Poor sleep is linked to some of the most common MS symptoms; this includes the symptoms that are the focus of My MS Toolkit: Pain, emotional changes, brain fog (cognitive issues that affect thinking) and fatigue.

• Pain There may be a back and forth between pain and poor sleep in MS. People living with MS report that pain and spasticity can sometimes interfere with sleep. And, on the flip side, poor sleep can make pain feel worse. Over the long term, consistently poor sleep can even contribute to the onset of chronic pain.
• Emotional changes e.g. low mood/depression The link between emotions and sleep in MS is well established. Feeling anxious or upset or low mood can make it harder to get good quality sleep, and poor sleep can make it harder to maintain a positive mood during the day. Long periods of poor sleep can also cause the onset of depression and anxiety.
• Brain fog People living with MS often have problems with thinking, such as foggy or slow thinking, and problems with memory, concentration, or finding the right words when speaking. While these problems are often chalked up to having MS, sleep has a strong influence on thinking ability and links between poor sleep and performance on cognitive tests has been shown in MS.
• Fatigue Fatigue is one of the most common symptoms of MS. Approximately 90% of people living with MS report significant fatigue that interferes with daily life. Fatigue can be experienced as mental (or cognitive) fatigue, physical fatigue, or emotional fatigue. Although MS fatigue is different from the sleepiness or tiredness from a lack of sleep, poor sleep can make you feel more fatigued.

Getting enough sleep – and the right kind of sleep – may help you manage the symptoms of MS.

Some barriers to good sleep require that you work together with your healthcare professional. For instance, you should talk to your healthcare team if things like muscle spasticity, needing to urinate frequently during the night, or your medications are interfering with your sleep.

As well as working with your healthcare team, there are things that you can do to help yourself get a good night’s sleep. Changing your sleeping habits may be key to improving your sleep. Use the Sleep Work Sheet to help you and your healthcare professional make a plan for improving your sleep habits.

• Get into or stay in bed only when you are tired. Forcing yourself to stay in bed or fighting with your body to fall asleep may only make things worse.
• Get out of bed if you are not asleep after 15 minutes. If you have not fallen asleep in this time, your body isn’t ready to sleep yet. Go into another room and do something quiet, such as reading or listening to music. Go back to bed when you start feeling sleepy.
• Reclaim your bed for sleep. Try to avoid other activities, such as reading, eating, or watching TV in bed, if possible.
• Try not to watch the clock. Watching the time pass and worrying about how much time you have left to sleep may make it more difficult to fall asleep. Turn your clock toward the wall so you can’t focus on the time.
• Avoid stimulating activities before going to bed. For example, do not watch action movies or get into conversations or projects that may upset or excite you. Although exercise can help you sleep better, avoid exercising in the hour or two before you intend to go to sleep.

It can be hard to change your sleep habits, but there are steps you can take to help your body adopt new habits.

To help you start and stick with a sleep routine, try to:

• Follow a schedule, even on weekends.
• Go to bed at the same time each night, even if you don’t feel tired yet, so your body gets used to a regular sleep pattern.
• Get up at the same time every morning even if you didn’t sleep well the night before. This helps reinforce your regular sleep pattern. Use an alarm clock to help you wake up.
• Avoid napping a lot during the day. While you may need to nap a little during the day, napping for more than 30 to 60 minutes may disrupt your night-time sleep pattern. Although it may be difficult to change your napping habits, consider whether your daytime naps are making it harder for you to feel completely rested.

Set up your bedroom to help you sleep:

• Try to keep your room at a comfortable temperature. Temperatures that are too hot or too cold may disrupt your sleep.
• Use shades or drapes to keep out the light. Try sleeping with an eye mask.
• Noise, even at low levels, may disturb your sleep. To help block out sounds that may keep you awake, you may want to consider using fans, which generate white noise, or ear plugs.
• Make your room comfortable to you. If needed, adjust the padding thickness on your mattress to your liking. If you have pain or soreness, consider adjusting or changing your pillows or mattress to better support those areas.
• Try to keep your room free of pets. Consider keeping pets off the bed because they may wake you up or keep you awake when they move or make noise.

Lowering your body temperature near bedtime may tell your body it is time to go to sleep. You may want to:

• Take a bath before bedtime. Your body temperature will drop naturally after your bath.
• Avoid exercise too close to bedtime. Physical activity raises your body temperature and may keep you awake if done within 2 hours of going to bed.

You may find it helpful to:

• Avoid eating a heavy meal or drinking too much before bedtime. While a light snack, such as a banana or small glass of warm milk, may help you sleep, too much food or liquid may make it hard to fall asleep or stay asleep. Limiting fluids before bedtime may cut down on how often you need to go to the bathroom during the night.
• Avoid caffeine for 4 to 6 hours before bedtime. The caffeine in coffee, chocolate, some soft drinks, teas (including some green teas), diet medicines, and some pain medicines may keep you from sleeping well. If you take herbal supplements, check to see whether they are known to interfere with sleep.
• Avoid alcohol before bedtime. Although alcohol may help you fall asleep, it may also increase the number of times you wake up or need to go to the bathroom during the night.
• Do not smoke near bedtime or during the night. Nicotine is a stimulant that can cause shallow sleeping and sleeplessness.

To mentally prepare yourself for sleep, try to:

• Do something that is calming to you. Listen to music, read a magazine, or try using a relaxation technique, such as meditation. See the Relaxation step for different techniques you can try.
• Write down your thoughts in a ‘worry book.’ Set aside time the next day to think about the problem you wrote down and how to solve it. Problems that cause worry at night often seem smaller in the daytime.

MYTH:

‘I will sleep whenever I get a chance.’

FACT:

Going to sleep and waking up at the same time every day helps your body learn a pattern of sleep.

You may feel you have too much to do to set enough time aside to sleep each night. This may mean you are overdoing it and need more sleep than you are currently getting.

The skills in the Energy Management step may help you take the first steps toward figuring out the right amount of activity for you each day so you leave yourself enough time to sleep at night.

MYTH:

‘I’ll be tired the next day if I change my sleep habits.’

FACT:

It’s true that when you change your sleep pattern, you may be a bit more tired at first. Changing old habits and learning how to get a good, restful night’s sleep doesn’t happen immediately. Give yourself a few weeks to get used to the new pattern and for your body to adjust.

Helping your body get used to a new sleep pattern takes time and effort.

Whatever challenges you face in sticking to your new sleep pattern, be sure to:

• Pace yourself to keep symptoms from flaring up. Flare-ups, or periods when your symptoms are more intense, may interfere with sleep. Use the ideas in the Energy Management step to help you get through the day without overdoing it.
• Keep track of your progress. Use the ideas in the Goal Setting step to help you see how you are doing. It may take up to several weeks to notice improvements in your sleeping habits. Know that your efforts are not wasted because improving your sleep may help ease the symptoms related to your multiple sclerosis.