During a recent conversation with a group of patients living with multiple sclerosis, one theme came up again and again: the issue of MS and fatigue. Patients tell us consistently that fatigue is one of their most troublesome symptoms and describe the frustration they experience when they try to explain it to family members and friends. It is very difficult to convey how debilitating this overwhelming sense of tiredness is in a way that others can understand.
Research shows that up to 90% of people with MS experience fatigue. It is a complex and multi-faceted symptom. There are different types of fatigue and even more potential causes of fatigue. One of the frequent causes of fatigue is sleep disturbance.
Research also shows that around 50% of MS patients experience sleeping problems. This includes both difficulty falling asleep as well as difficulty staying asleep throughout the night. Sleep disturbances can result from disease related factors such as pain, muscle spasms, periodic limb movements, nocturia, and anxiety. They can also exacerbate other MS problems such as pain, depression, and daytime sleepiness.
Although it’s clear that many MS patients suffer from reduced quality of sleep, the exact relationship between poor sleep and fatigue is unclear. In a recent study published in Frontiers in Neurology, researchers from the Kessler Foundation concluded that sleep quality is likely the dominant factor in MS fatigue. The study included 107 individuals with MS, and about two thirds of participants (61 percent) reported both poor sleep and fatigue.
Another study, conducted in 2005 by Strober and Arnett and published in Archives of Clinical Neuropsychology, demonstrated that the effective treatment of sleep problems can reduce fatigue. Their study also found that sleep disturbance was more predictive of fatigue than depression or disease severity. Those finding were replicated in another study in 2012 by Gharzadeh et al. Additional research by Attarian and colleagues in 2004 also identified a relationship between fatigue and disrupted sleep or abnormal sleep cycles. All of these findings suggest that sleep disturbance might be the most significant cause of fatigue in MS patients.
What is very clear is that quality sleep is extraordinarily important for MS patients overall – both for reducing fatigue and helping to manage other symptoms. Sleep deprivation negatively impacts brain functions, including memory, mood, and appetite regulation. Poor sleep has also been shown to, under some circumstances, lead to severe depression.
Below are some tips for getting a good night’s sleep:
- Talk with your doctor about treatments that can relieve potential MS symptoms such as spasticity, bladder trouble, or depression that may be keeping you awake.
- Try to practice relaxation routines in the evening before you go to bed – such as meditation or deep breathing exercises.
- Do your best to go to bed at about the same time every night.
- If you aren’t able to fall asleep after about 10-15 minutes, don’t continue to lie in bed. Try to do something that is relaxing – such as reading.
- Avoid caffeine and alcohol within 4-6 hours of bedtime.
- Exercise regularly during the day. It’s best not to exercise within 3 hours before bedtime.
- Set your alarm clock for the same time each time each day.
- If you are still having trouble sleeping, please talk to your doctor. They can help you figure out what’s going on and refer you to a sleep specialist if necessary.