Help Your MS with Better Sleep

Getting good sleep is the dream but it can be challenging when you have MS. Sleep disorders, MS symptoms, and circadian rhythm problems can all contribute to sleep disruption. Here’s what may help.

People with multiple sclerosis (MS) are about four times more likely to have sleep disturbances than people without MS, research suggests.

Fatigue is a separate but related condition that’s also very common. It’s often caused directly by MS itself, but the same research acknowledges that not getting enough good quality sleep can contribute.

“Sleep’s not just the lack of being awake. It’s essential for people to feel good and healthy, and quality of life is not going to be good in somebody who has poor quality sleep,” says Dr. Rock Heyman, chief of the Division of Neuroimmunology and Multiple Sclerosis at the University of Pittsburgh Medical Center (UPMC) and an associate professor of neurology at the University of Pittsburgh School of Medicine.

The quality of your sleep can even influence the progression of MS, in part by impairing the remyelination process that’s crucial to maintaining and regaining function.

Assessing your sleep quality and taking action to get good quality sleep can help manage your MS.

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How many people with MS have trouble sleeping?

People with MS are a lot more likely to experience difficulty sleeping than the general population. Research suggests somewhere between 25% and 54% of people with MS have some form of sleep issue.

In other words, if you have MS and find it difficult to get a good night’s sleep, you’re not alone.

Causes of sleep difficulties in MS

The factors that contribute to sleep issues are complex, so a combination of issues may be preventing you from getting a good night’s sleep.

Sleep disorders

Some sleep disorders are common in people with MS. These include insomnia, sleep apnea, restless legs syndrome, and narcolepsy, among others.

MS symptoms

The Multiple Sclerosis Association of America (MSAA) says having to pee in the middle of the night (aka nocturia) is one major cause of sleep disturbances in people with MS. That’s because MS can cause issues with nerves and muscles that affect the bladder, which can cause urgency and incontinence — including during the night.

According to the MSAA, spasticity — when your muscles involuntarily become tight, rigid, and often painful — can also interfere with your ability to sleep.

People with MS who have limited mobility may wake up in the nighttime feeling uncomfortable if they’ve been in one position too long but don’t have the ability to turn over or shift their weight.

Research suggests that the MS disease process itself might directly affect sleep, too.

Issues with your circadian rhythm

Beyond these symptomatic reasons, scientists aren’t certain exactly what causes sleep disturbances in people with MS, but some have proposed it may be related to disturbances in your body clock, also called your circadian rhythm.

The main control center for your circadian rhythm is a small cluster of cells in your hypothalamus, located deep in your brain.

“The brain is our organizer for the normal rhythm of wake and sleep, and so people with MS can have abnormal circadian rhythms that can be directly from the disease,” Heyman explains.

Many everyday factors, including temperature and light exposure, can reinforce or disrupt the circadian rhythm in addition to the medical issues directly related to MS, Heyman says.

Medications

Medications you’re taking for MS may also affect your sleep.

For example, interferon-beta, which is used in many MS disease-modifying therapies (DMTs), may impact sleep, thereby increasing fatigue, depression, and poor quality of life. Natalizumab, used in Tysabri, may improve sleep.

Some medications used to treat symptoms of MS may also affect sleep, but it varies from person to person. Some people may find the following medications improve sleep, while others find that they interfere with sleep:

• muscle relaxants
• antidepressants
• carbamazepine, used to treat pain
• gabapentin, which treats pain, numbness, and pins and needles
• anticholinergics, which is used for urinary issues like urgency and incontinence
• cannabinoids like THC and CBD

9 ways to get better sleep with MS

There are lots of things you can do to help yourself get consistently better sleep with MS.

1. Reserve a doctor visit just to talk about sleep

Sleep is a core issue in MS, yet doctor visits can become centered on other topics, like medications, infections, and even health insurance, says Heyman. He recommends letting your doctor know you’d like to focus on sleep during your checkup.

“Make sure they know that’s important to you,” Heyman says, and that you’d like to work with them to figure out what might be causing your sleep difficulties and then find personalized solutions, he explains.

2. Limit having to pee during the night

If you typically have to get up one or more times during the night to pee, try to stop drinking fluids about 3 hours before bedtime. Just be sure not to limit your hydration at other times.

Also limit your intake of caffeine and alcohol, especially later in the day, since both can interfere with your ability to sleep.

