#096: From Fatigue to Focus. The Power of Sleep and Exercise in Managing MS an ECTRIMS Special

Sleep is one of the most critical yet often underestimated aspects of managing MS. For many of us living with MS, poor sleep can worsen fatigue, brain fog, and other symptoms, making daily life even more challenging. The good news is that improving your sleep isn’t just possible—it can lead to meaningful improvements in your energy, mood, and overall well-being. In this summary from ECTRIMS 2024 papers, I’ll explore recent research on how sleep and physical activity interact in MS, along with tips to help you get the restorative rest you deserve.

Table of Contents

1. Assessment of sleep quality and its relationship with physical activity in patients with Relapsing-Remiting Multiple Sclerosis

by RocĂ­o LĂ³pez Ruiz et. al

Sleep and MS: How Better Sleep Can Improve Your Quality of Life

If you’re living with MS, you’ve likely experienced challenges with sleep. Many people with MS report trouble falling asleep, staying asleep, or feeling rested when they wake up. These difficulties can lead to fatigue, mood changes, and difficulty concentrating, making it even harder to manage daily life. The good news? A new study offers insight into how improving your sleep quality could positively affect your MS journey—and how physical activity might play a big role.

What Was the Study About?

This study focused on understanding the relationship between sleep quality and physical activity in people with relapsing-remitting MS (RRMS). Researchers conducted a 12-week exercise program and tracked changes in sleep, fatigue, cognitive function, and overall quality of life. The aim was simple: to see if moderate physical activity could help improve sleep and its related challenges.

Key Findings

Here’s what the study discovered and why it’s important for you:

  1. Improved Sleep Quality:

    • Participants reported better sleep efficiency, longer sleep duration, and fewer interruptions after completing the program.
    • On average, the time it took to fall asleep decreased significantly (from 11 minutes pre-program to just 9 minutes post-program).
  2. Reduced Fatigue:

    • Fatigue levels were lower after the program, helping participants feel more energized and better equipped to manage daily tasks.
  3. Better Cognitive Performance:

    • Some participants experienced slight improvements in memory, focus, and reaction time, although more research is needed to confirm these findings.
  4. Enhanced Quality of Life:

    • Improvements in sleep and reduced fatigue led to better overall well-being and mood.

Why Does This Matter for You?

Sleep plays a crucial role in managing MS symptoms. When your body gets the rest it needs, you’re better equipped to handle fatigue, maintain focus, and manage stress. The study highlights how a simple, moderate exercise routine can help improve your sleep and, in turn, your quality of life.

How Reliable Is This Study?

This was a single-center observational study with a small sample size (23 participants). On the Cochrane scale, it provides moderate evidence due to its controlled design and specific outcome measurements. While it doesn’t prove causation, it strongly suggests that exercise could be a helpful tool for improving sleep in people with MS.

What Can You Do?

If you’re struggling with sleep and want to try improving it, here are a few tips inspired by the study:

  1. Incorporate Gentle Exercise:

    • Activities like yoga, swimming, or walking can be effective. Aim for consistency over intensity—just 20–30 minutes a day can make a difference.
  2. Create a Sleep Routine:

    • Go to bed and wake up at the same time each day. Avoid screens and caffeine before bedtime to improve your chances of restful sleep.
  3. Track Your Progress:

    • Keep a sleep diary to note what’s working and what isn’t. This can also be helpful when discussing your symptoms with a healthcare provider.
  4. Talk to Your Doctor:

    • If you’re experiencing persistent sleep issues, bring them up during your next appointment. They can help tailor a plan that works for your specific needs.

Takeaway

Good sleep isn’t just a luxury—it’s essential for your health and well-being, especially when living with MS. This study underscores that moderate physical activity could be a game-changer for improving sleep and reducing fatigue. Small, consistent changes can make a big difference. So why not give it a try? A better night’s sleep might just be the start of a more energized and fulfilling day. You’ve got this!

2. Sleep disorders and fatigue in multiple sclerosis: association and interaction.

by GabrielÄ— PupelytÄ— et. al

Sleep Disorders and Fatigue in MS: Why Sleep Matters More Than Ever

If you’re living with relapsing-remitting multiple sclerosis (RRMS), you might already know that good sleep can feel elusive. This study dives deep into the link between sleep disorders, fatigue, and MS, offering valuable insights into how improving sleep could significantly impact your quality of life.

