Rest up and feel better tomorrow with these specialist- and research-supported strategies.

Getting better sleep is one of the most important ways to thrive with multiple sclerosis.

“Sleep is a game-changer in terms of quality of life,” says Julie Fiol, RN, director of MS information and resources for the National MS Society.

It’s vital to promoting healthy cognitive function, mental health, cardiovascular and muscle capacity, and energy levels. However, she explains that many people with MS struggle with sleep — 80 percent report dealing with fatigue.

If you have MS, you need more than just good sleep hygiene (a regular sleep schedule, avoiding devices and TV before bed, etc.) on your side.

It’s possible that since lesions can affect any and all areas of the brain, MS may directly impact circadian function and sleep quality, explains Dr. Kapil Sachdeva, a clinical neurophysiologist at Northwestern Medicine Central DuPage Hospital.

MS-fueled issues, such as pain, muscle spasticity, urinary frequency, mood changes, and restless legs syndrome frequently contribute to tossing and turning.

Unfortunately, he adds, many medications used in the management of MS can further inhibit sleep.

With so many factors at play, it’s important to not just address your sleep symptoms, but what’s actually triggering them. And that’s going to be different for everyone.

Sachdeva stresses the need to communicate all of your symptoms and concerns to your specialist so that, together, you can create a comprehensive sleep plan that’s right for you.

What might your plan include? Here are five possible ways to take sleep-wrecking symptoms of MS head-on to improve your sleep, health, and life.

Depression is one of the most common effects of MS, according to Fiol, and is a common contributor to insomnia, or an inability to fall or stay asleep. However, help is available.

While you can do a lot on your own to encourage your mental and emotional health — such as practicing good self-care, spending time engaged in meaningful experiences, and investing in personal relationships — it can be incredibly beneficial to also consult a professional, Sachdeva says.

Options include:

Cognitive behavioral therapy is a form of talk therapy that’s focused on challenging and adjusting unhelpful thought patterns into more useful ones.

“Cognitive behavioral therapy is really going to touch on so many of the issues that could be contributing to poor sleep,” Fiol says. For example, CBT can promote improved pain management, reduced depressive symptoms, and lower anxiety levels.

Moreover, a recent study shows that cognitive behavioral therapy for insomnia (CBT-I) reduces the severity of insomnia, improves sleep quality, and reduces levels of fatigue.

Reach out to your MS specialist or health insurance company to find a cognitive behavioral therapist that fits your needs. Keep in mind that many offer telehealth services and virtual visits.

According to a 2019 study, exercise can safely and effectively improve sleep quality in people with MS.

But when levels of fatigue and other physical symptoms of MS are high, and levels of physical function are low, it’s natural to not want to exercise or to get frustrated with workouts.

However, Fiol stresses that no matter the situation, you can integrate forms of appropriate movement into your day. For example, cane-assisted and seated exercises are effective options during attacks or when physical abilities are limited, and there’s no minimum dose of movement you need to make a positive impact on your sleep.

Every bit helps.

Focus on small, doable changes, such as taking a few daily laps down the hallway and back again, waking up in the morning with a 10-minute yoga flow, or doing some arm circles to break up long computer stints.

The goal isn’t pain or muscle soreness — it’s to get the blood flowing, release some feel-good endorphins and neurotransmitters, and help your brain best program its sleep cycles.

For the best effects, try to schedule your activity at least a few hours ahead of bedtime, Sachdeva says. If you notice feeling too revved up for sleep because of your workouts, try moving them earlier in the day.

“Pain, burning sensations, and muscle spasticity seem to flare up for most people at night,” Fiol explains. “It’s possible that pain levels can change throughout the day, but it’s also possible that people are less distracted at night and thus more aware of discomfort and symptoms.”

Before turning to opioids or pain medications, she recommends talking to your doctor about other options and not limiting yourself to medication only.

Fiol notes that acupuncture, massage, mindfulness meditation, and physical therapy can all influence pain and its contributors.

Nerve-block and Botox injections can alleviate localized pain and muscle spasticity.

Lastly, many non-pain medications, such as antidepressants, can also be used to change the way the body processes pain signals, Sachdeva says.

Bladder and bowel dysfunction are common in MS. If you have a frequent and urgent need to go, long bouts of continuous sleep can feel impossible.

However, limiting caffeine and alcohol intake, not smoking, avoiding greasy foods, and not eating or drinking anything within a couple of hours of bedtime can all help, Sachdeva says.

You can also talk to your doctor about your bladder or bowel issues. For example, if you’re taking any medications that can increase urine output, your doctor may suggest taking it in the morning instead of at night, Sachdeva says, adding that you also shouldn’t hesitate to reach out to a urologist or gastroenterologist for additional assistance.

They can help identify food intolerances, underlying digestive issues, and help you with methods to fully empty your bladder and bowels when you use the restroom, he says.

Registered dietitians can also be a great resource when trying to optimize your diet for GI health.

Low vitamin D levels and vitamin D deficiency are risk factors for both developing MS and advancing symptoms. They’re also associated with insomnia.

Meanwhile, many people with MS reporting having restless legs syndrome, which can be related to iron deficiencies, Sachdeva says.

The exact link isn’t known, but if you have frequent sleep troubles or restless legs syndrome, it could be worth having your vitamin levels checked with a simple blood test.

If your levels are low, your doctor can help you figure out how best to get them where they need to be through diet and lifestyle modifications.

For example, while you can find iron in foods such as red meats and beans, and vitamin D in dairy and green, leafy vegetables, the body produces the bulk of its vitamin D through exposure to sunlight.

Iron deficiency anemia, in which the body lacks sufficient red blood cells for transporting oxygen throughout the body, can also cause extreme fatigue. According to research, anemia is strongly associated with MS.

Depending on the severity of any deficiency, supplementation may be necessary, but don’t add a supplement routine before first consulting your doctor.

If MS symptoms have made it feel impossible to get the shut-eye you need, you don’t need to feel hopeless.

Getting to the bottom of why you’re struggling and taking some simple steps can help you hit the hay and feel better for it the next day.


K. Aleisha Fetters, MS, CSCS, is a certified strength and conditioning specialist who regularly contributes to publications including TIME, Men’s Health, Women’s Health, Runner’s World, SELF, U.S. News & World Report, Diabetic Living, and O, The Oprah Magazine. Her books include “Give Yourself MORE” and “Fitness Hacks for Over 50.” You can usually find her in workout clothes and cat hair.