Insomnia and MS: Expert Approaches to Better Sleep

Feeling fatigued? Take a look at how multiple sclerosis can affect your sleep and the actions you can take today for a more restful night.

Getting better sleep is one of the most important ways to thrive with multiple sclerosis (MS).

“Sleep is a game-changer in terms of quality of life,” says Julie Fiol, RN, director of MS information and resources for the National MS Society.

It’s vital to promoting healthy cognitive function, mental health, cardiovascular and muscle capacity, and energy levels. However, many people with MS struggle with sleep — around 80 percent report dealing with fatigue.

Of course, good sleep hygiene, including a regular sleep schedule, avoiding devices before bed, and creating a restful space, is important in the quest for good sleep. But if you have MS, you need more than just good sleep hygiene on your side.

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Multiple sclerosis and insomnia: Connections

Insomnia refers to trouble falling asleep or staying asleep. You may experience trouble falling asleep at bedtime, waking in the middle of the night, or waking early in the morning and feeling unable to go back to sleep. You may feel like even when you have slept, you do not feel rested. All these factors can lead to fatigue during the day.

There are many reasons why people with multiple sclerosis are more likely to experience insomnia. It’s possible that since lesions can affect any and all areas of the brain, MS may directly impact circadian function and sleep quality, explains Dr. Kapil Sachdeva, a clinical neurophysiologist at Northwestern Medicine Central DuPage Hospital.

MS-fueled issues, such as pain, muscle spasticity, urinary frequency, mood changes, and restless legs syndrome may also frequently contribute to tossing and turning.

Sachdeva adds that many medications used in the management of MS can further inhibit sleep. 

How can you improve sleep when living with MS?

With so many factors at play, it’s important to not just address your sleep symptoms but also determine what’s actually triggering them. And that’s going to be different for everyone.

Sachdeva stresses the need to communicate all your symptoms and concerns to your specialist so that, together, you can create a comprehensive sleep plan that’s right for you.

What might your plan include? Here are some possible ways to take on your sleep challenges to improve your sleep, health, and life.

Talk with a mental health expert

Depression is one of the most common effects of MS, according to Fiol, and is a common contributor to insomnia, or an inability to fall or stay asleep. However, help is available.

While you can do a lot on your own to encourage your mental and emotional health — such as practicing good self-care, spending time engaged in meaningful experiences, and investing in personal relationships — it can be incredibly beneficial to also consult a professional, Sachdeva says.

Options include:

• talking with a psychologist
• discussing medication options with a psychiatrist
• working with a cognitive behavioral therapist

Cognitive behavioral therapy is a form of talk therapy that’s focused on challenging and adjusting unhelpful thought patterns into more useful ones.

“Cognitive behavioral therapy is really going to touch on so many of the issues that could be contributing to poor sleep,” Fiol says. For example, CBT can promote improved pain management, reduced depressive symptoms, and lower anxiety levels.

Moreover, a 2020 study shows that cognitive behavioral therapy for insomnia (CBT-I) reduces the severity of insomnia, improves sleep quality, and reduces levels of fatigue.

Reach out to your MS specialist or health insurance company to find a cognitive behavioral therapist who fits your needs. Keep in mind that many offer telehealth services and virtual visits.

Find physical activities that fit your needs

According to a 2019 study, exercise can safely and effectively improve sleep quality in people with MS.

But when levels of fatigue and other physical symptoms of MS are high, and levels of physical function are low, it’s natural to not want to exercise or to get frustrated with workouts.

However, Fiol stresses that no matter the situation, you can integrate forms of appropriate movement into your day. For example, cane-assisted and seated exercises are effective options during attacks or when physical abilities are limited, and there’s no minimum dose of movement you need to make a positive impact on your sleep.

Every bit helps.

Focus on small, doable changes, such as taking a few daily laps down the hallway and back again, waking up in the morning with a 10-minute yoga flow, or doing some arm circles to break up long computer stints. Even short bursts of exercise can have benefits.

The goal isn’t pain or muscle soreness — it’s to get the blood flowing, release some feel-good endorphins and neurotransmitters, and help your brain best program its sleep cycles.

For the best effects, try to schedule your activity at least a few hours ahead of bedtime, Sachdeva says. If you notice feeling too revved up for sleep because of your workouts, try moving them earlier in the day.

Take a multidisciplinary approach to pain management

“Pain, burning sensations, and muscle spasticity seem to flare up for most people at night,” Fiol explains. “It’s possible that pain levels can change throughout the day, but it’s also possible that people are less distracted at night and thus more aware of discomfort and symptoms.”

Before turning to opioids or pain medications, she recommends talking to your doctor about other options and not limiting yourself to medication only.

Fiol notes that acupuncture, massage, mindfulness meditation, and physical therapy can all influence pain and its contributors.

Nerve-block and Botox injections can alleviate localized pain and muscle spasticity.

Lastly, many non-pain medications, such as antidepressants, can also be used to change the way the body processes pain signals, Sachdeva says.

“I meditate before I go to sleep. I wake up 2 or 3 times during the night, so I meditate some more until I doze off again. It has helped me relax.” — Anonymous

See more sleep tips from Bezzy MS members: 6 Tips to Fall Asleep and Stay Asleep with MS.

Get your bladder and bowels under control

Bladder and bowel dysfunction are common in MS. If you have a frequent and urgent need to go, long bouts of continuous sleep can feel impossible.

Limiting caffeine and alcohol intake, not smoking, avoiding greasy foods, and not eating or drinking anything within a couple of hours of bedtime can all help, Sachdeva says. There are also exercises to strengthen your bladder and improve bladder control

You can also talk with your doctor about your bladder or bowel issues. For example, if you’re taking any medications that can increase urine output, your doctor may suggest taking it in the morning instead of at night, Sachdeva says, adding that you also shouldn’t hesitate to reach out to a urologist or gastroenterologist for additional assistance.

They can help identify food intolerances, underlying digestive issues, and help you with methods to fully empty your bladder and bowels when you use the restroom, he says.

Registered dietitians can also be a great resource when trying to optimize your diet for GI health.

Check your vitamin levels

Low vitamin D levels and vitamin D deficiency are risk factors for both developing MS and advancing symptoms. They’re also associated with insomnia.

Meanwhile, many people with MS report having restless legs syndrome, which can be related to iron deficiencies, Sachdeva says.

The exact link isn’t known, but if you have frequent sleep troubles or restless legs syndrome, it could be worth having your vitamin levels checked with a simple blood test.

If your levels are low, your doctor can help you figure out how best to improve your levels through dietary and lifestyle modifications. 

For example, while iron is found in foods such as red meat and beans and vitamin D in dairy and green, leafy vegetables, the body produces the bulk of its vitamin D through exposure to sunlight.

Iron deficiency anemia, in which the body lacks sufficient red blood cells for transporting oxygen throughout the body, can also cause extreme fatigue. According to research, anemia is strongly associated with MS.

Depending on the severity of any deficiency, supplementation may be necessary but do not add a supplement routine before first consulting your doctor.

The bottom line

If MS symptoms have made it feel impossible to get the shut-eye you need, you don’t need to feel hopeless.

Getting to the bottom of why you’re struggling and taking some simple steps can help you hit the hay and feel better for it the next day.