Why This Study Matters

Over half of people with RRMS report long-term sleep issues, including trouble falling asleep, staying asleep, or waking up feeling refreshed. This study examined how common these issues are, how they connect to fatigue, and what can be done to address them.

What Did the Researchers Look At?

The study included 50 patients with RRMS and compared them to 52 healthy adults of similar age and sex. The researchers analyzed:

  • Sleep patterns using advanced tests like polysomnography (a detailed sleep study).
  • Fatigue levels using standardized questionnaires.
  • The connection between poor sleep and fatigue severity in MS patients.

Key Findings

  1. Insomnia Is More Common in MS:

    • People with RRMS were more likely to experience clinical insomnia compared to the healthy group.
  2. Poor Sleep Quality = Higher Fatigue:

    • Those with worse sleep quality had significantly higher levels of fatigue. This connection was particularly strong for MS-related fatigue, which can feel different from the fatigue healthy people experience.
  3. Sleep Efficiency and REM Sleep Decrease in MS:

    • Polysomnography revealed that MS patients had:
      • Lower sleep efficiency (less time spent sleeping relative to time in bed).
      • Shorter REM sleep periods, which are essential for mental restoration.
  4. Sleep Disorders Exacerbate Fatigue:

    • Sleep apnea and other sleep disorders were more common in the MS group, further contributing to daytime fatigue.

What Does This Mean for You?

The study highlights a critical connection between sleep and fatigue in MS. By addressing sleep issues, you could potentially reduce fatigue and feel more energized for daily activities. Sleep isn’t just a comfort—it’s a cornerstone of managing MS effectively.

How Reliable Is This Study?

This research is based on a controlled observational study, which provides moderate evidence on the Cochrane scale. Polysomnography adds a high level of detail to the findings, making the results reliable. However, larger studies could strengthen these insights.

What Can You Do to Improve Your Sleep?

  1. Consult a Sleep Specialist:

    • If you struggle with insomnia or suspect a sleep disorder like sleep apnea, speak to your doctor. Polysomnography or other tests can provide valuable insights.
  2. Create a Sleep-Friendly Environment:

    • Keep your bedroom cool, quiet, and dark.
    • Establish a consistent bedtime routine to train your body for better sleep.
  3. Explore Relaxation Techniques:

    • Practices like mindfulness, deep breathing, or light yoga before bed can help calm your mind and prepare you for rest.
  4. Stay Active:

    • Gentle exercise during the day, like walking or stretching, can improve sleep quality over time. Just avoid intense activity right before bed.
  5. Track Your Progress:

    • Use a sleep diary or app to monitor your sleep patterns and identify triggers that disrupt your rest.

Takeaway

Good sleep is essential for everyone, but it’s especially crucial when you’re managing MS. This study underscores that addressing sleep issues can significantly reduce fatigue and improve overall well-being. By taking small, consistent steps to improve your sleep quality, you’re investing in your health and resilience. Remember, even small changes can lead to big improvements over time. Sleep well, and take care—you deserve it!

3. Relationship between sleep disorders and information processing speed in multiple sclerosis

by Fereshteh Ashtari et. al

Sleep and Brain Function in MS: How Sleep Disorders Affect Information Processing

If you’re living with progressive multiple sclerosis (pMS), you probably already know how challenging cognitive symptoms can be. This study sheds light on how certain sleep disorders—like restless leg syndrome (RLS) and obstructive sleep apnea (OSA)—impact brain functions like information processing speed (IPS). The good news? Understanding this connection could help you take proactive steps to improve both sleep and brain function.

What Was the Study About?

This research focused on the link between sleep disorders and information processing speed in people with MS. The goal was to investigate whether RLS or OSA, two common sleep issues in MS, could affect cognitive performance, especially the ability to process information quickly.

