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Poor sleep is common in MS

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Sleep is a very important part of healthy living but there is no set rule on how much sleep is needed. Some people manage perfectly well on four or five hours, whilst others need eight or more.

During sleep there are many complex and important processes going on in the body that allow people to wake up the next day feeling refreshed. Not getting enough sleep leads to lack of energy, irritability and decreased concentration, attention, memory and motivation.

Problems getting enough high quality sleep are common in the general population. This study looked to see what proportion of people with MS experienced poor sleep and what factors led to sleep difficulties.

How the study was carried out

90 people with MS, who had been diagnosed for between 13 to 18 years, and 108 controls, matched for age and sex, took part in the study. They answered a postal questionnaire about sleep called the Pittsburgh Sleep Quality Index (PSQI). It asks general questions about sleep over the last month including:

  • What time do you usually go to bed?
  • How long does it usually take you to fall asleep?
  • How many hours of sleep do you get (not always the same as the number of hours in bed)?

There are also questions about how often someone has difficulty sleeping, the quality of their sleep and the difficulties they may face because of sleep problems such as when driving or socialising. Their room mate or bed partner also completes questions about how much they have noticed them snoring, twitching and having restless sleep. Each question on this section of the questionnaire has four different answers to choose from ranging from "no problem" to "a very big problem".

The answers to all the questions are scored in seven categories to give an estimate of various sleep characteristics such as sleep quality or disturbance and the effects on daytime activities. The seven scores are added together to give the global PSQI score. Participants in this study were separated into good sleepers and poor sleepers based on their global PSQI score.

The researchers also noted whether someone used medication (especially disease modifying therapy or antidepressant drugs) and measured daytime sleepiness, pain, depression and fatigue using appropriate questionnaires. Quality of life was measured using a questionnaire called the Multiple Sclerosis Impact Scale (MSIS-29).

What was found

Participants with MS had an average age of 45 which compared well with the controls (average age 44). Pain, fatigue and depression were common in people with MS. 35 people with MS (43%) received disease modifying therapy (beta interferon, glatiramer acetate or natalizumab).

The researchers found that, on average, people with MS had a higher global PSQI score indicating a poorer quality of sleep. In addition, they found that 67% of people with MS were classed as poor sleepers compared with 44% of the controls. The main factors associated with sleep disturbance were pain and fatigue and it was more common in women. People with MS who had moderate depression and those on antidepressant medication, all experienced poor sleep. In addition, using disease modifying therapy or having a reduced quality of life was associated with poor sleep.

What does it mean?

Poor sleep is common in people with MS. The researchers suggest that it is important to identify sleep problems early and to treat the contributing factors, such as pain, where possible.

Bøe Lunde HM, Aae TF, Indrevåg W et al.
Poor sleep in patients with multiple sclerosis.
PLoS One. 2012;7(11):e49996.

More about sleep and MS

This study adds to the evidence that people with MS often experience sleep problems. It highlights the importance of getting treatment for symptoms that may contribute to poor sleep. Common ones are pain, depression, spasms and bladder problems. If injecting one of the disease modifying therapies leads to poor sleep, it may help to change to a different time of day. You can read more about the causes of sleep problems in the A to Z of MS.

Better treatment for troublesome symptoms may help but there is often scope for other changes. For example, having a better bedtime routine so that you are as relaxed and ready for sleep as possible. We have some tips for better sleeping and NHS Choices also offers suggestions on better sleep.

Research by topic areas...

Symptoms and symptom management

Hebert JR, Corboy JR.
The association between multiple sclerosis-related fatigue and balance as a function of central sensory integration.
Gait Posture.2012 Nov 28. doi:pii: S0966-6362(12)00388-810.1016/j.gaitpost.2012.10.015.[Epub ahead of print]

Disease modifying treatments

Coles AJ.
Alemtuzumab therapy for multiple sclerosis
Neurotherapeutics. 2012 Nov 27. [Epub ahead of print]

Other treatments

Goodman AD, Stone RT.
Enhancing neural transmission in multiple sclerosis (4-aminopyridine therapy).
Neurotherapeutics. 2012 Nov 27. [Epub ahead of print]

Gaillet S, Bardot P, Bernuz B,et al.
Five years follow-up study and failures analysis of Botulinum toxin repeated injections to treat neurogenic detrusor overactivity.
Prog Urol. 2012 Dec;22(17):1064-70.

Langford RM, Mares J, Novotna A, et al.
A double-blind, randomized, placebo-controlled, parallel-group study of THC/CBD oromucosal spray in combination with the existing treatment regimen, in the relief of central neuropathic pain in patients with multiple sclerosis.
J Neurol. 2012 Nov 21. [Epub ahead of print]

Co-existing conditions

Etemadifar M, Roomizadeh P, Abtahi SH, et al.
Linkage of multiple sclerosis and Guillain-Barre syndrome: a population-based survey in Isfahan, Iran.
Autoimmune Dis. 2012;2012:232139.

