Insomnia is a common sleep disorder in people diagnosed with multiple sclerosis (MS) as is fatigue. Fatigue in MS is not like most healthy people consider the term. The level of fatigue most multiple sclerosis patients endure is more like a feeling of crushing exhaustion. Poor sleep quality can make levels of fatigue as well as other ms symptoms much more profound. This cannot be stressed enough. If you have MS or are the caregiver of someone with the disease sleep quality needs to be a primary focus towards quality of life.
Unfortunately just as is the case with the general world population sleep disorders often are not diagnosed or under diagnosed. Additionally sleep disorders when they are addressed are often treated with quick fixes such as melatonin or drugs to assist with sleeping. These solutions may in fact be warranted to use but all too often they do not result in the maximum amount of quality sleep that may be possible for the individual.
Further, since improvement may be significant or noticeable patients, caregivers or the patients health care provider may consider the problem solved. It is ever so IMPORTANT to achieve the best quality of sleep that the individual enduring MS can achieve and not simply settling for some improvement.
Insomnia is the condition where a person cannot initially fall asleep or they awaken many times during sleep. It is important to understand that insomnia is not a disease but is a symptom that results from other factors that contribute to the symptom.
There are several different classifications of insomnia that affect people with multiple sclerosis and the general global population.
Acute insomnia is brief in duration and often occurs due to life circumstances such nervousness about taking a test or a job performance evaluation for example. This type of passing sleep disruption is short term and usually resolves itself without any intervention required. Acute insomnia may be the result of singular stressful events, jet lag or even a night out on the town. Point being acute insomnia is not a condition that is long term.
Chronic insomnia is signified by frequent events of disrupted sleep that are ongoing and may have many causes such as environmental issues, poor sleep habits, medications that disrupt sleep and diseases or clinical disorders such as multiple sclerosis. Chronic insomnia may also be comorbid (linked to other conditions) such as medical issues or psychiatric disorders.
People living with insomnia have difficulty falling asleep, staying asleep, awakening too early from sleep or any combination thereof. Treating insomnia may require behavioral changes, psychological assessments, medications, evaluation of sleeping environment of a combination thereof.
Types Of Insomnia:
- Initial Insomnia: Difficulty falling asleep at night.
- Middle Insomnia: Waking up during the night and not being able to fall back asleep quickly.
- Terminal Insomnia: Waking up too early.
Other sleep disorders such as nocturia which results in a person needing to urinate or the feeling they need to urinate many times during sleep often results in middle insomnia and is not
uncommon among MS patients. Sleep Apnea which is a condition that can result in snoring, gasps for breath and more can result in awakening and thus middle insomnia.
Some of the known items that can cause or be contributors to insomnia include: caffeine and coffee, tobacco, nicotine, alcohol, decongestants that contain pseudoephedrine, diuretics such as furosemide (Lasix), hydrochlorothiazide (Dyazide) especially if taken in the evening or at bedtime. Antidepressants such as bupropion (Wellbutrin & Zyban), fluoxetine (Prozac) as well as appetite suppressants such as sibutramine (Meridia), phentermine (Fastin) are known to cause problems towards insomnia, as are amphetamines and antihistamines.
Look up your medications side effects online to see if sleep disorders such as insomnia are noted or if you are able to do so speak with your pharmacist about the medications you take as they have access to all the side effects and many understand the complex interactions of multiple medications. If sleep issues are associated with a medication speak to your healthcare provider about changing dosing schedules or other prospective options that may be available to you.
Stress, anxiety and thoughts of depression can result in initial insomnia as well as middle or terminal insomnia.
Symptoms Of Insomnia:
Some Symptoms Of Insomnia Include:
- Difficulty falling asleep
- Difficulty staying asleep (waking up during the night and having trouble returning to sleep)
- Waking up too early in the morning
- Waking up irritable or feeling as though little quality sleep was obtained
- Unrefreshing sleep (also called “non-restorative sleep”)
- Fatigue or low energy
- Situational awareness
- Reaction times to tasks
- Cognitive impairment, such as difficulty concentrating
- Mood disturbance, such as irritability
- Behavior problems, such as feeling impulsive or aggression
- Difficulty at work or school
- Difficulty in personal relationships, including family, friends and caregivers
Diagnosing insomnia is an ongoing process. As noted above some of the first steps that you need to review are the medications you take as well as prospective lifestyle influences such as caffeine intake also noted above. Review if you experience stress before going to sleep and evaluate existing medical conditions. It is also wise to consider documenting as much of your sleep matters are you can known as a “sleep diary”.
