Symtom Awareness

Sleep Problems and MS
While sleep problems are seldom listed as a typical symptom of multiple sclerosis, most professionals who treat individuals with MS will agree that sleep problems are a common complaint. As studies continue to identify the effects of MS, sleep issues are becoming increasingly more recognized as a significant influence.

Susan Forwell, MA(OT)C, PhD (candidate) is an occupational therapist on faculty in the School of Rehabilitation Science at the University of British Columbia (UBC) in Vancouver. She is also a member of MSAA’s Healthcare Advisory Council. Ms. Forwell has been involved with a study at UBC that looked at fatigue in MS, which found sleep to be a major issue. The results of this study have been submitted for publication.

According to Ms. Forwell, “In this recent fatigue study, 58 percent of the cohort, which was made up of individuals with MS who identified fatigue as a problem, had sleep difficulties. Interrupted sleep was by far the biggest issue, and this could contribute to the fatigue experienced by the study participants.”

Ms. Forwell went on to explain that interrupted sleep may be caused by any one of a number of different factors. Physical symptoms are sometimes at fault, such as urinary frequency or muscle spasms. Social issues commonly interrupt sleep as well, and these might include children coming home late, pets making noise during the night, or a snoring spouse.

“Active solutions need to be individualized,” Ms. Forwell points out. “If urinary frequency is interrupting sleep, then a complete urinary workup needs to be done so the symptom may be treated medically. A prescription may be given and/or behavioral changes recommended, such as avoiding certain types of drinks and limiting fluids before going to bed. If social issues are to blame, members of the household need to think of solutions to minimize noise and other interferences that can disrupt an individual’s sleep.”

Some study participants also experienced insomnia, which is the inability to fall asleep initially or after waking up during the night. Depression, stress, or anxiety can all affect one’s ability to fall asleep. Medications can also play a role, as can other mood-altering substances, such has having a glass of wine before bed. While alcohol is thought to help someone relax, it can act as a stimulant and reduce one’s ability to sleep.

Please note that individuals experiencing sleep problems should visit their physician. Any changes in medications, fluid intake, or routine should only be done under the guidance of a medical professional.

Ms. Forwell views sleep as a critical issue for individuals with MS, one which can greatly affect quality of life, from enjoying a restful sleep at night to feeling refreshed during the day. She believes that further study of sleep problems with MS is greatly needed, and this will ultimately lead to better strategies for individuals with MS to get a good night’s sleep.

Many books and resources are available to help with overcoming insomnia. One is The Sleep Rx, written by Norman Ford and published by Prentice Hall. This book gives 75 tips for getting a good night’s sleep, and is available for loan through MSAA’s Lending Library.

While individuals should see their physician before making any changes to their medication or routine, The Sleep Rx offers some tips that anyone can try without the worry of affecting one’s health. Although the very first tip is to take a hot bath – something most people with MS must avoid – other tips include relaxation techniques, avoiding stimulants, and changing bedtime rituals.

For instance, keeping the house cooler, sipping warm milk, visiting the bathroom, dimming the bedroom lights, doing stretching exercises, and avoiding stimulating TV or reading (with exciting or violent stories and images) can all help before bedtime to encourage falling asleep faster. Throughout the day, limiting caffeine and alcohol, not smoking, limiting or avoiding daytime napping, and participating in moderate exercise (as recommended by one’s doctor), can all help to reduce insomnia.

Additionally, Ford recommends reserving one’s bed for sleeping and romance only. This way a person is programmed for these things when in bed, and not as likely to want to stay up to watch TV or have an evening snack in bed. Ford’s book also suggests getting a back and foot massage before going to sleep – or even rubbing one’s own feet to help feel relaxed. Finding ways to reduce anxiety, reading a dull book, and sipping on calming herbal teas are mentioned as well.

Once in bed and ready to sleep, Ford uses imagery to help promote relaxation. He suggests lying back and imagining the scenes, sounds, and smells of a tropical beach. Tightening each muscle group (such as one’s right arm or shoulders and chest) one at a time for a count of six, and then relaxing the muscles while exhaling, promotes further relaxation, followed by returning to the beach scene.
Once again, anyone experiencing sleep problems should consult his or her physician. For more information and tips for better sleep, please see p. 48 on how to borrow The Sleep Rx, or call MSAA’s Helpline at (800) 532-7667 for other resources. Many thanks to Susan Forwell for her help with this article.