How to Get Better Sleep with MS

Getting quality sleep is important, both for managing MS and for your overall health. Here’s what to know about sleep and MS, including tips for getting better sleep despite your symptoms.

How Does MS Affect Sleep?

Like other people, most adults with MS should aim to get about six to eight hours of quality sleep each night. But MS can interfere with sleep in multiple ways.

“If you have MS lesions that are affecting areas of the brain that impact the sleep-wake cycle, that has a direct impact on sleep,” explains Catherine Siengsukon, Ph.D., director of the Sleep, Health & Wellness Laboratory and co-director of the multiple sclerosis STEP UP program at the University of Kansas Medical Center in Kansas City.

Specific symptoms can also affect sleep, adds Kathy Costello, a certified registered nurse practitioner and vice president of programs at Can Do Multiple Sclerosis, in Avon, Colorado. Those include:

• Bladder issues. Frequent nighttime bathroom visits are one of the most common reasons for sleep disruptions in people who have MS. “Turning on lights to ensure safety on the way to the commode is important, but bright light can also disrupt the ability to fall back to sleep after emptying the bladder,” adds Costello.
• Neuropathic pain. “This is generally described as a burning sensation or shooting pain sensation that can occur anywhere but is often experienced in the arms or legs,” Costello says. “When other stimuli are reduced—such as when trying to fall asleep—pain sensation may feel worse and interfere with falling or staying asleep.”
• Spasticity or spasms. “Tight muscles (spasticity) can be painful and can make positioning in bed challenging, and both can interfere with sleep,” Costello says. “Spasms (muscle cramps) can also be quite painful and interfere with sleep.” For many people with MS, these symptoms are worse overnight when movement is reduced.
• Mood issues. Depression is one of the most common complications of MS, and the unpredictable nature of MS often leads to feelings of anxiety. Both depression and anxiety are known to interfere with falling and staying asleep, Costello says.
• Heat sensitivity. Many people with MS are sensitive to heat. “It’s often comforting to snuggle under the covers, but this can provoke overheating later during the night, which can cause you to wake up,” explains Costello. Then, it can take some time to cool down enough to fall back asleep.

When they interfere with sleep, these factors can all contribute to fatigue—one of the most common and debilitating MS symptoms. And while daytime napping may help with fatigue in the short term, it can also make it more difficult to get quality sleep at night.

Meanwhile, research also shows that certain sleep disorders are more common in people who have MS, including:

• Insomnia
• Narcolepsy
• Nocturnal movement disorders (like restless legs syndrome or periodic limb movement disorder)
• Rapid eye movement (REM) sleep disorders
• Sleep apnea

Not to mention, certain MS medications, including disease-modifying therapies as well as medications that are used to treat specific symptoms, may come with side effects that could affect your ability to wind down and get a good night’s sleep.

The Importance of Good Sleep If You Have MS

Sleep is important for everyone’s overall health, but a good night’s sleep is especially important for people who have MS.

“When you're not sleeping well, that can exacerbate anxiety and depression; it can impact your ability to cope with things that are stressful; it can impact cognitive function,” Siengsukon says. “If you're feeling tired and fatigued, then you're going to be less active [and] make poorer food choices. So, there's definitely all these downstream consequences when you're not sleeping well that can be particularly impactful for people with MS.”

Among these consequences of sleep deprivation are pseudo-relapses, where people with MS feel that their symptoms worsen.

While lack of sleep can cause issues, prioritizing quality sleep can have positive effects on MS, notes Costello. Those include:

• Improved mood. Research suggests that quality sleep boosts mood, and improved mood may in turn lead to better sleep quality.
• Enhanced memory. “During sleep, processes in your brain occur that make memories stick. People getting sufficient sleep have better recall and generally feel mentally sharp,” Costello says. “Poor sleep, on the other hand, can increase the feelings of fogginess. While cognitive problems in MS are related to damage from the disease itself, these issues can feel worse when sleep is challenged.”
• Reduced inflammation. Multiple sclerosis is characterized by inflammatory attacks on the central nervous system. Lack of regular, quality sleep has been shown to increase inflammation, whereas consistently getting good sleep can help lower inflammation.

