Living with multiple sclerosis (MS) can feel like an unpredictable journey, with each person’s experience being unique. One of the often-overlooked aspects of MS is its impact on sleep patterns, especially when it comes to circadian rhythms. Let’s explore the connection between circadian rhythm, sleep issues, and how they influence fatigue in people with MS.
What Are Circadian Rhythms?
Circadian rhythms are your body’s internal clock, which help regulate sleep-wake cycles, energy levels, and even body temperature. This 24-hour cycle is driven by cues like light and darkness, telling you when to feel awake or tired (Reddy et al., 2023). These rhythms can sometimes be disrupted by both changing environmental factors (e.g., diet, exercise, being up at night, being exposed to light pollution) and internal factors (e.g., hormonal changes, gene mutations). The disruption of these rhythms can lead to sleep disorders like insomnia or fragmented sleep, which are common among people with MS (Čarnická et al., 2015; Reddy et al., 2023).
Sleep Disorders and MS – A Vicious Cycle
Research suggests that MS and sleep disorders may exacerbate each other in a cyclical manner. Sleep disorders like insomnia or irregular circadian rhythms can worsen symptoms like fatigue, pain, and cognitive fog (a feeling of mental cloudiness that makes it hard to think clearly), which are challenges many individuals with MS already face (Zimek et al., 2023; Čarnická et al., 2015).
MS can impact parts of the brain that control sleep cycles and neuroimmune responses. Your nervous system (brain) and immune system (a group of cells, tissues and organs that protect your body from disease and infection) work together to combat disease, this may also affect how your body regulates sleep (Čarnická et al., 2015). This can leave you feeling unrested no matter how long you have been in bed.
Fatigue in MS
It is important to understand that fatigue in MS can be different from regular tiredness. MS-related fatigue is not just about feeling sleepy–it can be an overwhelming sense of exhaustion that does not improve with rest (Zimek et al., 2023; Ayache et al., 2022). This type of fatigue can make even simple tasks feel extremely difficult and it is often difficult to predict (Ayache et al., 2022).
This fatigue may be linked to how the immune system, brain, and body’s energy metabolism are impacted in MS. Chronic inflammation and damage to the nerves can make it harder for cells to produce the energy you need, leaving one feeling drained (Zimek et al., 2023; Ayache et al., 2022).
Exciting New Research on MS and Sleep
Researchers are continuously exploring the link between sleep and MS to improve the quality of life for those affected. Recent studies, such as the one conducted by Braley et al. (2024), are looking at how cognitive behavioural and medicinal therapies could potentially help regulate sleep patterns and reduce fatigue. There’s also promising research into how lifestyle interventions, like optimizing light exposure (Voggenberger et al., 2022), diet (Pivarova-Ramich et al., 2022) and exercise (Weinert & Gubin, 2022) can help reset circadian rhythms in people with MS.
Helpful Resources
For more tips and resources on managing MS and sleep, consider visiting:
And remember, every person’s MS journey is unique. If you or someone you know is struggling with sleep issues, reach out to a healthcare provider to find the best strategies to help you!
Written by Nahid M.
References:
Ayache, S. S., Serratrice, N., Abi Lahoud, G. N., & Chalah, M. A. (2022). Fatigue in multiple sclerosis: A review of the exploratory and therapeutic potential of non-invasive brain stimulation. *Frontiers in Neurology, 13*, 813965. https://doi.org/10.3389/fneur.2022.813965
Braley, T. J., Ehde, D. M., Alschuler, K. N., Little, R., Ng, Y. T., Zhai, Y., von Geldern, G., Chervin, R. D., Conroy, D., Valentine, T. R., Romeo, A. R., LaRocca, N., Hamade, M., Jordan, A., Singh, M., Segal, B. M., & Kratz, A. L. (2024). Comparative effectiveness of cognitive behavioural therapy, modafinil, and their combination for treating fatigue in multiple sclerosis (Combo-MS): A randomised, statistician-blinded, parallel-arm trial. The Lancet Neurology, 23(11), 1108–1118. https://doi.org/10.1016/s1474-4422(24)00354-5
Čarnická, Z., Kollár, B., Šiarnik, P., Krížová, L., Klobučníková, K., & Turčáni, P. (2015). Sleep disorders in patients with multiple sclerosis. *Journal of Clinical Sleep Medicine*, *11*(5), 553-557. https://doi.org/10.5664/jcsm.4702
Pivovarova-Ramich, O., Zimmermann, H. G., & Paul, F. (2023). Multiple sclerosis and circadian rhythms: Can diet act as a treatment? *Acta Physiologica, 237*(4). https://doi.org/10.1111/apha.13939
Reddy, S., Reddy, V., & Sharma, S. (2023). Physiology, circadian rhythm. In *StatPearls [Internet]*. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK519507/
Voggenberger, L., Böck, M., Moser, D., Lorbeer, G., Altmann, P., Leutmezer, F., Berger, T., & Seidel, S. (2022). Bright light therapy as a non-pharmacological treatment option for multiple sclerosis-related fatigue: A randomized sham-controlled trial. *Multiple Sclerosis Journal – Experimental, Translational and Clinical, 8*(4), 20552173221133262. https://doi.org/10.1177/20552173221133262
Weinert, D., & Gubin, D. (2022). The impact of physical activity on the circadian system: Benefits for health, performance, and wellbeing. *Applied Sciences, 12*(18), 9220. https://doi.org/10.3390/app12189220
Zimek, D., Miklusova, M., & Mares, J. (2023). Overview of the current pathophysiology of fatigue in multiple sclerosis, its diagnosis and treatment options: Review article. *Neuropsychiatric Disease and Treatment, 19*, 2485-2497. https://doi.org/10.2147/NDT.S429862