If these lifestyle adjustments don’t help, speak with your doctor about the issue. They may prescribe medication to help you manage your bladder symptoms.

3. Practice good sleep hygiene

Good sleep habits, which collectively are known as sleep hygiene, are everyday choices that can make a big difference in the quality and quantity of your sleep.

Here are a few sleep hygiene tips for people with MS from the MSAA:

• Head to bed at the same time every day.
• Try not to work, watch TV, read, or scroll through your phone in bed.
• If you drink caffeine, do so only in the morning.
• Avoid drinking alcohol close to bedtime.
• Limit daytime naps to improve your nighttime sleep.
• Avoid stressful activities right before bed.
• Try turning down the lights 2 hours before bedtime.
• If you can’t fall asleep within 20 minutes, get up and go sit in a relaxing place and read. Once you start to feel sleepy, go back to bed and try again. Repeat this cycle until you fall asleep.

You might also want to try using a weighted blanket. While the research to date about their effectiveness is inconclusive, they’re a popular sleep aid in the Bezzy MS community.

4. Find exercise that’s right for you

It’s well known that exercise can improve sleep quality and help with insomnia. The important thing is to choose a type of exercise that you enjoy and that you can modify for your needs.

“It can improve the quality of sleep and quality of life in so many ways,” Heyman says.

Exercising regularly can also help improve your mood, bladder and bowel control, and other factors that might be affecting your sleep.

And in case you’re wondering, exercising in the evening is perfectly fine — it won’t keep you awake at night and it might help you go to sleep, he says.

5. Get help turning over in the night

It’s normal to toss and turn in the night to avoid being in the same position for a prolonged period. But if you have difficulty turning over, you may wake up feeling uncomfortable.

You may want to install a grab bar on the side of your bed that can help you turn yourself over. Or, if you have a sleeping partner, consider asking them to help turn your body to a more comfortable sleeping position.

If you’re experiencing this issue, speak with your doctor. They may be able to provide additional personalized recommendations.

6. Dietary supplements might help

Low vitamin D levels and vitamin D deficiency are associated with shorter amounts of time spent sleeping, and with waking up in the night.

If you think you might be low in these or other nutrients, ask your doctor to test your levels. If you’d benefit from taking supplements, they can recommend an appropriate dose. Eating more nutrient-dense foods is always a good idea, too, and may help you get what your body needs.

7. Get help for depression

People with MS have a higher risk of depression than people without the condition — an estimated 50% of people with MS will have depressive disorders during their lifetime.

And depression can disturb your sleep. “It can be self-fulfilling. If somebody is depressed or anxious, it can make sleep worse, which will then make their mood worse,” says Heyman. If you think you’re experiencing depression, speak with your doctor. Cognitive behavioral therapy (CBT), either alone or combined with medication, can help.

8. Modify medications if necessary

Some medications for MS can interfere with sleep. If you suspect this is happening to you, speak with your doctor and see if modifying your medication might be an option.

One drug called dalfampridine is used to improve walking ability in some people with MS, and is typically taken every 12 hours. Taking it right before bed can cause insomnia, but doctors aren’t always aware it can have this effect, says Heyman.

If you take this medication, Heyman suggests asking your healthcare professional if you can take your second dose of the day earlier in the evening rather than right before bed as it’s usually prescribed.

The same principle applies to medications that people may take for fatigue in the afternoon — like modafinil. “It’s better to try to keep that to earlier in the day,” Heyman recommends.

On the other hand, some drugs that help treat MS symptoms may indirectly help improve your sleep. For example, you may want to consider asking your doctor about treatment for pain or spasticity if you find these symptoms are keeping you awake at night.

9. Get help treating a sleep disorder, if you have one

By the same token, if you have a sleep disorder, treating it directly can help a lot. Treatments are available for the common sleep disorders in MS, which we listed earlier.

If you have a sleep disorder or think you have one, tell your doctor about the symptoms you’re experiencing so they can help diagnose and treat it.

The takeaway

If you have a hard time getting a good night’s sleep, you’re not alone.

However, know you are in control of many factors that affect sleep, and there’s a lot you can do to set yourself up for sleep success.

“I think patients being educated is a big first step, and then talking with their primary care provider [or] neurologist,” says Heyman. “There are many different options to treat [sleep difficulties] before going to sleeping pills.”