Miya Pearson
Sleep is critical for learning, memory, and problem-solving, and it is essential for the body's internal systems, including the heart, lungs, and hormones. Unfortunately, poor sleep is common in people with multiple sclerosis (MS), with about 50% of MS patients experiencing some form of sleep disturbance. This can be due to physical symptoms of MS, such as numbness, muscle spasms, and pain, or other conditions such as restless leg syndrome or sleep apnea. Sleep disorders are often underdiagnosed and undertreated in people with MS, but there are strategies and treatments that can help. For example, sleep medications like zolpidem (Ambien) or anti-anxiety medications like alprazolam (Xanax) can aid sleep. Additionally, establishing good sleep habits, also known as sleep hygiene, can improve sleep quality. In some cases, consulting a sleep specialist may be necessary to address complex sleep disorders.
| Characteristics | Values |
|---|---|
| Percentage of people with MS who experience sleep disturbances | 47%-50% |
| Sleep-related issues faced by MS patients | Involuntary twitches, kicking, muscle spasms, pain, frequent nighttime urination, sleepwalking, night terrors, difficulty changing position in bed, poor sleep hygiene, insomnia, narcolepsy, rapid eye movement (REM) sleep behaviour disorder, restless legs syndrome (RLS), periodic limb movement disorder (PLMD) |
| Medication | Ropinirole (Requip), pramipexole (Mirapex), zolpidem (Ambien, Ambien CR), eszopiclone (Lunesta), alprazolam (Xanax), gabapentin (Neurontin), modafinil (Provigil), dopaminergic agents, benzodiazepines, narcotics, anticonvulsants, anti-anxiety medications, antidepressants, stimulants |
| Other strategies | Regular sleep habits, maintaining a comfortable temperature, comfortable bedding, reducing noise, rails on the bed, turning the patient during the night, consulting a urologist, speaking to a neurologist or physical therapist, changing the timing of treatment |
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What You'll Learn
Sleep medications
Sleep is critical for learning, memory, and problem-solving, and can affect the body's internal systems, such as the heart, lungs, and hormones. Poor sleep is common in people with multiple sclerosis, with about 50% of people with MS experiencing some form of sleep disturbance. Six per cent of MS patients have a diagnosable sleep disorder, such as involuntary twitches and kicking, called a sleep-related movement disorder.
For sleep-related movement disorders, medications are usually the first line of defence. Dopaminergic agents like ropinirole (Requip) and pramipexole (Mirapex) are traditionally used for Parkinson's disease, but they increase dopamine, a neurotransmitter that regulates muscle movements. Benzodiazepines and narcotics may also be helpful for sleep-related movement disorders. Patients with narcolepsy also respond well to medication—usually stimulant and antidepressant drugs. In addition to pain meds (especially narcotics) and anticonvulsant drugs such as gabapentin (Neurontin), many MS patients take sleep medications like zolpidem (Ambien, Ambien CR), eszopiclone (Lunesta), and even anti-anxiety medications such as alprazolam (Xanax).
Modafinil (Provigil) promotes wakefulness and is approved for narcolepsy. Some patients with MS find it helpful. However, it is important to note that sleep medications can be addictive and impact sleep patterns for days after taking them. They may also interact with other prescriptions.
Some treatments for MS can cause side effects that affect sleep. For example, beta interferon DMDs (Rebif, Avonex, Plegridy, Extavia, and Betaferon) can affect sleep. Typically, the advice is to take them in the evening so you can sleep through the side-effects. However, if you find that you are not sleeping well, you might prefer to take them earlier in the day. It is important to speak to your doctor before making any changes to your medication.
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Sleep disorders
Sleep is critical for learning, memory, and problem-solving, and it also affects the body's internal systems, especially the heart, lungs, and hormones. Poor sleep is common in people with multiple sclerosis (MS), with about 50% of people with MS experiencing some form of sleep disturbance and 6% having a diagnosable sleep disorder. Sleep disorders in people with MS are often under-diagnosed and under-treated.
There are many reasons why MS patients may have trouble sleeping. Firstly, MS symptoms such as numbness, muscle spasms, and debilitating pain can make sleep difficult. Secondly, certain medications for MS, such as beta interferon DMDs (Rebif, Avonex, Plegridy, Extavia, and Betaferon), can cause side effects that affect sleep. Thirdly, other conditions common in people with MS, such as restless legs syndrome (RLS), sleep apnea, and rapid eye movement (REM) sleep behavior disorder, can disrupt sleep. Additionally, lifestyle factors such as stress, depression, and poor sleep hygiene can also contribute to sleep disturbances in people with MS.
To improve sleep in people with MS, a comprehensive approach is needed that addresses various factors. Here are some strategies that may help:
- Consult a sleep specialist or a urologist: If you have complex sleep disorders or frequent nighttime urination (nocturia), seeking specialized help is important.
- Treat other conditions: Work with your healthcare team to manage any other conditions that may be affecting your sleep, such as RLS, sleep apnea, or depression.
- Optimize your sleep environment: Ensure your bedroom is at a comfortable temperature, minimize noise, and consider bed rails or handles to assist with changing positions.
- Practice good sleep hygiene: Establish regular sleep habits, including a consistent sleep schedule. Avoid napping too much during the day to prevent nighttime insomnia.
- Medication adjustments: Discuss with your doctor whether alternative treatments or changing the timing of your medication could reduce side effects that interfere with sleep.
