How to Get a Good Night’s Sleep When You Have MS

Symptoms of multiple sclerosis (MS)?— from spasticity to bladder problems to heat sensitivity?— are prime examples of how MS often gets in the way of a good night’s sleep.

But not all?sleep problems?in?people with MS are directly or even indirectly caused by MS. Pain or anxiety from any source, or just poor sleep habits, can interfere with sleep quantity and quality.

Don’t underestimate the importance of getting adequate sleep; it improves your quality of life generally and can help you live better with the effects of MS. Fatigue is one of the most prominent MS symptoms.

“Speak with your medical care provider about sleep issues,” recommends Kathy Costello, NP, an adult nurse practitioner and the chief operating officer at Can Do MS, a nonprofit organization that provides health and wellness services to people with MS and their families. Don't rely on?over-the-counter medication?or figure it's something you just have to live with, Costello advises.

“Self-management is important, but asking for help is equally important," Costello says. A medical evaluation can determine what’s causing your sleep problems and the best way to resolve them.

Here are some of the most common underlying sleep issues in people with MS.

Pain of Any Type Can Awaken You

“Any type of pain can interrupt sleep — whether?MS-related or other pain,” says Costello. “MS pain that commonly interferes with sleep is neuropathic pain — often described as burning, shooting, searing, or deeply aching. This pain can be relentless and is often worse at night.”

Musculoskeletal pain can occur from a compensatory gait pattern (due to leg weakness or?foot drop). Sometimes a change in gait can produce back or hip pain?that may interfere with sleep, says Costello.

“Poor seating for those people with MS who spend a lot of time seated can produce back pain or pain in the hips, neck, and legs that can be more bothersome at night,” she adds.

Spasticity — which can cause chronic muscle tightness or sudden, sporadic contractions of a muscle or muscle group — will cause pain, and the pain from sporadic spasms, as well as possible twitching or jerking, can cause multiple interruptions to your sleep cycle, frequently waking you. This type of fragmented sleep can leave you feeling exhausted in the morning.

“Nighttime or nocturnal spasms are common in MS, and it is important to let your MS provider know if you are experiencing this symptom, as it is treatable,” says Costello.

Your MS doctor may prescribe medication,?rehabilitation exercises, or a combination of both to help get a handle on spasticity so that you can sleep more soundly.

Nocturia Disrupts Sleep Repeatedly

Nocturia, or the need to urinate during the night, happens when bladder muscles are spastic, contracting when they aren’t supposed to and giving you the feeling that you have to urinate.

According to Costello, “An evaluation of the bladder by a MS-knowledgeable urologist can be very helpful, as there are different types of bladder problems in MS that can produce symptoms, including some that are more disruptive at night.”

If overactive bladder is determined to be the cause of your nocturia, your urologist can recommend?a number of treatments for it, including various types of medication, Botox injections, or electrical nerve stimulation, also known as neuromodulation therapy.

Also ask your doctor how much fluid you should be drinking and when. Don't limit fluids so much that you become dehydrated, but do create a plan to taper off fluid intake before bedtime.

Restless Legs Syndrome a Common Cause of Sleep Problems

Restless legs syndrome (RLS)?is one of the most?common sleep disorders for people with MS. The urge to move the legs and the unpleasant sensations that accompany this urge typically occur at night or when legs are at rest.

“RLS may be related to abnormalities in neurotransmitters that help regulate muscle movements or in the part of the central nervous system that controls automatic movements,” says Michelle Drerup, PsyD, a sleep psychologist and the director of behavioral sleep medicine at the Cleveland Clinic’s Sleep Disorders Center in Ohio.

Dr. Drerup adds, “According to research, people with MS who have a more severe disease course and?lesions in their cervical spinal cord are at a higher risk for restless legs syndrome. In addition, medication used to treat MS?may also cause or worsen these problems.”

Heat Complicates Both MS Symptoms and Sleep

“People with MS could have pain. They could have bladder issues. There’s a higher incidence of restless leg–type symptoms or restless leg syndrome, and that affects sleep in and of itself. So if you’re overheated, all those symptoms are going to be heightened, and that’s going to impact sleep potentially significantly,” explains Martin I. Belkin, DO, a neurologist at the Michigan Institute for Neurological Disorders in the Detroit metro area.

How can you stay cool while getting some shut-eye? Dr. Belkin recommends sleeping in an air-conditioned environment and staying hydrated, as well as using cooling devices like neck wraps and cooling vests. And if you don’t have traditional air-conditioning, he adds, using a fan can help.

But when it comes to preventing heat from hampering your sleep, Belkin advises addressing underlying MS symptoms that can be worsened by heat.

“The key is treating a lot of those underlying symptoms — making sure the pain is adequately treated, that coexisting restless leg syndrome or other sleep disorders are being treated, and that the bladder dysfunction is being treated. If you can treat those underlying symptoms that are worsened by the heat, then you can get better sleep,” he says.

Periodic Limb Movements in Sleep Can Also Affect Sleep Quality

People who have RLS frequently also have?periodic leg movements in sleep (PLMS), sometimes called periodic limb movement disorder, but having PLMS does not automatically mean a diagnosis of RLS.

PLMS is a rhythmic movement of the lower extremities, bending at the hips, knees, or toes during sleep. The constant movement can result in a less-than-ideal sleep cycle.

Sleep Apnea Is Serious but Treatable

Sleep apnea?is characterized by snoring at night and excessive sleepiness during the day, and?can be diagnosed with a sleep study. Sleep apnea can cause serious strain on the heart when untreated, so it is very important to be evaluated by a doctor if you’re experiencing symptoms associated with this condition.

