Does MS Affect Sleep?
If you have MS, you’re probably all too familiar with the effects it can have on your body. But did you know that MS can also affect your sleep?
According to a recent study, nearly 50% of people with MS say they experience problems with sleep. That’s why we’ve put together this helpful guide on how to get a good night’s sleep when you have MS.
So if you’re struggling to catch some Zzzs, read on for our top tips…
Table of Contents
What is multiple sclerosis?
Multiple sclerosis (MS) is a chronic, immune-mediated inflammatory and neurodegenerative disorder. It is influenced by various factors, including smoking, teenage BMI, Epstein-Barr virus, sun exposure, vitamin D, shift work and sleep patterns. MS can cause irregular sleep-wake patterns, restricted sleep duration, poor sleep quality and disturbed melatonin secretion.
Insufficient sleep, sleep quality and circadian disruption may also affect the risk of MS. MS can cause fatigue, which can be the first symptom of the disease in some cases. Treatments for MS-related sleep disorders include medication, lifestyle changes, counselling and cognitive behavioural therapy.
Does MS affect sleep?
Yes, according to research Multiple sclerosis (MS) affect sleep. It can cause various sleep disturbances, including difficulty falling or staying asleep, waking up during the night, and early waking. This can lead to decreased quality of sleep, which can have a wide range of effects on daily life. Poor sleep quality and quantity can lead to daytime sleepiness, decreased concentration and memory, worsening depression, and the inability to work effectively.
Lack of sleep can worsen pain, fatigue, and other MS symptoms, and lack of adequate sleep can contribute to fatigue and other MS symptoms. Certain medications, such as stimulants, can have a side effect of keeping people up at night.
In order to manage sleep disturbances caused by MS, it is important to identify all possible causes and contributing factors, and to discuss these with a primary care physician or MS provider.
What are the symptoms of MS related sleep disorders?
1. Difficulty falling asleep
The symptoms of difficulty falling asleep related to MS can include over-activation, worry, an upset event, a disruption in the biological clock or circadian rhythm, sensory disruptions from noise or light, sleep apnea, restless legs syndrome, sleepwalking, sleep terrors, nightmares, waking up confused, and overeating while asleep.
Grinding teeth and/or snoring can also be disruptive to one’s sleep and may have health implications. Other underlying medical conditions can also affect sleep, so it is important to investigate, diagnose, and treat them.
2. Trouble staying asleep
The symptoms of trouble sleeping related to MS can include over-activation, where too much on the mind prevents sleep; circadian rhythm disorders, where the biological clock is not working properly; disruption from light; sleep apnea, which causes difficulty breathing and frequent waking; restless legs syndrome, which results in an urge to move.
3. Waking up too early
The symptoms of waking up too early in MS related sleep disorders can vary but typically include: difficulty falling asleep or staying asleep, waking up several times during the night, or waking up earlier than desired. Other common symptoms may include fatigue, decreased concentration, irritability, difficulty concentrating, mood swings, and headaches. Sensory disturbances such as noise can also affect one’s sleep cycle, making it difficult to fall asleep or stay asleep.
4. Feeling tired throughout the day
Feeling excessively tired during the day and having difficulty staying asleep throughout the night can be signs of a sleep disorder related to MS. MS patients may experience middle insomnia (not being able to fall back asleep). If a person with MS is experiencing fatigue during the day, power napping could be a solution.
5. Having trouble concentrating
Symptoms of having trouble concentrating in connection with MS-related sleep disorders include: excessive sleepiness during the day (hypersomnia or hypersomnolence), uncontrollable lapses into sleep (narcolepsy), excessive daytime sleepiness, feeling sleepy, grumpy or “down” during the day, sleeping fewer than 7 hours most nights, and still feeling tired even after having 8 hours of sleep or more.
6. Feeling muscle spasms
The symptoms of muscle spasms related to MS sleep disorders can include neuropathic pain, which is often described as burning, shooting, searing, or deeply aching. Additionally, musculoskeletal pain can occur from a compensatory gait pattern due to leg weakness or foot drop, as well as from poor seating resulting in back, hip, neck, and leg pain. If your blanket hurts your leg or your hands go numb at night it is also a sign.
Spasticity, which can cause chronic muscle tightness or sudden, sporadic contractions of a muscle or muscle group, can lead to pain and fragmented sleep. Lastly, nocturnal spasms are a common MS symptom, and can cause frequent interruptions to the sleep cycle.
Causes of sleep problems in people with MS
1. Disorders of the central nervous system
People with Multiple Sclerosis (MS) are at an increased risk for sleep problems due to disorders of the central nervous system. These sleep disorders include insomnia, sleep-disordered breathing, and restless legs syndrome.