Clinical Insomnia Diagnosis:
Your doctor will likely diagnose insomnia based on your medical and sleep histories and a physical exam. He or she also may recommend a sleep study if the cause of your insomnia is unclear.
To find out To find out what’s causing your insomnia, your doctor may ask whether you:
- Have any new or ongoing health problems
- Have painful injuries or health conditions, such as arthritis
- Take any medicines, either over-the-counter or prescription
- Have symptoms or a history of depression, anxiety, or psychosis
- Are coping with highly stressful life events, such as divorce or death
Your physician may ask questions about your work and leisure habits. For example, he or she may ask about your work and exercise routines; your use of caffeine, tobacco, and alcohol; and your long-distance travel history. You may be asked about any new or ongoing work or personal problems or other stresses in your life. Also, he or she may ask whether you have other family members who have sleep problems.
Your answers can give clues about what’s causing your insomnia.
To get a better sense of your sleep problem, your doctor will ask you for details about your sleep habits.
Before your visit, think about how to describe your problems, including:
- How often you have trouble sleeping and how long you’ve had the problem
- When you go to bed and get up on workdays and days off
- How long it takes you to fall asleep, how often you wake up at night, and how long it takes to fall back asleep
- Whether you snore loudly and often or wake up gasping or feeling out of breath
- How refreshed you feel when you wake up, and how tired you feel during the day
- How often you doze off or have trouble staying awake during routine tasks, especially driving
To find out what’s causing or worsening your insomnia, your doctor also may ask you:
- Whether you worry about falling asleep, staying asleep, or getting enough sleep
- What you eat or drink, and whether you take medicines before going to bed
- What routine you follow before going to bed
- What the noise level, lighting, and temperature are like where you sleep
- What distractions, such as a TV or computer, are in your bedroom
To help your doctor, consider keeping a sleep diary for 1 or 2 weeks. Write down when you go to sleep, wake up, and take naps. (For example, you might note: Went to bed at 10 a.m.; woke up at 3 a.m. and couldn’t fall back asleep; napped after work for 2 hours.)
Also write down how much you sleep each night, as well as how sleepy you feel throughout the day.
Your doctor will do a physical exam to rule out other medical problems that might cause insomnia. You also may need blood tests to check for thyroid problems or other conditions that can cause sleep problems.
Your doctor may recommend a sleep study called a polysomnogram (PSG) if he or she thinks an underlying sleep disorder is causing your insomnia.
You’ll likely stay overnight at a sleep center for this study. The PSG records brain activity, eye movements, heart rate, and blood pressure.
A PSG also records the amount of oxygen in your blood, how much air is moving through your nose while you breathe, snoring, and chest movements. The chest movements show whether you’re making an effort to breathe.
As with all sleep disorders it is important to try and eliminate or reduce lifestyle factors or medical related factors that cause sleep disruption. If for example spasticity, pain or anxiety are resulting in insomnia it is imperative to try eliminate and/or reduce these in order to lessen the occurrence of insomnia or other sleep dysfunctions. Please review the proper areas of the website in respect to the MS related symptoms you have that you know are impacting your quality of sleep for possible solutions or mechanisms to reduce symptom impacts.
Treating sleep disorders can be a methodical process of trying different mechanisms from more natural therapies such as breathing exercises, meditation before bedtime reducing stress for example as well as lifestyle changes such as avoidance of caffeine, nicotine. Lifestyle changes may include reviewing any medications you are taking and adjusting the schedule of when taking the dosages.
With any changes you make towards better quality of sleep make sure and document the results and give changes some time to work using a sleep diary. This way you can measure if alterations are working or not and also record for your health care team valuable information in helping eliminate sleeping disorders.
