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Sleep and MS: Improving sleep habits help manage MS

Sleep and MS: The Importance of Managing Your Sleep

The Center for Disease Control and Prevention (CDC) has called “insufficient sleep a public health epidemic.” A third of U.S. adults report that they usually get less than the recommended amount of sleep.  As the CDC warns, “Not getting enough sleep is linked with many chronic diseases and conditions – such as type 2 diabetes, heart disease, obesity, and depression – that threaten our nation’s health.” For those dealing with the chronic disease of Multiple Sclerosis (MS), combating poor sleep is an important strategy in managing the disease.

Fatigue, Sleep and MS

Fatigue is the most common symptom of MS. According to the Cleveland Clinic, overwhelming fatigue is described by 75% to 90% of MS patients. As many as 40% of patients describe fatigue as their most disabling symptom. Fatigue however is not related to the severity or to the duration of MS.

The causes of MS-related fatigue are multifactorial. The issue is not always the amount of sleep: MS can affect the quality of sleep. The primary factor affecting sleep in MS patients is the disease itself because of the damage to structures in the brain. Secondary factors that disrupt sleep arise from some of the symptoms that accompany MS. That includes bladder issues (especially frequent nighttime urination), anxiety, and stress. Finally, there are sleep disorders, such as restless leg syndrome, periodic limb movement disorder, and sleep apnea, which are not unique to MS but are seen more often in the MS population.

The consequences of MS-related insomnia and fatigue can be devastating to the MS patient. Fatigue contributes to missed activities in life, such as work, social gatherings, and even parenting. Moreover, it also is the root of some of the most common complaints by MS patients, including concentration, memory, mood, and even motor performance.

What should you do if you want to address your sleep disorder?

The first step is to rule out sleep disorders that are not related to MS. Talk to your neurologist about whether you should be evaluated at a sleep center.

The second step is to examine your diet.  Consider what you eat just before bed, how much caffeine do you drink, what time you have dinner).

After you eliminate any other factors, it’s time to reteach your brain and develop new sleep habits through Cognitive Behavioral Therapy for Insomnia. The good news: you can take on this structured program by yourself to modify your sleep patterns.

How To Improve Your Sleep

Most adults require 6-8 hours of sleep at night. Staying in bed longer, whether you are asleep or not, is not helpful.  You need to train your brain that it is time for sleep when you get into bed.  Doing any other activities in bed, such as reading or watching TV, will “confuse” your brain. So, do not get into bed until you are tired. If you get into bed and are still awake after 20 minutes, get out of bed and sit in a chair. Best to then listen to calming music or do some mindless activity such as knitting.  As you become drowsy, try getting into bed again. It may take some time for this training to see a change, but don’t give up.

Maintaining a regular sleep schedule is important. Get into bed at the same time each night and out of bed at the same time each morning. (No more sleeping in on weekends!)

The next step is to relax your brain.  Watching TV, playing a video game, or going on Facebook stimulate the brain. You should avoid these activities for 1-2 hours before bedtime. Many studies have shown that the blue light emitted by your cell phone restrains the production of melatonin, the hormone that controls circadian rhythm, a.k.a. your sleep-awake cycle. So ditch the phone before bedtime!

Napping during the day can impact sleeping well at night.  If you feel a need to nap, do it earlier in the day and for no longer than 30 minutes. A nap longer than that puts you into a full sleep cycle and you may wake up groggy.

Medications can be useful but should be used in combination with Cognitive Behavioral Therapy for Insomnia.  If you have insomnia, then sleep aids like prescription medication and over-the-counter melatonin can be helpful for abbreviated periods of time. If you cannot sleep because of pain or spasms, then medications directly addressing those symptoms will help you sleep.

The Importance of Managing Your Sleep

Just as managing MS is a lifelong job, so is managing your sleep habits.  Not only will you feel better during the day and function better neurologically, but you may be beneficially impacting the course of your disease. A 2019 study found a link between the quality of sleep and the disease progression in MS patients. Sleep quality affects myelination. Myelin is the coating of the nerve cells in the brain and spinal cord that are damaged during a MS flare. Good sleep hygiene promotes more effective structural and functional recovery — which is orchestrated by the cells that create myelin. Source.

Focusing on self-care is essential for MS patients and one good place to start is getting a good night’s sleep.

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