Skip to navigation Skip to content



In this article
Quality sleep is important to maintaining good health, but getting good sleep can be complicated. Issues ranging from insomnia to sleep apnea and from restless legs syndrome to narcolepsy can affect your ability to get adequate, quality sleep.
Lack of restful sleep can cause daytime sleepiness and — in MS — have serious consequences for cognition, fatigue, mood swings, and physical symptoms such as balance, spasticity and pain. Studies suggest that people with MS may be up to 3 times more likely to experience sleep disturbances than the general population, and about 2 times as likely to experience a reduced quality of sleep.

Sleep disturbance is a general term for a wide range of sleep-related symptoms and disorders, and can include:
  • Difficulty with initiating or maintaining sleep, also known as insomnia
  • Difficulty with too much sleep, also known as hypersomnia or hypersomnolence
  • Uncontrollable lapses into sleep, also known as narcolepsy
  • Sleep related breathing difficulty, including sleep apnea
  • Abnormal movements during sleep, including restless legs/body syndrome
  • Abnormal behaviors during sleep including acting out dreams
  • Daytime dysfunction, including excessive daytime sleepiness

Are you sleep-deprived?

If you answer yes to any of the following questions, you may not be getting enough good quality sleep.
  • Do you feel sleepy, grumpy or "down" during much of the day?
  • Do you fall asleep as soon as your head hits the pillow?
  • Do you sleep fewer than 7 hours most nights?
  • Do you still feel tired even after having 8 hours of sleep or more?

Causes of sleep disturbances in MS

Research over the past decade has aimed to better understand the causes of sleep disturbance in MS. MS can impact sleep in a number of ways including:
  • Interruption of the body’s essential hormones and physiological processes (e.g., hunger/thirst, temperature regulation, stress response) can cause hypersomnia and narcolepsy, and make it difficult to maintain a consistent sleep-wake cycle. This can disrupt breathing — resulting in sleep apnea and sleep behavior disorders.
  • Disruption of key neurotransmitters involved in sleep like hypocretin, dopamine, norepinephrine and melatonin can result in narcolepsy, fatigue and poor sleep efficiency.
  • Deficiencies in Vitamin D and other nutrients that may help regulate sleep
  • Side effects of MS medications including the disease-modifying therapies, corticosteroids, and stimulant medications for fatigue
  • Increased napping during the day due to fatigue
  • Reduced physical activity due to fatigue and MS-related disability
  • Emotional changes including stress, anxiety or depression.
  • Other MS symptoms including restless legs, pain, urinary or bowel symptoms, and temperature dysregulation

Strategies to get the sleep you need

  • Treat MS symptoms that may cause sleepiness
  • Consider the side effects of medications
  • Sleeping pills may be of some benefit, at least for a short time. However, many experts recommend taking them as only a last resort because they lose their effectiveness quickly and are potentially addictive.
  • Medical devices such as continuous positive airway pressure (CPAP) and bright-light therapy lamps/boxes can help.
  • Cognitive Behavioral Therapy (CBT) can help with insomnia.
In addition to treatment options, there are some things you can do to improve your chances of getting adequate sleep—mostly in the form of positive habits:
  • Go to bed and get up at the same time every day—and no more than 1 hour later on weekends. Regularity helps set your biological clock.
  • Clear your mind before bed. Do you rehash the day's problems or worry about tomorrow once you are in bed? It may help to write a list of today's worries and things to do tomorrow well before bedtime.
  • Plan your exercise to occur about 4-6 hours before bedtime. Exercise is a stimulant, so don't exercise close to bedtime.
  • Limit your caffeine use to the morning. Don't use alcohol or nicotine within 6 hours of bedtime.
  • Create a bedtime ritual to signal the body and mind to slow down. Change into pajamas, wash up and brush your teeth at least an hour before sleep. In that last hour, wind down by listening to calm music, reading or writing in a journal.
  • Don't drink a lot of fluids just before bedtime. Urinate before going to bed.
  • Make sure your bedroom is cool, quiet and dark.
  • Try a relaxation technique that you like (breathing, imagery or muscle relaxation) once the lights are off.
  • Use your bedroom for sleeping and sex only. Don't read, watch TV or talk on the phone in bed.
  • If you don't fall asleep within 15-20 minutes… get up. Don't stay in bed and watch the clock. Do something boring and relaxing (read something light or watch an old movie).
Depression and emotional problems can keep you up. Ask for a referral to a mental-health professional if you’ve noticed any emotional changes.


Assessing your sleep is the first step to identifying sleep-related problems and/or clinically significant sleep disorders. Before your next medical appointment, it may be helpful to print the questionnaire found in this professional paper and bring your responses with you to your health care provider.

Additional resources