Multiple Sclerosis and Insomnia

Sleep disorders underdiagnosed in people with MS

A senior woman dealing with insomnia.
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Fatigue is a common symptom of multiple sclerosis (MS) and one that can make even the most basic, everyday tasks seem difficult. In fact, people with MS often describe the experience as "crushing" or "draining" and report that their fatigue can affect everything from concentration to their ability to sleep at night.

It is this latter issue (having trouble sleeping) that causes concern among doctors and researchers alike, many of whom believe that insomnia, sleep deprivation, and other sleep-related disorders are grossly underdiagnosed in people with MS.

Causes of Insomnia in People With MS

One study, conducted by researchers at University of California Davis School of Medicine, reported that the rate of moderate to severe insomnia in people with MS was 38 percent, more than twice the national average. Moreover, 52 percent said that it took them more than an hour to fall asleep at night.

The researchers concluded uncontrolled or worsening MS symptoms combined with anxiety and depression were largely to blame. As such, the insomnia wasn’t considered a separate sleeping disorder but rather the consequence of the physical and emotional burden commonly experienced by people with MS.

Other contributing factors to sleep disturbances seen in those with MS include:

  • Certain hormonal irregularities which may cause breathing disruption and sleep apnea.
  • Disruption of dopamine and norepinephrine (which are neurotransmitters or chemical messengers in the brain) may result in narcolepsy and interfere with sleep patterns.
  • Napping in the daytime due to fatigue may lead to insomnia at night.
  • MS symptoms like restless legs, temperature dysregulation, and urinary control may also interrupt sleep.

Types of Insomnia

The causes and treatment of insomnia vary by the type experienced.

Initial Insomnia

Initial insomnia is defined as the inability or difficulty a person has in falling asleep.

In people with MS, initial insomnia may be caused by neuropathic or musculoskeletal pain as well as certain medications known to cause sleeping difficulties.

Middle Insomnia

Middle insomnia is when you awaken during the night and cannot fall back asleep. Ironically, people with higher daytime fatigue are more likely to experience middle insomnia. Other MS-related symptoms such as muscle spasms and nocturia (the urge to urinate at night) can also cause this effect.

Terminal Insomnia

Terminal insomnia is simply waking up too early. The cause of terminal insomnia in people with MS is not well-understood but some believe that a lack of exposure to daylight (particularly in those with depression) may contribute to this.

Treating Insomnia

While many people consider sleeping pills to be the first-line treatment of choice for insomnia, sleep medications have their downsides and limitations. All in all, while they may offer benefits over the short term, the drugs tend to lose their effectiveness quickly and are potentially addictive.

Other people turn to medical devices such as continuous positive airway pressure (CPAP) to treat sleep apnea and bright light therapy to treat circadian rhythm sleep disorders.

These conditions, though, need to be diagnosed by a healthcare professional first.

Beyond these types of medical interventions, there are things you and your doctor can do to address sleep-related disorders (and these are true regardless of whether or not you have MS):

  • Get plenty of natural light exposure during the day.
  • Go to bed and get up at the same time every day, including weekends.
  • Exercise regularly to improve sleep but don’t do it within four to six hours of your bedtime as it can overstimulate you.
  • Limit your caffeine, alcohol, and nicotine intake six hours before bedtime.
  • Stop drinking any fluids a couple of hours before going to bed.
  • Try to clear your mind when in bed. Avoid TV or electronic devices.
  • Keep the bedroom dark and the temperature cool.
  • Do not lie awake in the middle of the night. Get up, read a book, or do some other activity to settle your mind before returning to bed.

A Word From Verywell

If you are having sleeping difficulties and have tried simple measures like the ones mentioned above without much relief, be sure to talk with your neurologist. Together, you may be able to find the culprit behind your sleep problems like an MS medication or symptom that is causing or contributing to your insomnia.

That said, sometimes, a referral to a sleep specialist is needed to get to the root of the problem.

Source:

Brass, S.; Li, C.; and Auerbach, S. "The Underdiagnosis of Sleep Disorders in Patients with Multiple Sclerosis." Journal of Clinical Sleep Medicine. 2014; 10(9):1025-31.

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