Perspectives in MS
Perspectives in MS

Fatigue and MS: Part 2 - Sleep Hygiene

The treatment of fatigue in MS patients can take several forms: good sleep hygiene, medications to combat fatigue, avoidance of medications that cause sedation during the daytime, and medications to aid sleep at night.

The first thing I suggest to my patients who complain of fatigue is to try to get a good night’s sleep by practicing good sleep hygiene. Unlike medications, it is free, and there are no side effects. Many of these suggestions are “common sense” but very few people are able to practice them.

Here are some good sleep hygiene tips:

  1. Maintain a regular sleep schedule by going to bed and waking up at the same time every day. A calm sleep routine prior to bedtime will help train your brain to fall asleep at the same time every night. Many of my patients find that meditation or taking a hot bath helps relax them before they go to bed.
  2. Avoid long naps, if at all possible, especially later in the day.
  3. Keep the bedroom a calm, quiet, cool, dark place. Several people I know greatly improved their sleep by buying a white noise machine to block out loud noises or a dark curtain to put over their window.
  4. Train yourself to keep the bedroom primarily for sleep (and sex). It's a mistake to eat, watch TV, play video games, or surf the internet in bed.
  5. Avoid exercising close to bed time.
  6. Avoid drinking alcohol or caffeine for 4-6 hours prior to sleeping. Although alcohol can certainly make you tired, it often wears off several hours later and there is a rebound effect that wakes people from sleep.
  7. Have your doctor review your nighttime medications to see if there are any that might cause sleeplessness.
  8. If you can't fall asleep within 15-20 minutes, get out of bed and read something calming in a soft light until you are ready to try again.
  9. Take a short-well timed nap not too late in the day; this can be wonderfully restorative for those whose schedules allow.

I realize that many of these suggestions sound easy, but actually might be quite difficult to practice. Not too many of my younger patients want to go to bed at 10pm every night. And many of my patients have children or pets that wake them up. Since I practice in New York City (“the city that never sleeps”), loud sirens, honking horns, and construction are an inevitable part of life. Still, as much as possible, following the above advice can make a major impact in patient’s lives.

Additionally, patients should try to take it easy on themselves during the day and know their own limits. Many patients cannot exercise as much as they used to or stay up late with their friends at parties. I certainly encourage my patients to do whatever they can in terms of exercise and socializing, but to know and respect their limits.

I am available via e-mail at and will try to answer all questions.

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Tags: Living With , Symptom Management

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About the Author

Dr. Howard is a neurologist & psychiatrist, and an expert in multiple sclerosis.

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