A to Z of MS
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A to Z of MS Sleep
Poor sleep is common in people with multiple sclerosis, with about 50% of people with MS reported to experience some form of sleep disturbance.
Poor sleep quality and quantity can impact on daily life, causing daytime sleepiness, decreased concentration and memory, worsening depression, and the inability to work effectively. A lack of sleep can also lead to low energy levels or make fatigue (and other symptoms of MS) much worse.
The types of insomnia that people with MS may experience include difficulty falling asleep, difficulty maintaining sleep (such as waking up during the night or not being able to fall back asleep immediately) and early wakening.
By addressing the causes of the poor sleep quality and establishing good daily sleep habits, people with MS can greatly improve overall energy levels and quality of life.
Causes of sleep disturbance in MS
There can be many reasons why getting good quality sleep is difficult:
- MS related symptoms that make sleep difficult or interrupted. These include:
- pain (neuropathic or musculoskeletal)
- restless legs syndrome
- anxiety and/or depression
- side effects of certain medications
- nocturia (the urge to urinate frequently at night)
- sleep apnoea (abnormal pauses in breathing)
- high levels of daytime fatigue.
- Family responsibilities that mean less time available for sleep
- Concerns and worries that make it difficult to 'switch off' and drift into sleep or produce restless sleep
- Being less active, which can alter sleep patterns as can a lack of exposure to daylight.
Treatment and management
Sleep disturbance may be due to a variety of symptoms related to MS and many of those symptoms are treatable or may be improved by changing medications or altering the time the treatment is taken. For example, treatment options for pain can include medications such as gabapentin, which has been shown to improve nocturnal pain and also promote restorative sleep.
General tips improving sleep quality
Sleep quality can be improved by establishing regular habits or good 'sleep hygiene':
- try to stay as physically active as possible during the day, but allow plenty of time to wind down before bedtime
- avoid getting overtired by doing too much, as being too tired can make it difficult to get to sleep
- ensure some daily exposure to sunlight and avoid bright lights in the evening
- avoid unnecessary stress or stimulants (eg caffeine, chocolate, alcohol) in the late afternoon and evening
- keep the same nightly ritual every day throughout the week
- establish a bedtime routine that can include, for example, relaxation, a warm 'milky' drink, taking a warm bath
- only use the bed as a place for sleeping, not for other activities such as watching TV
- instead of lying in bed awake, after 15 minutes of not sleeping get out of bed and do something calming or boring, and return after a short period of time
- avoid getting too hot; although some people find having cold feet can also disturb sleep
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