- Pain management: Treatments for pain, such as gabapentin, can improve nighttime pain and promote better sleep.
- Manage stress and worries: Techniques such as relaxation or meditation can help calm your mind and improve sleep.
- Exercise: Physical activity can help reduce the impact of MS-related disabilities on sleep.
In some cases, medication may be necessary to treat sleep disorders in people with MS. Medications such as dopaminergic agents (e.g., ropinirole or pramipexole), benzodiazepines, narcotics, or sleep medications like zolpidem or eszopiclone may be prescribed to help with sleep-related movement disorders or insomnia. However, it is important to be cautious about the addictive nature of these drugs and their potential impact on sleep patterns.
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Lifestyle factors
Sleep Hygiene
Maintaining good "sleep hygiene" is essential for MS patients. This includes establishing regular sleep habits, such as a consistent sleep schedule, and creating a relaxing bedtime routine. If lying awake, it is recommended to get up and engage in a calming activity before returning to bed when feeling sleepier. Additionally, paying attention to factors like temperature, noise levels, and bed comfort can improve sleep quality.
Circadian Rhythm Disorders
Abnormalities in melatonin production can disrupt the body's natural sleep-wake cycle, leading to insomnia or daytime sleepiness. MS patients experiencing circadian rhythm disorders may benefit from consulting a sleep specialist to address these issues.
Restless Legs Syndrome (RLS)
RLS is a common issue for MS patients, causing unpleasant sensations in the legs and an urge to move them, especially at night. This can disrupt sleep and lead to poor sleep quality. Treatments for RLS may include medications or physical therapy to manage symptoms and improve sleep.
Nocturia
Nocturia, or frequent nighttime urination, is a significant cause of sleep interruption for MS patients. Bladder problems and the need to urinate multiple times during the night can disrupt sleep patterns. Consulting a urologist experienced in treating MS patients with urinary difficulties can help address nocturia and improve sleep.
Stress and Depression
The stress and depression accompanying MS can significantly impact sleep quality. Managing these factors through support groups, therapy, or medication can help improve sleep and overall well-being.
By addressing these lifestyle factors and working closely with their healthcare team, MS patients can improve their sleep quality and manage their symptoms more effectively.
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Treatment side effects
Sleep is critical for learning, memory, and problem-solving, and can affect the body's internal systems, such as the heart, lungs, and hormones. Poor sleep is common in people with multiple sclerosis, with about 50% of people with MS experiencing some form of sleep disturbance. Beyond the physical symptoms of the disease, 6% of MS patients have a diagnosable sleep disorder.
Some treatments for MS can cause side effects that affect sleep. For example, the beta interferon DMDs (Rebif, Avonex, Plegridy, Extavia, and Betaferon) can cause side effects that may disrupt sleep. Typically, the advice is to take them in the evening so that patients can sleep through the side effects. However, if patients find that they are not sleeping well, they may prefer to take them earlier in the day.
Other treatments, such as dopaminergic agents like ropinirole (Requip) and pramipexole (Mirapex), are traditionally used for Parkinson's disease but can also be prescribed for sleep-related movement disorders in MS patients. While these medications can help regulate muscle movements, they may also have side effects that impact sleep patterns.
Additionally, medications for pain, such as narcotics and gabapentin, can be beneficial for managing pain and promoting better sleep in MS patients. However, these medications may also have side effects, and their effectiveness may wear off within six hours for most people. This can lead to a cycle of lying awake at night and struggling to stay awake during the day.
It is important for MS patients to discuss any sleep issues with their healthcare providers. They may be able to offer alternative treatments or suggest changes to the timing of treatment to minimize the impact on sleep. Finding ways to improve sleep quality can help manage MS symptoms and improve overall health and well-being.
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Sleep specialists
In addition to medical treatments, sleep specialists can provide guidance on sleep hygiene and sleep habits. This includes advice on the optimal temperature for sleep, the importance of a comfortable and supportive bed, and strategies for managing noise or light disturbances. For patients who experience difficulty turning in bed due to MS-related mobility issues, specialists may recommend installing rails on one side of the bed to facilitate position changes.
For complex sleep disorders, a sleep specialist can provide comprehensive care that takes into account various factors affecting sleep. This may include addressing stress and depression, which are common in MS and can impact sleep quality. Sleep specialists can also help identify and treat other conditions that may be contributing to sleep disturbances, such as restless legs syndrome (RLS), sleep apnea, or rapid eye movement (REM) sleep behavior disorder.
In summary, sleep specialists play a crucial role in helping MS patients improve their sleep quality by addressing both MS-related symptoms and other factors that impact sleep. Their expertise enables them to provide tailored advice and medical treatments to promote better sleep, which can ultimately enhance overall health and well-being in this vulnerable population.
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Frequently asked questions
Some medications that MS patients can take to help them sleep include dopaminergic agents like ropinirole (Requip) and pramipexole (Mirapex), zolpidem (Ambien, Ambien CR), eszopiclone (Lunesta), and anti-anxiety medications such as alprazolam (Xanax).
Non-medical strategies that may help MS patients sleep include installing rails on one side of the bed to help with changing position, speaking to a neurologist or physical therapist about sleep issues, and improving sleep hygiene by maintaining a regular sleep schedule, optimizing the bedroom temperature, and reducing noise.
Common sleep disorders associated with MS include insomnia, sleep-related movement disorders, sleep apnea, restless legs syndrome (RLS), and rapid eye movement (REM) sleep behavior disorder.