- Insomnia is characterized by difficulty initiating or maintaining sleep and can exist as a symptom or as a disorder associated with distress and impairments in functioning.
- Sleep-disordered breathing includes both central sleep apnea, where there are repeated episodes of upper airway obstruction and hypoxia during sleep, and obstructive sleep apnea, where there is an intermittent lack of respiratory effort.
- Restless legs syndrome is characterized by restlessness or uncomfortable sensations in the lower extremities that are exacerbated by rest and relieved by movement.
These disorders are often caused by MS symptoms such as chronic pain, neurogenic bladder, spasticity, and comorbid anxiety and depression.
2. Neuropathic pain
Neuropathic pain is a type of chronic pain caused by damage or dysfunction of the nervous system. It is commonly described as burning, shooting, searing, or deeply aching pain. This type of pain is often worse at night, making it difficult for people with Multiple Sclerosis (MS) to get a good night’s sleep. Neuropathic pain is caused by a variety of factors, including damage to the nerves, inflammation, and the presence of MS-related lesions.
3. Anxiety and depression
People with MS often experience depression and anxiety, which can profoundly disrupt sleep. Anxiety can make it difficult to fall asleep, as worrying thoughts can keep the brain active even when one is trying to rest.
Stress and depression can contribute to fatigue, making relaxation before bedtime key to better sleep. EMDR therapy or Cognitive-behavioral therapy for insomnia, medications, psychotherapy, and relaxation techniques may help alleviate the effects of anxiety and depression on sleep problems in people with MS.
4. Difficulty falling asleep
The difficulty falling asleep symptom of sleep problems in people with MS is when they have difficulty drifting off to sleep due to stress, anxiety, or depression. This can be the result of MS related symptoms, such as spasms, pain, restless legs syndrome, anxiety and/or depression, side effects of certain medications. It can also be caused by family responsibilities, concerns and worries, certain medications, lack of physical activity, lack of exposure to daylight, and lesions in the brain responsible for sleep.
People with MS are also less likely to get deep sleep. The difficulty falling asleep symptom can be addressed by going to bed and waking up at the same time every day (10pm is the best time to go to bed). If the difficulty persists, a sleep study may be necessary to diagnose and treat sleep apnea. (Newer gadgets like an Apple Watch can detect sleep apnea)
5. Feeling tired throughout the day
The symptoms of fatigue throughout the day in people with MS include excessive tiredness, frequent napping like teenagers, irritability and an overall lack of energy. MS patients who experience fatigue may also have difficulty staying asleep, feel drowsy during the day, and have difficulty focusing and performing daily activities.
Furthermore, fatigue could be so severe that it prevents the person from getting out of bed.
6. Changes in sleep patterns
People with MS can experience a variety of changes in their sleep patterns. Short sleep duration, defined as sleeping less than 7 hours per night, has been associated with increased risk of developing MS. Those with MS may also experience a disruption in their circadian rhythm, which can make it more difficult to fall asleep and stay asleep.
Low sleep quality, as reported in the Karolinska Sleep Questionnaire, has also been linked to increased risk of developing MS. Other factors such as shift work, noise and light disturbances, and sleep apnea can further complicate the sleep patterns of those with MS especially when someone has to sleep with a CPAP machine.
Why is it hard to sleep with MS?
People with multiple sclerosis (MS) may be up to three times more likely to have trouble sleeping, and twice as likely to have lower-quality sleep, than the average person. Fatigue can lead to increased daytime napping and reduced physical activity, making it even harder to sleep. In addition, people with MS are less likely to get deep sleep, which can affect other MS symptoms like cognition, fatigue, mood swings, balance, pain, and spasticity.
What sleep disorders are associated with ms?
Sleep disorders associated with multiple sclerosis (MS) include
- restless legs syndrome (RLS),
- sleep-disordered breathing (SDB),
- rapid eye movement (REM) sleep behavior disorder.
Insomnia is characterized by difficulty initiating and maintaining sleep, and is often caused by nocturia, muscle stiffness, leg spasms. Sleep-disordered breathing is more common in MS, and is likely caused by inactivity due to disability.
How to get a good night’s sleep when you have MS
How can you get a good night’s sleep when you have MS?
- Stick to a regular sleep schedule of your own chronotype: Try to go to bed and wake up at the same time every day, even on weekends. This can help regulate your body’s sleep-wake cycle. Naps do not count as sleep.
- Create a comfortable sleep environment: Make sure your bedroom is cool, quiet, and dark. Invest in a comfortable mattress and pillows, and use bedding that suits your preferences.