Key Findings

  1. Restless Leg Syndrome Affects Brain Speed:

    • The study found a strong association between RLS symptoms and slower IPS. In other words, people with RLS were more likely to have reduced cognitive function, as measured by specific tests.
  2. Obstructive Sleep Apnea (OSA) Was Less Impactful:

    • While OSA was evaluated, it didn’t show the same significant connection to reduced IPS in this particular group of participants.
  3. Why This Matters:

    • Slower IPS is one of the most common cognitive symptoms in MS, affecting your ability to quickly think, respond, and make decisions. By identifying sleep disorders like RLS, it’s possible to address this symptom and potentially improve cognitive function.

How Reliable Is This Study?

This was a cross-sectional observational study, which provides moderate-level evidence on the Cochrane scale. While it doesn’t prove that RLS directly causes cognitive slowing, it highlights a significant association that’s worth exploring further. The study’s use of validated questionnaires and cognitive tests strengthens its findings.

What Does This Mean for You?

Improving sleep quality can be a powerful way to boost your brain health and overall well-being. If you’re experiencing sleep issues like RLS or OSA, addressing them might also improve cognitive symptoms.

Steps You Can Take:

  1. Talk to Your Doctor About Sleep:

    • If you suspect RLS or OSA, ask your healthcare provider for advice. They may recommend sleep studies or treatments to address these conditions.
  2. Prioritize Sleep Hygiene:

    • Maintain a consistent sleep schedule.
    • Limit caffeine and screen time before bed.
    • Create a comfortable sleep environment with minimal distractions.
  3. Track Symptoms:

    • Keep a diary of your sleep patterns and cognitive symptoms. This can help you and your doctor spot patterns and evaluate the impact of treatments.
  4. Consider Therapies for RLS:

    • Medications or lifestyle changes, like regular exercise and a diet rich in magnesium and iron, might help reduce RLS symptoms.

Takeaway

This study reminds us of the critical role sleep plays in managing MS, particularly when it comes to brain function. By addressing sleep disorders like RLS, you might not only improve how well you rest but also enhance your cognitive abilities and quality of life. Small changes can make a big difference, so why not start with one tonight? Rest well—you deserve it!

4. Ketogenic Diet in patients with Multiple Sclerosis: effect on Fatigue, Quality of Sleep and Sleepiness.

by Francesca Filippi et. al

Can a Ketogenic Diet Help with Sleep and Fatigue in MS? Insights from Recent Research

Living with multiple sclerosis (MS) often means navigating challenges like fatigue and sleep difficulties, which can have a significant impact on your quality of life. A recent study explored whether a ketogenic diet (KD) could help improve these symptoms—and the results are promising! Let’s break it down.

What Was the Study About?

Researchers examined the effects of a three-month ketogenic diet on fatigue, sleep quality, and daytime sleepiness in 38 people with MS. The ketogenic diet is a low-carbohydrate, high-fat diet often used in managing certain medical conditions. The participants followed different types of KD depending on their weight and health goals.

The study used several tools to measure progress:

  • Fatigue Severity Scale (FSS): To assess fatigue levels.
  • Pittsburgh Sleep Quality Index (PSQI): To evaluate sleep quality.
  • Epworth Sleepiness Scale (ESS): To measure daytime sleepiness.

They also tracked changes in body composition, including body mass index (BMI) and fat mass (FM).

Key Findings

  1. Reduced Fatigue:

    • Fatigue scores dropped significantly, meaning participants felt less exhausted after three months on the diet.
  2. Improved Sleep Quality:

    • Sleep quality scores improved, showing that participants experienced better rest at night.
  3. Less Daytime Sleepiness:

    • Participants reported feeling less sleepy during the day, which can make it easier to stay active and engaged.
  4. Healthier Body Composition:

    • BMI and fat mass both decreased, which can be beneficial for overall health and inflammation in MS.

Why Does This Matter?

Fatigue and poor sleep are common and often debilitating symptoms of MS. This study suggests that adopting a ketogenic diet might help manage these issues, offering a non-pharmaceutical approach to improving quality of life.

How Reliable Is This Study?

This was a small, observational study conducted at a single center, which provides moderate evidence on the Cochrane scale. While the findings are encouraging, more extensive research is needed to confirm these results and explore long-term effects.

What Does This Mean for You?