Treatment with a?continuous positive airway pressure (CPAP) machine (a special breathing device and mask used while sleeping) or surgery may be necessary for moderate to severe cases.

For people who snore but don’t have sleep apnea, or for those who have very mild sleep apnea, there are a few things you can do on your own to improve the flow of air to your lungs while sleeping, including the following:

• Sleep on your side to keep your airways open.
• Avoid alcohol close to bedtime.
• Try over-the-counter nose strips to keep the nostrils more open.
• Lose weight if you’re overweight.

Depression Worsens Insomnia and Vice Versa

But?insomnia can also lead to or worsen depression, underscoring the importance of speaking to your doctor if you have either depression or persistent sleep problems.

Depression can be treated effectively with psychotherapy, medication, or a combination of the two.

Anxiety Prevents Falling Asleep

Anxious feelings can make it difficult to fall asleep, but there are ways to learn to “turn off” your brain.

“The ‘brain dump,’ or constructive worry time, is a technique to help?decrease anxiety and racing thoughts at night,” says Drerup. Set aside 10 to 15 minutes earlier in the day to write out worries and concerns that are likely to interfere with sleep.

“At night, if you begin to worry, you can remind yourself that you have dealt with this problem already when you were at your problem-solving best and put it aside for the time being," she says.

Even if your anxiety is caused by something you can't change, such as the unpredictability of your?MS symptoms, there are?strategies that can help. Your MS doctor may suggest?relaxation techniques, counseling, cognitive-behavioral strategies, or a support group as possible tools for helping you gain peace of mind and get the restful sleep you need.

Good Sleep Involves Many Factors

"Sleep is a fairly complex activity," Costello says. It “involves our circadian rhythm cycle (our internal clock that manages our sleep-wake cycle) and many chemicals and hormones that send various signals throughout the central nervous system to turn up or turn down cell activity.” Costello notes that there are many things that can interfere with sleep — caffeine intake, screen time while in bed, mood changes or disorders, such as anxiety or stress, the environment of sleep (temperature, comfort, darkness), and the medical issues that we discussed above, such as pain, limb movements, spasticity, and bladder issues.

Because MS is a neurological condition, it may not be a single symptom preventing you from?sleeping soundly — and it may take time to uncover and address all the causes of disrupted sleep.

If nothing seems to be resolving your sleep problem, your doctor may refer you to a sleep specialist to try to determine the root of the problem. During a session in a sleep lab, physicians can monitor your brain waves and breathing and gather other data to get an in-depth look at what's happening when you sleep. Identifying any abnormalities can provide useful answers that can lead to proper treatment and an improved sleep pattern.

A comprehensive MS care center, which coordinates multidisciplinary care for people living with the condition, will have the expertise to manage sleep disorders in MS — especially if that center collaborates with sleep medicine physicians. You can search for a care center near you through the NMSS and the Consortium of Multiple Sclerosis Centers.

The Basics of Good Sleep Hygiene

No matter what’s at the heart of your sleep problems, failing to maintain good “sleep hygiene” can make it worse. Here are some things you can do to prepare for a good night's sleep.

Have a Pre-Bedtime Routine

“Create a ‘buffer zone,’ or a nightly evening routine before bedtime that lasts between 30 and 60 minutes and helps you unwind for the day and prepare for sleep,” says Drerup.

In addition to powering down all electronics, an evening routine can include doing some yoga or gentle stretching, reading in a dim light, meditating, or writing in a gratitude journal, says Drerup.

Create a Dark, Comfortable Environment

Make your bedroom environment quiet, dark, and cool so it’s conducive to sleeping.

"As much as possible, you want the bedroom to be reserved for sleep and intimacy," says Costello. Take out the TV, and put in room-darkening curtains. Turn your mattress if it feels worn, and invest in comfortable pillows. Adjust the thermostat so that you're neither too cool nor too hot.

Establish a Sleeping Pattern

Go to bed at the same time every night. Wake up at the same time every morning. Programming your body to expect a certain schedule can help regulate your sleeping pattern.

To prevent problems falling asleep or disrupted sleep, avoid?eating a large meal right before bed,?using any kind of nicotine, or?drinking alcohol or caffeinated beverages close to bedtime.

"Alcohol may make you feel drowsy, but it is a depressant, and after the initial drowsiness wears off, the nervous system rebounds and can be disruptive later on during the sleep cycle," explains Costello.

Don’t Take Long Daytime Naps

Don’t take long naps?in the afternoon. Settle for a catnap if you're feeling fatigued — just long enough to feel rested, but not so long that you aren't able to fall asleep at bedtime.

Try a Relaxation App

Consider trying a relaxation app to help put you to sleep.?Here are some options.

• Pzizz ($7.99 per month, or $49.99 per year), for example, plays a combination of music and voice for any length of time you choose to help put you to sleep.
• Better Sleep?($59.99 per year) also plays soothing music and other sounds, with optional meditation and movement modules to induce sleep.
• Headspace ($12.99 per month, or $69.99 per year) offers meditation and mindfulness tools, as well as “sleepcasts,” to help you get the rest you need.
• And the free app?White Noise?Lite plays sounds of ocean waves, thunder, rain, and similar noises. The basic versions of these apps are free and available for both iOS and Android devices.

The Takeaway

If you’re experiencing sleep problems, which are more common in people with MS, talk with your doctor. Sleep is a complex process that is so important to your health, and there are steps you can take to get better rest.

Additional reporting by Christina Vogt and Deborah Shapiro.