Sleep Issues

Sleep and MS

There is nothing like a good night’s sleep to restore oneself physically, mentally, and emotionally. Unfortunately, more than half of people with MS experience difficulty sleeping. Inadequate sleep leads to fatigue, the most common and one of the most debilitating symptoms of MS. It also causes daytime drowsiness, lack of mental clarity, and a reduced ability to use one’s resources to solve problems. Many possible causes of sleep problems for people with MS can be identified, including: bladder problems, depression, spasticity and frequent leg movements, difficulty changing position in bed, and poor sleep hygiene.

Causes of Sleep Problems in MS

Frequent Nighttime Urination

The need to urinate during the night, referred to as nocturia, is likely the most common culprit in sleep interruption for people with MS. Bladder problems are common in MS, and many people need to use the bathroom multiple times each night. Most people are able to regain sleep after getting up once, but it becomes increasingly difficult to sleep soundly when sleep is interrupted many times per night due to the need to urinate.

Fortunately, a number of solutions are available for urinary frequency in MS. Consulting with a urologist (a physician who specializes in urinary difficulties) is an important first step. If you are having nocturia and/or the frequent or urgent need to urinate during the day, ask your neurologist to refer you to a urologist experienced with patients who have MS, and who has experience treating the symptoms of a neurogenic bladder.

Strategies to Help: Some people with the frequent and urgent need to urinate restrict their liquid intake, but this is not a healthy practice and can lead to other problems. Drink normally during the day, but have your last drink about three hours before going to bed. Drinks with caffeine stimulate the bladder, so reduce your caffeine intake, or drink caffeinated beverages only in the morning. Alcoholic beverages often cause nighttime urination, so do not drink alcoholic beverages late at night.

Certain medications may help. Ditropan, Vesicare.

Depression

Depression interferes with one’s ability to sleep. One of the main symptoms of depression is poor sleep. “Early morning awakening” is a common sleep problem in people who are depressed. People with this problem are able to fall asleep, but they wake up in the early morning hours and are unable to get back to sleep. Knowing the other symptoms of depression can help you to determine if depression is interfering with your sleep. Common signs of depression include:

• Feeling low or down
• Poor appetite or overeating
• Low energy
• Low self-esteem
• Difficulty with attention and concentration
• Feeling hopeless

Strategies to Help: The best treatment for depression in MS is the combination of counseling and medication. 

Spasticity

Spasticity is a common symptom of MS, which is characterized by muscles becoming tight and sometimes even rigid. Spasticity can be very uncomfortable or even painful, and limb movements may be associated with spasticity as well. Pain from spasticity can interfere with sleep.

Sleeping Position

The human body was not designed to sleep in one position all night. Our skin and tissue experience a great deal of pressure from the weight of our bodies when we are asleep. We therefore must move and change position multiple times during the night. When we change position, we wake up briefly, but if we are good sleepers we fall right back to sleep and don’t even remember waking up. Some people with mobility problems due to MS have more difficulty moving around in bed at night. The pain and discomfort coming from the skin and tissues that are making contact with the bed can keep a person awake.

Strategies to Help: If turning in bed is difficult, install rails on one side of your bed, so you can use your arms to change position. Sometimes partners arrange to turn the partner who has MS during the night. You should take care not to cause your partner to lose too much sleep with the task of turning you in bed. Speaking to your neurologist or physical therapist about this problem can be very useful.

Sleep Hygiene

1. Use your bed only for sleep and sex
2. Reduce stimulant use (caffeine) later in the day; avoid alcohol use in the evening
3. Go to bed at the same time every night
4. Stop working, making phone calls, or participating in any stressful activity two hours before bedtime
5. Set your alarm clock for eight hours after bedtime
6. When you get into bed, think about pleasant memories from the past; try to remember more and more details
7. If you haven’t fallen asleep after 20 minutes, get out of bed
8. Once out of bed, sit in a comfortable chair in a quiet place and read something that is not stimulating; when you feel like you are ready to fall asleep, get back into bed, but repeat steps 6 and 7, as many times as needed
9. Discontinue napping during the day

With regard to alcohol, we know that drinking a small amount of an alcoholic beverage can help a person to fall asleep. What people often do not realize, however, is that alcohol has a “rebound” effect, causing people to wake up during the night. It also causes people to need to urinate more frequently during the night, another cause of lost sleep.

Working with a trained psychologist on your sleep hygiene program is advisable, as a program often needs to be individualized or “tweaked” for each person, and adjusted over time. When people have tried to improve their sleep hygiene and have been unable to improve their sleep, they sometimes use medication to help them sleep.