If someone were to ask me what my three favourite places in the world were, my bed would definitely be one of them. Since I was diagnosed with MS in 2008, fatigue has been a constant symptom with which I’ve had to contend.
I lead a busy life. I work full time, I’m active in the patient advocacy arena, I try to have a social life, and I exercise regularly. All this takes energy that diminishes significantly if I’ve not had enough good quality sleep.
But, like anyone who’s ever struggled to fall asleep knows, the more stressed you become about getting good sleep, the harder it is to achieve. Not only do I find it more difficult to fall asleep when I’m stressed, but when I do it is often fitful and disturbed and I am prone to bad dreams. I used to become really wound up if I couldn’t get to bed on time, or if something disturbed my afternoon nap.
Now I try to let it go and to focus instead on the things I can control. These form the basis of good sleep hygiene and the following tips have helped me.
Keep a sleep diary
It’s handy to keep a sleep diary to find out what works for you, and what may be preventing you from getting good quality sleep. Make a note of your activities during the day, what you’ve had to eat and drink and when, your mood, and the time you go to bed and wake up. You might see patterns emerge that will show what is optimal for you. Generally, adults between the ages of 18 and 64 are recommended to have seven to nine hours of sleep per night, but find out what’s best for you. I believe my body responds best to between six and eight hours’ sleep. Any more or any less and I struggle to function.
Routine, routine, routine
My body doesn’t adjust well to doing things differently. It likes routine and predictability. I always try to go to bed and wake up at around the same time every day, even at weekends. I try to take my afternoon naps at around the same time. If I miss my napping window, I will try to power through rather than taking a nap too late as this might make me unable to fall asleep at bedtime.
I also try to minimise my naps to no more than half an hour if it’s the morning and two hours if it’s the afternoon. This might work differently for different people, but I find the important thing is to not nap for too long, too late in the day. I also have a regular routine before going to bed at night which I try to stick to.
Say no to late night feasts
I find “eating breakfast like a king, lunch like a prince and dinner like a pauper” has positive effects on my sleep. Large quantities of rich, spicy or heavy food can cause indigestion. When you have this close to bedtime, it can result in painful heartburn, which can cause disturbed sleep.
I try to have my main meal as early in the day as possible. If it needs to be in the evening, I’ll try to finish at least three or four hours before going to bed. If I eat a snack before bedtime, it will be something light, such as oatcakes, cereal bars or crackers.
Exercise as early as possible
While exercise can help me to get a better night’s sleep, I find the timing of it important. High intensity exercise can cause the body to produce cortisol, a stress hormone, which causes the brain to be more alert. As someone who works full time, I’m only able to exercise in the evenings. Therefore, if I’m working out, I try to finish at least three hours before going to sleep. This gives me enough time to come down off the “exercise high” to the point where I’m tired from the exertion and am ready to go to bed anyway.
Wind down before bedtime
As mentioned above, I try to maintain a bedtime routine of activities that relaxes me. This starts with a warm, milky drink in the evening and a nice hot shower. Then I will “process” my day by writing in my journal. I’ll also note down things I need to remember for the following day so that I’m not thinking about it when I go to sleep. I might put on some relaxing music, sounds, or a guided mindfulness exercise or meditation to fall asleep to. There are plenty of options on YouTube and Spotify, as well as apps such as Headspace and Calm. I particularly enjoy falling asleep to sounds of the ocean or forest.
Be mindful what you drink
As I’ve just mentioned, I enjoy a warm drink in the evening. That is, unless my bladder issues have been particularly bad that day. If that’s the case, I’ll stop drinking around two hours before going to bed.
As a rule, I don’t drink much caffeine and I’m teetotal. But if you do drink alcohol and caffeine, it’s recommended not to consume either for at least four to six hours before going to bed, as they can act as stimulants. They may also aggravate MS bladder symptoms, which could result in you waking up repeatedly to go to the bathroom during the night.
Keep it moderate
Having your room at the right temperature is key to ensure a comfortable sleep. Since my MS diagnosis, I’ve had problems regulating my body temperature. This means if my bedroom gets too cold when I’m asleep, I’ll experience severe night sweats. Wearing extra layers exacerbates the issue also.
Now I have a portable temperature-controlled heater in my bedroom to ensure I’m warm enough, especially in the winter months. Plus, I’ll have a warm shower before going to bed, to raise my body temperature and to relax me.
Everyone is different though, so if heat affects your sleep, then try having a cool shower before bed. You may also want to invest in an air conditioning unit or fan. Instead of heating up hot water bottles I freeze them. Ice packs and cold sheets can also come in handy for a cooler night’s sleep.
Limit screen time before bed
It’s common knowledge that we should limit our screen time before bed. This is the aspect of good sleep hygiene that I struggle with the most. Just before bed is usually the time when I’m able to catch up with my social media, respond to emails and text messages, and see what’s been happening in the world. I’ve come to realise that it’s better for me to catch up on the things I want to, rather than just avoiding using my phone before bed. Otherwise I stress out more and that affects my sleep anyway!
Therefore, to minimise disruption to my sleep, I make sure I have “night mode” switched on (this reduces the “blue light” emitted from screens that can disrupt sleep) and I never check my phone if I wake up during the night.
Everyone with MS is different. Neuropathic pain, frequent trips to the bathroom, muscle spasms and sensory problems can all disturb someone’s sleep. Some medications can disrupt sleeping patterns too. The tips above aren’t meant to be a cure-all, rather they’re about helping to promote better sleep.
If symptoms are keeping you up at night then I’d recommend talking to your healthcare team. There may be things they can do to help.
UK/MED/19/0261 October 2019