Because insomnia can have many contributing factors it is a good plan of action to work with your health care team and a sleep specialist in an attempt to find a baseline for quality sleep. A sleep clinic may also be in order so your restful state can be monitored. Some people will use a digital camcorder to record their sleep and thus be able to see if they are tossing or turning for example. A partner can also monitor sleep patterns and record what they see. Once this baseline is found the further gains in quality of sleep may be attempted. Often prescriptions are written to help sleep dysfunctions such as insomnia and this may well be required. However higher quality sleep is often still available by working through problems that are impacting quality of sleep.
- Speak with your health care provider or a skilled pharmacist about medications you currently take to ascertain if and of the drugs impact sleep quality and what adjustments may be available to you for medications that effect sleep quality.
- Avoid caffeine, tobacco, and other stimulants. The effects of these substances can last as long as 8 hours.
Naturals Therapies and Help with Insomnia Include:
- Removing stress before bedtime
- Deep Breathing Therapy
- Adopt bedtime habits such as:
- Go to sleep around the same time each night and wake up around the same time each morning, even on weekends.
- As possible avoid matters that may disrupt the schedule.
- Create a routine that helps you wind down and relax for example:
- Reading a book
- Listen to mood music
- Take a hot bath
- Go to sleep around the same time each night and wake up around the same time each morning, even on weekends.
- Utilize mental imaging (Click here to learn more about mental imaging)
- Schedule any daily exercise at least 5 to 6 hours before going to bed.
- Do not eat heavy meals or drink a lot before bedtime.
- Make your bedroom sleep-friendly such as avoiding bright lighting while winding down.
- Try to limit possible distractions, such as a TV, radio, computer, or pets. Your bedroom also should be dark and quiet.
- Make sure the temperature of your bedroom is comfortable.
- Make sure your bedding, mattress, pillow(s) and blanket(s) are comfortable.
- This can be a significant factor in all matters of quality of sleep.
- Avoid napping during the day.
Cognitive-Behavioral Therapy (CBT):
CBT for insomnia targets the thoughts and actions that can disrupt sleep. This therapy encourages good sleep habits and uses several methods to relieve sleep anxiety.
For example, relaxation techniques and biofeedback are used to reduce anxiety. These strategies help you better control your breathing, heart rate, muscles, and mood.
CBT also aims to replace sleep anxiety with more positive thinking that links being in bed with being asleep. This method also teaches you what to do if you’re unable to fall asleep within a reasonable time.
CBT also may involve talking with a therapist one-on-one or in group sessions to help you consider your thoughts and feelings about sleep. This method may encourage you to describe thoughts racing through your mind in terms of how they look, feel, and sound. The goal is for your mind to settle down and stop racing.
CBT also focuses on limiting the time you spend in bed while awake. This method involves setting a sleep schedule. At first, you will limit your total time in bed to the typical short length of time you’re usually asleep.
This schedule might make you even more tired because some of the allotted time in bed will be taken up by problems falling asleep. However, the resulting tiredness is intended to help you get to sleep more quickly. Over time, the length of time spent in bed is increased until you get a full night of sleep.
For success with CBT, you may need to see a therapist who is skilled in this approach weekly over 2 to 3 months. CBT works as well as prescription medicine for many people who have chronic insomnia. It also may provide better long-term relief than medicine alone.
For people who have insomnia and major depressive disorder, CBT combined with antidepressant medicines has shown promise in relieving both conditions.
Many prescription medicines are used to treat insomnia. Some are meant for short-term use, while others are meant for longer use.
Talk to your doctor about the benefits and side effects of insomnia medicines. For example, insomnia medicines can help you fall asleep, but you may feel groggy in the morning after taking them.
Rare side effects of these medicines include sleep eating, sleep walking, or driving while asleep. If you have side effects from an insomnia medicine, or if it doesn’t work well, tell your doctor. He or she might prescribe a different medicine.
Some insomnia medicines can be habit forming. Ask your doctor about the benefits and risks of insomnia medicines.
Some over-the-counter (OTC) products claim to treat insomnia. These products include melatonin, L-tryptophan supplements, and valerian teas or extracts.
Since these items are unregulated the dose and purity of these substances can vary. How well these products work and how safe they are is not well understood.
Some OTC products that contain antihistamines are sold as sleep aids. Although these products might make you sleepy, talk to your physician or care team before taking them.
Antihistamines pose risks for some people and these products may not offer the best treatment for your insomnia. Your doctor can advise you whether these products will benefit you.