5
  14. Sleep. (n.d.). National Multiple Sclerosis Society. https://www.nationalmssociety.org/Living-Well-With-MS/Diet-Exercise-Healthy-Behaviors/Sleep
  15. Spadola, C. E., Guo, N., Johnson, D. A., Sofer, T., Bertisch, S. M., Jackson, C. L., Rueschman, M., Mittleman, M. A., Wilson, J. G., & Redline, S. (2019). Evening intake of alcohol, caffeine, and nicotine: night-to-night associations with sleep duration and continuity among African Americans in the Jackson Heart Sleep Study. Sleep, 42(11). https://doi.org/10.1093/sleep/zsz136
  16. Stutz, J., Eiholzer, R., & Spengler, C. M. (2018). Effects of Evening Exercise on Sleep in Healthy Participants: A Systematic Review and Meta-Analysis. Sports Medicine, 49(2), 269–287. https://doi.org/10.1007/s40279-018-1015-0