Symptom Management

Rounding Up Those Elusive ZZZZs: Strategies for Better Sleep

By Robin Adams McBride

On the flickering late-night TV screen, a little pack of pale, skinny Zs on spindly legs scurry furtively through the streets of a darkened suburb – fugitives from some poor insomniac tossing in his bed. It's a commercial for a mattress store.

In another commercial, a sassy flock of unemployed counting sheep desperately taunts a former insomniac into a state of worry that neutralizes the comfort of his new mattress.

Still other commercials celebrate the benefits of various prescription and nonprescription sleep aids with shots of smiling, refreshed people awakening with their happy dogs and smiling children to greet a new day. If we are to believe the ads, sleeplessness pervades our society. But for those of us with MS, the solution is rarely as simple as a new mattress or a sleeping pill.

Thieves in the Night

What is robbing you of a good night’s sleep? Before you seek a solution, you must first identify the culprit. “One of the most prevalent causes of sleeplessness in MS is the worry and stress imposed by this unpredictable neurological disorder,” says Dr. Gary Birnbaum, Director of the MS Treatment and Research Center at the Minneapolis Clinic of Neurology. “Morning awakening is most frequently symptomatic of anxiety – waking in the wee hours and not being able to quiet the mind and get back to sleep.”

Medications can also contribute to sleeplessness. The interferon-based disease-modifying drugs commonly cause flu-like symptoms, which can make it difficult to fall asleep. Other medications commonly prescribed for treating MS symptoms are actually nervous system stimulants. These include Cylert® (pemoline), Symmetrel® (amantadine), and Provigil® (modafinil). Some antidepressants, particularly the selective serotonin reuptake inhibitors (SSRIs), such as Prozac®, Paxil®, Zoloft® and Effexor®, also have a stimulating effect. Ask your doctor or pharmacist how and when to take your prescriptions to promote a good night’s sleep.

Neurogenic bladder and urinary tract infections are both prevalent among those with MS. Repeated trips to the bathroom can certainly disturb your sleep. But there are pharmacological and behavioral options that may reduce these nightly jaunts to the bathroom. Pain, muscle spasms, cramps, myoclonic jerks, restless leg syndrome, spasticity, and hypersensitivity of the skin to bedclothes play significant roles in sleeplessness. Heat sensitivity can play a role – particularly during summer, but surprisingly, also in winter with heated homes sealed against the cold. Digestive difficulties such as gastric reflux disease can interfere with sleep, too.

Other neurological diagnoses, such as sleep apnea, can be a factor. “If the causes of sleeplessness are not readily identifiable,” Dr. Birnbaum advises, “further evaluation should be done.”


A visit to a reputable online forum for individuals with MS will turn up numerous late-night discussion threads on insomnia. Surprisingly, many people do rely on prescription sleep aids for relief. These certainly have their place, but long-term use is not the answer. For the active patient, there are many alternative strategies that can be found through research and talking to others with MS.

Physical/Environmental Strategies

Many people find that a good mattress or a foam topper for an existing mattress can make a world of difference. So, maybe there is something to those commercials! Cooling pillows, ice packs, and light bedclothes are also helpful. For shoulder, hip, knee, and ankle pain, the strategic use of extra pillows for limb positioning may provide relief, if they don't cause overheating. If necessary, speak to a physical or occupational therapist.

In northern or far southern latitudes, many people find the greatest relief when the weather turns cooler. The importance of creating a comfortable sleeping environment with fans, air-conditioning in the summer, and open windows in the cooler months can't be overemphasized.

Lifestyle Modifications

Avoid heavy meals, caffeine, alcohol, or strenuous exercise before sleep, Dr. Birnbaum advises. Also avoid disturbing TV shows, news, or suspenseful books and don’t work in bed. “Keep the bedroom for sex and sleeping,” he says.

A growing number of people are finding yoga, inspirational reading, audio books, warm (not hot) baths, and meditation or prayer effective lead-ins to sleep. If possible, create a serene atmosphere in your bedroom. Utilize pastel colors, soft lighting, soothing music, and uplifting fragrances. Make it a retreat for relaxation and inspiration – a true refuge from your busy life.

If you spend most of your time in bed, some of these ideas may not be feasible. Nevertheless, a peaceful routine in the last one or two hours before sleep may be helpful.

Alternative Therapies

Exercise, acupuncture, biofeedback, and hippotherapy have all shown beneficial effects on insomnia or sleep disturbances. However, more studies are needed to conclusively understand the benefits of these therapies for individuals with MS. It is always recommended that you talk with your doctor prior to beginning any new exercise or therapy.

Dietary Changes

For mild insomnia, a bedtime cup of chamomile tea or warm milk can provide sufficient relaxation. For leg cramps, you may benefit from additional calcium, magnesium, or potassium. Valerian has been used as a calming and sedating herb for more than 1,000 years. Other sedating herbs include Asian ginseng, Siberian ginseng, goldenseal, kava kava, and St. John’s wort. However, the safety and long-term effects of these herbs has not been established. Ask your doctor before taking any herbal supplement. Use caution if you are currently taking other sedating medications, such as Baclofen®, Zanaflex®, Klonopin®, or Valium®.

Good Night!

Rather than desperately pursuing those elusive ZZZZZs, find ways to entice them into your bed to cuddle up for a good night's sleep. They're probably as tired of running from you as you are of chasing them. Sweet dreams!


New Choices in Natural Healing by Bill Gottlieb and Doug Dellemore, Rodale Press, 1995

The Green Pharmacy by Dr. James A. Duke, Ph.D. , Rodale Press, 1997

Robin Adams McBride is a 60-year old mother, grandmother, and writer who has had MS since the early 1980s. She lives with her husband, Ray, in the Minneapolis area and works as a web developer/designer and editor for a non-profit organization. She says the years since she was diagnosed with MS have been the most growth- and love-filled of her life.

(Last reviewed 7/2009)