If fatigue and sleep issues are part of your MS journey, considering dietary changes could be a valuable addition to your care plan. Here’s how to start:

  1. Consult Your Healthcare Team:

    • Before starting any new diet, talk to your doctor or a registered dietitian. They can help ensure that a ketogenic diet is safe and appropriate for you.
  2. Make Gradual Changes:

    • A ketogenic diet involves significant dietary shifts, such as reducing carbohydrates and increasing healthy fats. Transitioning gradually can make it easier to adjust.
  3. Track Your Progress:

    • Keep a journal to monitor changes in your fatigue, sleep, and overall well-being. This can help you and your healthcare provider evaluate the diet’s impact.
  4. Combine with Other Approaches:

    • Pairing dietary changes with other lifestyle strategies, like regular exercise and good sleep hygiene, can amplify the benefits.

Takeaway

The ketogenic diet might offer a new way to manage some of the toughest symptoms of MS, like fatigue and sleep disturbances. While it’s not a one-size-fits-all solution, it’s an empowering reminder that lifestyle choices can make a meaningful difference. Why not explore this approach with your healthcare team and see if it could work for you? Small steps can lead to big improvements in how you feel and live.

5. Adolescent sleep patterns, genetic predisposition, and risk of multiple sclerosis

by Lars Alfredsson et. al

The Role of Sleep in MS Risk: What Recent Research Says

Getting enough good-quality sleep is vital for everyone, but it’s especially important if you’re living with multiple sclerosis (MS) or trying to reduce your risk of developing it. A recent study from the Karolinska Institute sheds light on how sleep during adolescence may influence MS risk later in life, especially for those with a genetic predisposition. Let’s break it down.


What Did the Study Look At?

This research explored the connection between adolescent sleep patterns, genetic predisposition (specifically the HLA-DRB1*15:01 gene, which is linked to a higher risk of MS), and the likelihood of developing MS.
The researchers analyzed data from 1,235 people with MS and 1,765 controls to see how sleep quality, duration, and timing during adolescence could interact with genetic risk factors.


Key Findings

  1. Sleep Duration Matters:

    • Adolescents who slept less than 7 hours per night had a 40% higher risk of developing MS compared to those who slept longer.
  2. Quality of Sleep Counts:

    • Poor sleep quality during adolescence was associated with an increased risk of MS.
  3. Genetics and Sleep Combine:

    • The risk was even higher for individuals who carried the HLA-DRB1*15:01 gene and had poor sleep patterns.
  4. Shifting Sleep Patterns:

    • Those with frequent changes in their sleep-wake schedule (e.g., staying up late and sleeping in on weekends) also faced an elevated risk of MS.

Why Does This Matter?

This study highlights that sleep isn’t just about feeling rested—it may play a critical role in reducing inflammation and supporting immune health, which is essential for managing or preventing MS. For those with a genetic predisposition, making sleep a priority could potentially lower their risk.


How Reliable Is This Study?

This research is based on a population-based case-control study, which provides moderate evidence according to the Cochrane scale. While it doesn’t prove that poor sleep directly causes MS, the strong association and large sample size make the findings meaningful. It’s an important piece of the puzzle that emphasizes how lifestyle factors like sleep can interact with genetic risks.


What Can You Do?

  1. Prioritize Sleep:

    • Aim for 7-9 hours of quality sleep each night. Try to stick to a consistent sleep schedule, even on weekends.
  2. Create a Restful Environment:

    • Keep your bedroom cool, dark, and quiet. Limit screen time before bed and consider relaxing bedtime routines like reading or meditation.
  3. Pay Attention to Sleep Quality:

    • If you wake up feeling unrefreshed or have trouble falling asleep, talk to your healthcare provider. Issues like sleep apnea or insomnia can often be treated.
  4. Support Young People:

    • If you have children or teenagers, encourage healthy sleep habits early. This study shows how important adolescent sleep is for long-term health.

Takeaway

This research is a powerful reminder that sleep is more than just rest—it’s an essential part of supporting your immune system and overall health. For those living with MS or at risk, improving your sleep could be a simple yet impactful step toward better well-being.

So, how about prioritizing sleep tonight? Small changes, like going to bed at the same time every night or reducing screen time, could make a big difference. You deserve it!

See you soon and try to make the best out of your life,
Nele

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Nele von Horsten

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I show you how to make the best of your life with MS from family to career to hobbies. Thanks to science and research, a lot is possible nowadays.

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