Assessment tools

Sleeman KE, Higginson IJ.
A psychometric validation of two brief measures to assess palliative need in patients severely affected by multiple sclerosis.
J Pain Symptom Manage. 2012 Nov 27. doi:pii: S0885-3924(12)00465-4.10.1016/j.jpainsymman.2012.08.007. [Epub ahead of print]

Rasova K, Martinkova P, Vyskotova J, et al.
Assessment set for evaluation of clinical outcomes in multiple sclerosis: psychometric properties.
Patient Relat Outcome Meas. 2012;3:59-70.

Pinder B, Lloyd AJ, Elwick H,et al.
Development and psychometric validation of the intermittent self-catheterization questionnaire.
Clin Ther. 2012 Nov 21. doi:pii: S0149-2918(12)00571-1. 10.1016/j.clinthera.2012.10.006. [Epub ahead of print]

Vitamin D

Mesliniene S, Ramrattan L, Giddings S, et al.
Role of vitamin D in the onset, progression and severity of multiple sclerosis.
Endocr Pract. 2012 Nov 27:1-22. [Epub ahead of print]

Salzer J, Hallmans G, Nyström M,et al.
Vitamin D as a protective factor in multiple sclerosis.
Neurology. 2012 Nov 20;79(21):2140-5.

Psychological aspects

Kraemer M, Herold M, Uekermann J, et al.
Theory of mind and empathy in patients at an early stage of relapsing remitting multiple sclerosis.
Clin Neurol Neurosurg. 2012 Nov 28. doi:pii: S0303-8467(12)00561-6. 10.1016/j.clineuro.2012.10.027. [Epub ahead of print]

Burns MN, Nawacki E, Siddique J,et al.
Prospective examination of anxiety and depression before and during confirmed and pseudoexacerbations in patients with multiple sclerosis.
Psychosom Med. 2012 Nov 28. [Epub ahead of print]

Cerasa A, Gioia MC, Valentino P,et al.
Computer-assisted cognitive rehabilitation of attention deficits for multiple sclerosis: a randomized trial with FMRI correlates.
Neurorehabil Neural Repair. 2012 Nov 27. [Epub ahead of print]

Amato MP, Langdon D, Montalban X, et al.
Treatment of cognitive impairment in multiple sclerosis: position paper.
J Neurol. 2012 Nov 23. [Epub ahead of print]

Physical activity

Skjerbæk AG, Møller AB, Jensen E, et al.
Heat sensitive persons with multiple sclerosis are more tolerant to resistance exercise than to endurance exercise.
Mult Scler. 2012 Nov 19. [Epub ahead of print]


Goodin DS, Ebers GC, Cutter G et al.
Cause of death in MS: long-term follow-up of a randomised cohort, 21 years after the start of the pivotal IFNß-1b study.
BMJ Open. 2012 Nov 30;2(6).

Ozakbas S, Kaya D, Idiman E.
Early onset multiple sclerosis has worse prognosis than adult onset multiple sclerosis based on cognition and magneticresonance imaging.
Autoimmune Dis. 2012;2012:563989.


Buzzard KA, Broadley SA, Butzkueven H.
What do effective treatments for multiple sclerosis tell us about the molecular mechanisms involved in pathogenesis?
Int J Mol Sci. 2012 Oct 4;13(10):12665-709.

Sheremata W, Tornes L.
Multiple sclerosis and the spinal cord.
Neurol Clin. 2013 Feb;31(1):55-77.

Kuusisto H, Wu X, Dastidar P, Luukkaala T, et al.
Volumetric MRI assessment of brain and spinal cord in finnish twins discordant for multiple sclerosis.
Medicina (Kaunas). 2012;48(9):437-41.


Peterson EW, Ben Ari E, Asano M et al.
Fall attributions among middle aged and older adults with multiple sclerosis.
Arch Phys Med Rehabil. 2012 Nov28. doi:pii: S0003-9993(12)01188-4. 10.1016/j.apmr.2012.11.027. [Epub ahead of print]

Stem cells

Patani R, Chandran S.
Experimental and therapeutic opportunities for stem cells in multiple sclerosis.
Int J Mol Sci. 2012 Nov 8;13(11):14470-91.

Atkins HL, Freedman MS.
Hematopoietic stem cell therapy for multiple sclerosis: top 10 lessons learned
Neurotherapeutics. 2012 Nov 29. [Epub ahead of print]


Evans C, Kingwell E, Zhu F,
Hospital admissions and MS: temporal trends and patient characteristics.
Am J Manag Care. 2012 Nov;18(11):735-42.

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