Getting A Good Night's Sleep When You Have MS

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TROUBLE SLEEPING WITH MS
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By Mikel Theobald

Symptoms of multiple sclerosis -- from spasticity and restless leg syndrome to heat sensitivity -- are prime examples of why living with MS often gets in the way of a good night’s sleep.

Speak with your medical care provider about sleep issues, recommends Nicholas LaRocca, PhD, vice president of health care delivery and policy research at the Multiple Sclerosis Society. Don’t rely on over-the-counter medications or figure it’s something you just have to live with. “Self-management is important, but asking for help is equally important,” he says. A medical evaluation can help determine the best way to resolve your sleep problem.

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In the meantime, here are things you can do to prepare for a good night’s sleep:

  • Create an environment that's conducive to sleeping. “As much as possible, you want the bedroom to be reserved for sleep and intimacy,” says LaRocca. Take out the TV and put in room-darkening curtains. Turn your mattress if it feels worn and invest in comfortable pillows. Adjust the thermostat so that you're neither too cool nor too hot.
  • Avoid eating a large meal or drinking alcohol or caffeinated beverages close to bedtime. “Alcohol may make you feel drowsy, but it is a depressant, and after the initial drowsiness wears off, the nervous system rebounds and can be disruptive later on during the sleep cycle,” explains LaRocca.
  • Don’t take long naps in the afternoon. Settle for a catnap if you're feeling fatigued -- just long enough to feel rested, but not so long that you aren’t able to fall asleep at bedtime.
  • Try to create and stick to a bedtime routine. Go to bed at the same time every night. Wake up at the same time every morning. Programming your body to expect a certain schedule can help regulate your sleeping pattern.

If you still have problems falling asleep or if you still wake up feeling tired, try to identify the source of your sleep problems and discuss it with your physician. Here are some of the most common underlying issues.

MS And Sleep Issues: Anxiety
Feeling anxious can make it difficult to fall asleep. Dr. LaRocca recommends examining the root of such feelings. Is there anything you can do to change the problem? For instance, if your mind races at night, thinking of tasks you need to complete in the future, grab a notepad and jot them down, then relax your mind so that your body can follow suit. If your anxiety is caused by something you can’t change, such as the unpredictability of your MS symptoms, you will need to find ways to come to terms with it. Your multiple sclerosis doctor may suggest relaxation techniques, counseling, cognitive behavioral strategies or a support group as possible tools for helping you gain peace of mind and hopefully get the restful sleep you need.

MS And Sleep Issues: Muscle Spasms And Spasticity
The pain and sporadic movements of multiple sclerosis spasticity can cause multiple interruptions to your sleep cycle, frequently waking you. This type of fragmented sleep can leave you feeling exhausted in the morning. “Sometimes spasticity can be triggered by external stimulants -- something about the bed, pajamas or linens,” explains LaRocca. Identify and avoid possible triggers. Your MS doctor may prescribe medication, rehabilitation exercises, or a combination of both to help get a handle on spasticity so that you can sleep more soundly.

MS And Sleep Issues: Nocturia
Nocturia, or the need to urinate during the night, happens when bladder muscles are spastic, contracting when they aren’t supposed to and giving you the feeling that you have to urinate. “This is a medical issue that should be evaluated,” says LaRocca. “It can get complicated to determine which parts of the voiding apparatus are being affected and how best to treat [the problem]”. Your multiple sclerosis doctor may recommend occasional use of catheters or another treatment option. Botox has recently been approved for reducing hyperactive bladder. Also ask your doctor how much fluid you should be drinking and when. Don’t limit fluids so much that you become dehydrated, but do create a plan to taper off fluid intake before bedtime.

MS And Sleep Issues: Restless Leg Syndrome
Restless leg syndrome (RLS) is one of the most common sleep disorders for people with multiple sclerosis. The urge to move legs and the unpleasant sensations that accompany this urge typically occur at night or when legs are at rest. You can reduce the risk by avoiding alcohol before bed. Your MS doctor may prescribe medication to help ease symptoms so that you're able to sleep without frequent interruption.

MS And Sleep Issues: Periodic Limb Movements In Sleep
People who have RLS frequently also have periodic leg movements in sleep (PLMS), but having PLMS does not automatically mean a diagnosis of RLS. PLMS is a rhythmic movement of the lower extremities, bending at the hips, knees or toes during sleep. The constant movement can result in a less-than-ideal sleep cycle. LaRocca suggests working with your doctor to make sure that what you're experiencing is in fact PLMS and not spasticity. PLMS is diagnosed by a full night polysomnogram, testing that monitors your movement while you sleep. If you do have PLMS, there are medications and treatment options that can effectively treat the condition.

MS And Sleep Issues: Sleep Apnea
Sleep apnea should be taken seriously, says LaRocca. Medical treatments such as CPAP (a special breathing device and mask used while sleeping) or surgery may be necessary for moderate to severe cases. For those without sleep apnea who snore, or for those who have very mild sleep apnea, there are a few things you can do on your own to improve the flow of air to lungs while sleeping:

  • Side sleeping is a better sleep position than sleeping on your back to keep your airways open.
  • Avoid alcohol close to bedtime.
  • Try over-the-counter nose strips that help by keeping nostrils more open.
  • Lose weight.

MS And Sleep Issues: Depression
Depression is common in people with MS. A study published in the Multiple Sclerosis Journal found that people with MS are more likely to be diagnosed as clinically depressed, the most severe form of depression, than the general population. Depression is known to disrupt sleep in different ways. “For some people it causes them to not sleep as much," explains LaRocca. "In others, it causes early awakening.” Depression is not a sign of weakness. It is a medical condition that can be treated effectively with therapy, medication, or a combination of the two.

MS And Sleep Issues: Nervous System Damage
“Sleep is a fairly complex activity," LaRocca says. "For many people, just addressing an individual problem is not necessarily going to do the trick. There may be other factors involved.” Because MS is a neurological condition, it may not be a single symptom preventing you from sleeping soundly -- it could, for instance, be damage to the nervous system that is disrupting your sleep cycle.

If nothing else resolves the issue, your doctor may refer you to a sleep specialist to try to determine the root of the problem. During a session in a sleep lab, physicians can monitor your brain waves and breathing and gather other data to get a precise idea of what's happening when you sleep. Identifying any abnormalities can provide useful answers that will lead to proper treatment and an improved sleep pattern.

"Getting A Good Night's Sleep When You Have MS" originally appeared on Everyday Health.

For more on sleep, click here.

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