MS and Insomnia: How to Break the Cycle

Practice healthy sleep habits

Woman with insomnia using laptop in bed
Peter Dazeley/Getty Images

The fatigue that comes with MS can have a very special “crushing” quality to it, making even simple endeavors feel difficult. While there are many reasons for this fatigue, poor sleep quality and quantity make fatigue (and other symptoms) much worse.

A 2014 study published in the Journal of Sleep Medicine showed that sleep disorders and deprivation are largely undiagnosed in people with MS; 38 percent of participants in this study had moderate to severe insomnia, and 52 percent said it took them more than an hour to fall asleep.

Yet only 4 or so percent of them reported being diagnosed with a sleep disorder by a physician. While it's important to note that insomnia in people with MS is often the result of uncontrolled or worsening symptoms (and the anxiety and depression caused by them) and not a separate sleep disorder, it is nonetheless important to be treated for those physical symptoms, the insomnia, or both, so that you can get the restful sleep you need. 

By improving sleep habits and addressing the causes of poor sleep, you can do a great deal to increase your overall energy levels. 

MS Insomnia Types 

There are a variety of reasons why people with MS have difficulty falling asleep and staying asleep. These include:

Initial Insomnia: Difficulty falling asleep at night. MS-related neuropathic or musculoskeletal pain and the anxiety it causes may make it difficult to fall asleep. Pain is not just an unpleasant sensory experience — it's also an unpleasant emotional one, as defined by the International Association for the Study of Pain.

Some side effects of medication can also cause you to have difficulty falling asleep.

Middle Insomnia: Waking up during the night and not being able to fall back asleep. Ironically, people with higher levels of daytime fatigue tend to experience middle insomnia, but the causal relationship is unclear.

Middle insomnia is also caused by nocturia (the urge to urinate frequently at night), a very common form of bladder dysfunction. Muscle spasms and pain can also wake a person in the middle of the night.

Terminal Insomnia: Waking up too early. The causes of terminal insomnia in MS patients are not well-understood, though lack of exposure to daylight can contribute to not sleeping long enough.

Build Healthy Sleep Habits 

There are many steps you can take to develop nighttime habits that support restful sleep with MS. All of these apply to the general population as well, as they are necessary elements of good sleep hygiene. They include: 

  • Getting exposure to natural light during the day
  • Avoiding caffeine, alcohol, and nicotine in the late afternoon and evening
  • Getting daily exercise, even if it's just taking a walk around the block
  • Having a bedtime routine that includes relaxation, such as meditation, writing in a journal, or listening to music
  • Avoiding watching TV or using electronics in bed
  • Keeping the same sleep schedule every day, including weekends
  • Not lying in bed awake; rather, getting up after 15 minutes of not sleeping (even if it's in the middle of the night, read a book or do another activity you find relaxing until you feel the urge to sleep)

    Try These MS-Specific Tips

    Stop drinking fluids a couple of hours before bed. This can help stave off multiple trips to the bathroom in the middle of the night. Make sure to still drink 6-8 cups of fluid a day. 

    Keep cool. I notice that I sleep horribly if I am too hot. While this is common for many people, those of us with MS are especially sensitive to heat. I know that the hotter I get, the “twitchier” and more anxious I tend to be. 

    Wear socks to bed. Though this may seem to contradict my last point, I almost always wear socks to bed, even in the summer. I often have the sensation that my feet are really cold (even if they are not), especially when I am experiencing numbness in my feet and legs.

    If you have this too, try keeping socks on. 

    Try acupuncture, biofeedback, or massage therapy. All of these have been shown to have a favorable impact on pain and insomnia. 

    Don't overstimulate yourself at night. Whether it be through rehashing the challenges you faced today, obsessing over your symptoms or a new medical bill, or even giving yourself your injections at night (especially if it doesn't go perfectly), overstimulating activities are not the best way to transition into bedtime. Instead, do these tasks during daylight hours and use the evenings to focus on yourself (While your injection is part of taking care of you, I wouldn't deem it part of "self-care"). Read a juicy book you've been meaning to, cuddle with your spouse, or draw in an adult coloring book (very popular these days). Ensuring you have adequate time to decompress at the end of the day will help you nod off quicker. 

    Work With Your Physician 

    As you work to incorporate these strategies into your routine, discussing any symptoms that are impeding your sleep with your doctor is absolutely crucial. Changes to your medications can be made to better control pain, bladder dysfunction, and many of the other symptoms of MS, so that you can rest easy again. It may be a bit of a process, but hang in there; a good night's sleep is right around the corner. 


    Brass S et al. The Underdiagnosis of Sleep Disorders in Patients with Multiple Sclerosis. Journal of Clinical Sleep Medicine. 2014. Volume 10 No. 09

    Stanton BR. Barnes F. Silber E. Sleep and fatigue in multiple sclerosis. Multiple Sclerosis. 2006; Volume 12, Number 4, pp. 481-486(6).


    Continue Reading