- Practice relaxation techniques: Engage in calming deep pressure activities before bed, read a book, take a warm bath, or practicing yoga nidra, listen to white noise or some calming music. You even can sleep with your ipods in.
- Exercise regularly to improve sleep, but don’t do it within four to six hours of your bedtime, as it can overstimulate you.
- Schedule naps earlier in the day.
- Avoid caffeine and alcohol before bed: Both alcohol and caffeine can interfere with sleep, so it’s best to avoid them in the hours leading up to bedtime.
- Talk to your healthcare provider: If you’re experiencing significant sleep disturbances, talk to your healthcare provider. They may recommend medications or other treatments to help improve your sleep quality.
- Manage other MS symptoms: Managing other MS symptoms, such as pain or muscle spasms, can also help improve sleep quality. Work with your healthcare team to develop a comprehensive treatment plan.
- Get plenty of natural light exposure during the day. Sleeping outside sometimes is amazing!
- Take supplements like vitamin D or melatonin to help regulate your sleep-wake cycle.
- Limit your caffeine, alcohol, and nicotine intake six hours before bedtime.
- Stop drinking any fluids a couple of hours before going to bed.
- Try to sleep with a weighted blanket
- Ask a sleeping partner to help you change sleeping positions.
- Use the power of positive thinking
Does MS symptoms get worse at night?
Does MS symptoms get worse at night? It is possible that some MS symptoms can worsen at night, particularly spasticity. This is because spasticity is often aggravated by a lack of movement, and it can be hard to move when you are sleeping. Insomnia is also closely linked to neurological diseases such as MS, so if you are suffering from insomnia, a neurologist would be able to help.
It is also important to keep cool at night to reduce the risk of symptoms worsening, as overheating can cause Uhthoff’s phenomenon. People with MS should make sure to maintain a comfortable temperature in their sleeping environment and avoid excess heat.
What are the symptoms of MS that can affect sleep?
MS can cause lesions in the brain which directly interfere with regulating sleep. Poor sleep quality may lead to problems with mood, energy, and even an increase in MS symptoms, which can lead to cognitive decline. It is important to discuss any current symptoms with a medical provider to identify any possible causes and contributing factors to sleep dysfunction.
MS can also affect sleep indirectly, such as through the side effects of medications or through fatigue. People with MS may be more likely to nap during the day as a result of fatigue, which can lead to poor sleep at night.
What is the prevalence of sleep disturbances in people with MS?
The prevalence of sleep disturbances in people with MS is around 50%. In a research surveys from 1063 individuals were considered complete and included in an analysis.It was found that the risk of sleep problems was greater for individuals with MS. Middle insomnia (night wakening) and terminal insomnia (early awakening) and obstructive sleep apnea (OSA) are also more prevalent in MS. Causes of OSA in MS may include inactivity due to disability, brainstem lesions that affect the respiratory centers.
Bamer AM, Johnson KL, Amtmann D, Kraft GH. Prevalence of sleep problems in individuals with multiple sclerosis. Mult Scler. 2008 Sep;14(8):1127-30. doi: 10.1177/1352458508092807. Epub 2008 Jul 16. PMID: 18632776; PMCID: PMC2845464.
Can multiple sclerosis cause insomnia?
Yes, multiple sclerosis (MS) can cause insomnia. Research suggests that over 50% of people with MS experience moderate to severe insomnia, which is more than twice the national average. Uncontrolled or worsening MS symptoms, combined with anxiety and depression, are often to blame for insomnia in people with MS.
Other contributing factors to sleep disturbances in MS include certain hormonal irregularities, disruption of dopamine and norepinephrine, and certain MS symptoms that can interrupt sleep.
What is the role of CBT-I in treating insomnia in people with MS?
The role of Cognitive Behavioral Therapy for Insomnia (CBT-I) in treating insomnia in people with MS has been shown to be effective in reducing symptoms of insomnia and increasing total sleep time. A retrospective study of 11 people with MS found that 86% experienced a reduction in insomnia symptoms, and 60% reported a reduction in fatigue. A case study of an individual with MS reported improvements in sleep quality, life satisfaction, anxiety and depression after a brief course of CBT-I.
Additionally, a randomized control trial demonstrated that CBT-I is feasible in people with MS and produced improvements in insomnia severity, sleep quality, sleep self-efficacy, as well as improvements in comorbid symptoms of fatigue, depression and anxiety. Japan’s Kaizen way is also for improving insomnia.
When applying these strategies, it is important to consider potential modifications to standard strategies to accommodate the unique needs of people with MS. For example, due to cognitive impairments associated with MS, individuals may need assistance from a caregiver or aide to complete sleep logs or use a clinical-grade actigraph or commercially available sleep tracker.
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