How to Get a Good Night’s Sleep

Certain lifestyle habits can really help you set yourself up for a better night's sleep. “Sometimes, using sleep promotion techniques helps you get to sleep easier and quicker and in a deeper stage of sleep; then you wake up less often,” Siengsukon says.

Start with these strategies:

• Go to bed and wake up at around the same time every day, even on days off from work or school.
• Get daily sunlight exposure in the morning to help establish healthy, regular sleep-wake cycles.
• Stick with a regular wind-down routine before bedtime that incorporates relaxation techniques.
• Use your bedroom for sleep and sex only.
• Avoid screen time and strenuous exercise in the hour before bedtime.
• If you have trouble falling asleep after 20 minutes, get out of bed and do something relaxing until you’re feeling sleepy.
• Avoid large meals, alcohol, caffeine, and nicotine use in the four hours before bedtime.

6 Sleep Tips for People with MS

Know that many of these common sleep promotion techniques can sometimes be difficult for people with MS because of the symptoms, says Siengsukon. “So, there are specific things that we might recommend for people with MS.” Those recommendations include options like the following.

Be Mindful of Fluid Intake

“Avoid fluids about two hours prior to bedtime to reduce nighttime bladder awakenings,” Costello says, noting the importance of avoiding irritating substances like caffeine or alcohol. She adds that “medication or other intervention may be needed” if bladder urgency is persistent.

Customize Your Thermostat

Finding the right bedroom temperature for you can help with MS-related heat intolerance. “It’s generally recommended to keep your bedroom at a cool temperature,” Siengsukon says. “A comfortable temperature is really probably the more important thing—you don't want to be too hot, and you don't want to be too cold. Usually, slightly cool is what we recommend.”

Practice Daytime Stretching

If spasticity keeps you up at night, consider enlisting the help of a physical therapist to develop a stretching routine that can help, or talking to your doctor about medication to help with spasticity. That said, Costello calls for patience: “It may take time to get on the best treatment plan for you.”

Adjust Your Napping Habits

“For some people with lots of MS fatigue, napping is part of a daily routine,” Costello says. “Shortening or eliminating naps can be a challenge.” Where possible, try scheduling naps earlier in the day to prevent issues with nighttime sleep.

Try to Stay Groggy If You Need to Get Up

For some people, nighttime awakenings are unavoidable. “If you do have to get up to go to the bathroom, make it so that you can get up quickly and easily, get to the bathroom safely, and then get back into bed quickly and easily and with as little stimulation as possible—that way you can fall asleep again,” Siengsukon says.

For example, if needed, use a nightlight—but keep it as dim as possible while still being useful to help light a safe path, Costello says.

If you’re dealing with MS-related mobility issues, getting out of bed when you’re having trouble falling asleep can be easier said than done, Siengsukon notes. You can also investigate alternatives that don’t require navigating around the house at night, like a bedside commode, Siengsukon says.

Enlist Help

If MS is affecting your cognition or motor skills, it may be difficult to implement some of these sleep tips, notes Siengsukon. “[In that case] it can be very important to include the bed partner, if there is one, or the caregiver,” she says.

Talk to Your Doctor About MS and Sleep

If you’re experiencing sleep issues, speak up. “Oftentimes, people with MS say, 'Oh, I just thought it was part of my MS,’ or ‘I thought it was just a part of getting older. I didn't realize there was anything I could do about it,’” says Siengsukon.

But that’s not necessarily true.

“Talk with your healthcare provider if you’re having sleep difficulties, because there may be something that could be done to help you sleep better,” she explains, “which then could have a positive impact on your health and well‑being in a more global sense.”

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