Symptom Management

We have a sleep problem. According to the Centers for Disease Control and Prevention, “50-70 million U.S. adults have sleep or wakefulness disorders.” Additionally, The National Health Institute reports that “30 percent of adults report an average of less than six hours of sleep per day.” In fact, the problem is so widespread that the CDC has labeled sleep-related issues a public health crisis.
 
The troubles that can come from poor sleep are far more serious than an occasional fit of yawning. Several serious problems can arise from sleep-related issues – from trouble concentrating, to impaired memory, and even dangerous accidents. The National Department of Transportation estimates that, annually, drowsy drivers are responsible for more than 1,500 fatalities and upwards of 40,000 nonfatal injuries. While people may not see poor sleep as a big problem in their daily lives, the consequences can be very real and dangerous.
 
When someone has MS, their symptoms can exacerbate sleep-related issues, or actually be the cause of sleep disturbances. In many cases, sleep-related issues can compound symptoms, resulting in a never-ending cycle of problems. This might mean that MS pain, spasticity, or bladder issues keep you awake at night, or regularly wake you from sleep. Those disturbances can result in poor sleep, which might then exacerbate fatigue, weakness, or cognitive issues. And then those issues may exacerbate your original symptoms, leading to even more sleep issues and worsening symptoms.
 
Good sleep habits are essential in order to stay healthy and accomplish your goals, and that is especially true for those facing MS and its symptoms. So, how do we start to solve our sleep problem?
 
First, it is important to understand how much sleep you should be getting. The National Institute of Health tells us that sleep requirements will vary between individuals and will change as we age, but they have laid out some guidelines for best health practices:
 

• School-aged children need 10 hours, at least
• Teens need 9-10 hours
• Adults need 7-8 hours

 
If you are regularly below these recommended numbers, it is important to get into a better sleep routine as soon as possible. A day, here and there, or a hectic week of poor sleep can be corrected easily. But if you are regularly getting less sleep than needed, the effects will build and may be more difficult to manage.
   
Next, you need to take the time and evaluate your current sleep quality. According to Dr. Abby Jean Hughes, assistant professor of Physical Medicine and Rehabilitation at Johns Hopkins, “assessing your sleep is the first step to identifying sleep-related problems and/or clinically significant sleep disorders.” Dr. Hughes recommends a self-assessment that you can use to evaluate your quality of sleep.
 
Using your previous month of sleep, answer these questions:
 

1. How long, on average, has it taken you to fall asleep?
2. How many hours of sleep, on average, did you get per night?
3. How many times, on average, did you wake up per night?
4. How many minutes per night, on average, did you spend in bed awake, unable to fall back asleep?
5. How rested, on average, did you feel upon waking in the morning?
6. How often, on average, did you take naps during the day?
7. How often did pain interfere with your sleep?
8. How often did spasticity/restless legs/ limbs/body interfere with your sleep?
9. How often did urinary/bowel symptoms interfere with your sleep?
10. How often did you take medication (prescription or over-the-counter) to help with sleep?
11. How often did you snore or experience shortness of breath upon waking?
12. How difficult was it to maintain alertness and energy during the day?

 
Discuss these questions, and your responses, with your healthcare provider. If you face any sleep-related issues, or have difficulty falling or staying asleep, a doctor may recommend that you take part in a sleep study. During a sleep study, your sleep is monitored by professionals using special equipment.
   
Once you have an understanding of how much sleep you need, and you have identified any problems affecting your quality of sleep, the next step will be correcting those poor sleep behaviors, treating sleep-related issues, and achieving a better sleep routine.
 
Dr. Hughes said, “Treating sleep disturbance in MS can be quite challenging due to its many potential causes, as well as potential side effects of some treatments.” Treatment options will depend on where your symptoms stem from:
 

• Are they the result of personal habits?
• Are they caused by MS symptoms?
• Are they the result of some other issue, like insomnia, restless leg syndrome, or sleep apnea?

 
If your sleep issues are because of personal habits, the National Sleep Foundation offers some recommended options for helping to get on a healthier sleep routine.
 

1. Stick to a sleep schedule. Set a specific bedtime and a specific wake time, even on weekends.
2. Practice a relaxing bedtime ritual, preferably away from bright lights.
3. Avoid naps.
4. Exercise daily. Even light exercise is better than no activity.
5. Evaluate your room. Ensure that your bedroom is cool, dark, and devoid of distractions.
6. Evaluate your mattress and pillows.
7. Stop using laptops, smartphones, or tablets in bed; and avoid heavy screen use before bed.
8. If you can’t sleep, get out of bed, go into another room, and do something relaxing until you are tired and ready to sleep.

 
By following these steps, you will create a separation between your sleep state and your active state. This will help keep your body’s natural “clock” working properly, and should make falling and staying asleep easier.
 
If your sleep-related issues are because of MS symptoms, talk to your healthcare team about symptom management. Eliminating those troublesome symptoms, or reducing their effect on your sleep, should be a main concern. In some cases, relaxant and sedative medications may be prescribed, but these are meant for short-term use and usually come with physical and cognitive side effects.
 
If conditions such as sleep apnea, insomnia, restless leg syndrome, or depression are the main factors behind your sleep issues, there are options for you. Always discuss these kinds of symptoms with your healthcare team. If you suffer from sleep apnea, which is when your breathing is interrupted during sleep, resulting in waking several time during sleep, the most common treatment is a continuous positive airway pressure machine. This device keeps your airways open while you sleep. For people struggling with insomnia or depression, cognitive behavioral therapy is a trusted option. This therapy works to change patterns of thinking and behavior by replacing unhelpful thoughts and behaviors with more adaptive ones. For those dealing with restless leg syndrome, which is characterized by an insatiable need to move your legs, self-care is typically the first-line treatment. This might mean more leg activity during the day or before bed, or regular leg massages. Medication can be prescribed in certain cases where self-care fails to alleviate your issues.
 
While many New Year’s resolutions may revolve around diets, exercise, or eliminating your pesky nail-biting habit, achieving a better sleep routine and getting better overall sleep should be at the top of your list. No matter what issues may be affecting your sleep, there are solutions to help. After all, some of the best weapons to use against MS are a well-rested body and mind. So, evaluate your situation, talk to a doctor, prepare your bedroom, and start getting some better sleep.