What Sleep Disorders Occur in Multiple Sclerosis?

Insomnia, Sleep Apnea, and Restless Legs Are Highly Prevalent

A woman with multiple sclerosis lies awake due to insomnia
A woman with multiple sclerosis lies awake due to insomnia. PhotoAlto/Frederic Cirou/PhotoAlto Agency RF Collections/Getty Images

Sleep problems commonly occur, but they seem to be of increased prevalence among people with multiple sclerosis (MS). What sleep problems are most often seen in MS? What are the optimal treatment options for people with insomnia, sleepiness, or fatigue in MS? Learn about the relationship between MS and sleep disorders such as insomnia (sometimes related to depression), sleep apnea, and restless legs syndrome, and some of the best treatment options.

Multiple Sclerosis and Sleep Disorders

Multiple sclerosis is a chronic, progressive neurological disorder that leads to the accumulation of destructive demyelinating plaques within the nervous system, affecting the white matter of the brain and spinal cord. It can lead to a variety of debilitating symptoms, including episodic or progressive weakness, numbness, difficulty with balance or walking, and speech abnormalities. When advanced, it can lead to significant impairment, disability, and death.

In addition, people with multiple sclerosis have a higher incidence of sleep disorders than occur in others. The most common sleep problems include:

  • Insomnia

Difficulty falling or staying asleep, characteristic of insomnia, may occur in the setting of associated depression. Moreover, immobility and spasticity in multiple sclerosis may affect the ability to move at night. This may increase pain that disturbs sleep.

Problems with the bladder may lead to spasticity and bedwetting (enuresis) may occur.

  • Excessive Daytime Sleepiness and Fatigue

People afflicted with MS seem to have higher incidences of both excessive daytime sleepiness and fatigue. Sleepiness, or drowsiness, describes the desire and ability to fall asleep.

It may manifest with falling asleep in sedentary situations, such as while watching television or reading. This may lead to an increased tendency for both intentional and unintentional naps.

In addition, fatigue is increased. This is characterized by an overall sense of body tiredness, exhaustion, and low energy. It may not necessarily correspond to an ability to fall asleep. People with insomnia often complain of fatigue without having daytime sleepiness.

  • Obstructive Sleep Apnea

Daytime sleepiness may occur as a symptom of untreated obstructive sleep apnea. It seems that people with multiple sclerosis are at increased risk of sleep apnea. Sleep apnea has a number of important symptoms and consequences. It is often associated with snoring, pauses in breathing, waking to urinate, and teeth grinding (or bruxism).

It is possible that these sleep-related breathing disturbances occur more often due to impaired control of breathing, either due to affected respiratory muscles or to a loss of control within the brainstem leading to central sleep apnea.

  • Restless Legs Syndrome

There is also increasing evidence that people with MS are more likely to have restless legs syndrome (RLS). RLS is associated with an uncomfortable feeling in the legs when lying down at night associated with an urge to move that is relieved by movement. In one study that included 1,500 subjects, the prevalence of RLS was 19 percent in people with MS, compared to only 4 percent of those without it.

Treatment of Sleep Disorders in Multiple Sclerosis

Fortunately, many of the same treatments that are effective in people without multiple sclerosis are also effective in those with the condition. Insomnia may respond to the use of sleeping pills or cognitive behavioral therapy for insomnia (CBTI). Excessive daytime sleepiness may be relieved by treating the underlying condition. For example, treatment of sleep apnea with continuous positive airway pressure (CPAP) or restless legs syndrome with medications may be helpful. When sleepiness or fatigue persists, medications including amantadine and stimulants may be helpful in providing relief.

If you have multiple sclerosis and have difficulty sleeping at night or staying awake during the day, speak with your doctor about further evaluation and discover some of the effective treatments that may be helpful to you.


Bradley, WG et al. Neurology in Clinical Practice. Butterman, Heinemann, & Elsevier. 5th edition, 2008, p. 1987.

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