Sleep disturbances, covering a broad spectrum of issues and diagnoses, are notably common among individuals with Multiple Sclerosis (MS). Disorders such as insomnia, sleep-disordered breathing, restless leg syndrome, and narcolepsy are more frequent in people with MS compared to the general population, with over half of those with MS experiencing sleep disruptions or dissatisfaction. This article will look at how sleep affects MS, and practical ways to help you get some shut-eye.
Can quality of sleep affect MS fatigue?
MS fatigue, thought to be caused by the reduction of energy available for essential functions due to widespread neuroinflammation and oxidative stress, is one of the most prevalent MS symptoms. A 2023 meta-analysis found strong correlations between self-reported measures of insomnia and sleep quality with MS fatigue. Interestingly however, objectively measured total sleep time and delayed sleep onset showed the weakest and non-significant link to MS fatigue.
Insomnia, restless leg syndrome, poor sleep quality, and excessive daytime sleepiness have been shown to be significant predictors of fatigue in people with MS. Frequent night awakenings also have a stronger relationship to fatigue.
How might sleep affect MS outcomes?
A 2019 study of 40 participants with relapsing-remitting MS explored the relationship between sleep quality, relapses and the Expanded Disability Status Scale (EDSS) score over a three-year period. Excluded from the study were those with symptoms likely to interfere with sleep quality, such as bladder dysfunction, severe pain, spasticity, psychiatric symptoms, and cognitive deficits. Participants reporting poor sleep quality as per the Pittsburgh Sleep Quality Index (PSQI) had a significantly higher probability of negative MS progression and increased relapse rates. These results suggest that the course of MS may be influenced by sleep quality, possibly due to impacts on myelin repair. Despite its limitations, including small sample size and reliance on PSQI scores without polysomnographic evaluations (brain wave, oxygen level, heart rate and breathing), the study highlights the need to address sleep issues for potentially better MS outcomes.
Improve sleep with nutrition
Addressing the role of nutrition and adhering to fundamental sleep hygiene principles may significantly enhance sleep quality and overall well-being.
Include:
- A diet high in fibre and vegetables – A healthy gut microbiome has been linked to better sleep. Fibre-rich fruits, vegetables, and whole grains feed the good bacteria in the gut, potentially promoting the production of sleep-supportive neurotransmitters like gamma-aminobutyric acid (GABA). Consider incorporating leafy greens such as spinach, Swiss chard and broccoli, legumes like black beans and lentils, and deep coloured fruit like blueberries into your meals.
- Fatty fish – Omega-3 fatty acids, EPA and DHA, have been linked to improved sleep efficiency. Include 2-3 portions of fatty fish (salmon, mackerel, anchovies, sardines or herring) in your diet each week, or include a quality EPA and DHA supplement.
- Tart cherry juice – Montmorency cherry juice contains naturally occurring melatonin and other antioxidants that may improve sleep duration and quality.
- Supplements (under guidance from a nutritionist) – Deficiencies in magnesium, zinc, or B vitamins may disrupt sleep. Magnesium plays a role in muscle relaxation and neurotransmitter function, while zinc is involved in melatonin metabolism.
- Relaxing herbs – Passionflower and valerian root tea (1-2 tbsp per infusion) an hour before bed may help ease anxiety and promote sleep.
- Probiotics – Certain strains of bacteria may improve sleep quality perception in people experiencing sleep disturbances. Probiotics help maintain a healthy gut microbiome which might contribute to better sleep.
- Tryptophan-rich food – Tryptophan is an amino acid which your body converts into melatonin, the sleep hormone. Include tryptophan-rich foods like salmon, nuts, prunes, soy products, quinoa, oats, and bananas in your diet to support melatonin production naturally.
Avoid:
- Caffeine – While caffeine may be seen as indispensable for many, it can stay in your system for hours, interfering with sleep by blocking the effects of adenosine, a naturally occurring chemical in your body that helps regulate sleep. Avoid caffeine in food and drinks in the afternoon and evening.
- Alcohol – Alcohol may make you drowsy initially, but it disrupts sleep later in the night by suppressing REM sleep, which is crucial for memory consolidation and emotional processing.
- Avoid refined sugars – High sugar intake has been associated with lighter and less restorative sleep. Swaps those cakes and biscuits for sweet treats such as chia puddings with fruit and nuts, or a seasonal fruit crumble topped with rolled oats, nuts, seeds, and spices.
- Acid reflux triggers – If you suffer from heartburn, avoid spicy or fatty foods close to bedtime, as they can worsen symptoms and disrupt your sleep.
Make lifestyle changes
- Epsom salt baths – Magnesium from Epsom salts absorbed through the skin may promote relaxation and better sleep. A warm bath with Epsom salts about an hour before bed can help ease muscle tension and prepare your body for sleep.
- Eat dinner earlier – Aim for dinner at least 2-3 hours before you hit the sack.
- Morning light – Expose yourself to bright natural light soon after waking up. This helps regulate your circadian rhythm, the internal body clock that governs sleep-wake cycles.
- Avoid screens – Power down electronic devices at least an hour before bed. The blue light emitted from phones and tablets can interfere with the production of melatonin, the sleep hormone.
- Consistent routine – Go to bed and wake up at the same time every day, even at the weekend, to help regulate your internal clock.
- Your environment – Make your bedroom conducive to sleep by keeping it cool, dark, and quiet. Consider blackout curtains, a face mask and earplugs.
- Wind down before bed – Incorporate relaxation techniques such as deep breathing, meditation, or gentle yoga before bed to calm the mind and prepare for sleep.
Prioritise sleep
We often overlook the importance of a peaceful slumber. Prioritising good sleep hygiene and addressing underlying nutritional factors could significantly improve your sleep routine and could potentially affect your MS health journey. Here’s to sweet dreams ahead!
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