Insomnia is a common symptom of multiple sclerosis, or MS. MS is an inflammatory disease that can become quite debilitating, including messing up sleep. Sleep deprivation can lead to daytime fatigue and low energy. Many experts believe that sleep-related disorders are direct consequences of the physical and emotional burden of MS. Continue reading to find out more about about MS and its impact on sleep, and how you can overcome these sleep issues. 

Causes of Insomnia 

Research suggests that uncontrolled or worsening MS symptoms combined with anxiety and depression are the major reasons for the insomnia in those with MS. 

Other contributing factors include: 

• Certain hormonal irregularities that can cause breathing disruptions, such as sleep apnea. 
• Disruption of dopamine and norepinephrine which can lead to narcolepsy and change sleeping patterns. 
• Napping during the day because of fatigue, and then messing up the sleep pattern for the night.  
• MS symptoms like restless legs, temperature dysregulation, and urinary control which can also interrupt sleep. 

Types 

There are three different types of insomnia. Each affects a different phase of sleep and has different MS-related causes. The first one is initial insomnia which is the inability to fall asleep. In people with MS, this initial insomnia can be caused by neuropathic or musculoskeletal pain as well as certain medications that are known to cause sleeping difficulties. 

The second type is middle insomnia which is waking up in the middle of the night and being unable to go back to sleep. This results in a longer WASO, or wakefulness after sleep onset. Individuals with higher daytime fatigue are more likely to experience middle insomnia. Other MS-related symptoms can also contribute to middle insomnia - like muscle spasms and nocturia. 

The final type, terminal insomnia, is waking up too early and not being able to fall back asleep. The cause of terminal insomnia in people with MS in not well-understood, but may have something to do with a lack of exposure to daylight, especially those with depression. 

Diagnosis 

There is no definitive diagnostic test for insomnia. Healthcare providers use many tools to diagnose symptoms including: 

• Sleep logs 
• Sleep inventories 
• Sleep studies 

Treatment

After getting a definitive diagnosis of insomnia, and determining the type of insomnia, a treatment plan can be created. The first step of a healthcare provider is to make sure that the MS symptoms contributing to sleep problems are addressed - like urinary issues or restless legs syndrome. 

Many people may think that sleeping pills are the first-line treatment for insomnia, but they have their own downsides and limitations. Plus, they are only good for short-term use, but only behavioral changes can truly cause significant improvement in insomnia symptoms. 

The best way to improve insomnia is through behavioral and lifestyle changes. Cognitive behavior therapy for insomnia, CBT-I, is a drug-free alternative that is normally the first-line treatment for insomnia. It benefits your brain by helping your bed be associated with sleep, not wakefulness. 

Other individuals use continuous positive airway pressure (CPAP) to treat sleep apnea and bright light therapy to help with circadian rhythm sleep disorders. These conditions need to be diagnosed by a healthcare professional first, however. 

Lifestyle changes can also really help address MS symptoms and insomnia symptoms. Some of these include getting plenty of natural light exposure, going to bed and getting up at the same time everyday (including weekends), exercising regularly, limit caffeine, alcohol and nicotine before bed, reducing fluids before bed, avoid electronic devices, keeping the room dark and temperature controlled, and avoiding lying in the bed awake in the middle of the night. 

To get help with your insomnia, please click the orange button below to take a free online sleep test and talk with one of our sleep health professionals. 

https://www.verywellhealth.com/ms-and-insomnia-2440627