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Sleep and MS


Updated June 20, 2014

As most of you with multiple sclerosis (MS) know first-hand, the fatigue that comes with MS has a very special, “crushing” quality to it, making even simple endeavors seem huge. While there are many reasons for this fatigue, poor sleep quality and quantity make fatigue (and other symptoms) much worse.

By improving sleep habits and addressing the causes of poor sleep, we can do a great deal to increase our overall energy levels. In a recent study of 60 patients with MS, about 50 percent reported some form of sleep disturbance or insomnia.

Insomnia and MS

People living with MS experience several different kinds of insomnia, such as:
  • Initial Insomnia: Difficulty falling asleep at night.
  • Middle Insomnia: Waking up during the night and not being able to fall back asleep quickly.
  • Terminal Insomnia: Waking up too early.

Causes of MS-Related Insomnia

There are a variety of reasons why people with MS have difficulty falling asleep and staying asleep. These include:
  • Initial Insomnia Causes: Anxiety and/or pain may make it difficult to fall asleep. Some side effects of medication can also cause you to have difficulty falling asleep.
  • Middle Insomnia Causes: 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: 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.

Getting a Good Night’s Sleep

You can improve your chances of getting a good night’s sleep by establishing good daily sleep habits, which include:
  • Exposure to bright lights during the day
  • Avoiding caffeine, alcohol and nicotine in the late afternoon and evening
  • Getting daily exercise
  • Having a bedtime routine that includes relaxation
  • Avoiding reading or watching TV in bed
  • Have the same sleep schedule every day, including weekends
  • Not lying in bed awake; rather, getting up after 15 minutes of not sleeping

Additional Tips

From my own experience, I will offer the following observations and things to try:
  • Keep Cool: I notice that I sleep horribly if I am too hot. While this is common for many people, people with MS are especially sensitive to heat. I know that the hotter I get, the “twitchier” and more anxious I tend to be. However…
  • Wear Socks to Bed: I almost always wear socks to bed, even in the summer, as 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.
  • Give Your Injection In The Morning: I don’t know about you, but I do not find “shot time” to be the most relaxing thing to help me transition into bedtime, especially if it doesn’t go perfectly. Also, I have found that my injection-site reactions tend to be worse after nighttime injections, as I think the medicine doesn’t get dispersed as well if I just go to bed afterwards. My sites tend to get really hot and itchy and often this sensation wakes me up. (Of course, disregard this advice if you take your interferon-based therapy at night to avoid some of the flu-like side effects.)


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

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