Non-drug interventions may improve sleep for MS patients
Exercise, behavioral strategies seen effective in meta-analysis
Non-pharmacological interventions such as mindfulness and exercise may improve sleep for people with multiple sclerosis (MS) while boosting overall psychological well-being and quality of life, according to a meta-analysis of several studies.
While the studies were very different from each other, making it difficult to draw reliable conclusions, the findings underscore the clinical relevance of non-pharmacological interventions as an alternative to or in combination with medications for sleep, the researchers said.
The study, “The Efficacy of Non-Pharmacological Interventions for Sleep Disorders in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis,” was published in the Journal of Sleep Research.
Damage to nerve cells in the brain and spinal cord lead to a range of MS symptoms, from problems with vision, balance, and coordination to numbness or tingling in different parts of the body. Many people with MS, up to 60%, also experience difficulty sleeping.
Sleep problems in MS can include insomnia (difficulty falling or staying asleep), sleep apnea (pauses in breathing during sleep), restless legs syndrome (a strong urge to move the legs), narcolepsy (suddenly falling asleep during the day), and rapid eye movement sleep behavior disorder (acting out dreams).
Sleep problems stem from disease, medications
These sleep problems can be caused by MS itself — due to damage in areas that control sleep — or by other factors such as pain and side effects of MS medications. Since medications used to treat sleep problems can also cause unwanted side effects, there is a growing interest in non-pharmacological interventions.
To understand how effective non-pharmacological interventions are for sleep problems in people with MS, researchers searched the medical literature for randomized, controlled studies measuring sleep quality. They identified nine studies testing different non-pharmacological interventions.
These studies, each covering 15–72 patients, came from the U.S., Turkey, Iran, and Jordan. Non-pharmacological interventions included mindfulness, exergaming (active video gaming), occupational therapy, cognitive behavioral therapy, aerobic exercise, and self-guided changes in physical activity.
In one study, mindfulness focused on present-moment awareness and emotional regulation, incorporating yoga, breathing exercises, and cognitive behavioral strategies to reduce stress. Sessions lasted one to four hours and were led by a certified instructor.
Another study tested exergaming, which included activities such as target shooting and rock climbing twice a week for eight weeks. Each session lasted 45 minutes. Physiotherapists tailored the video games based on each patient’s physical ability.
Other interventions targeted both sleep and physical health. One study combined sleep hygiene, moderate aerobic exercise, occupational therapy, and cognitive behavioral therapy to address sleep-related thoughts. In two other studies, patients learned behavioral strategies for insomnia — such as sleep schedules and progressive muscle relaxation — through weekly sessions over six weeks.
In one study, a stepper machine was used for 40 minutes of supervised aerobic exercise to improve cardiovascular health. Patients exercised at moderate intensity, with levels adjusted based on their heart rate. Two other studies focused on changing negative thoughts using relaxation techniques, discussions, and homework reviews.
While the studies used different tools to measure sleep quality, the pooled effect size — a measure of the strength of the relationship between interventions and improved sleep — was in favor of the non-pharmacological interventions versus control interventions.
“The pooled effect size was statistically significant,” the researchers wrote. This suggests that non-pharmacological interventions may help people with MS sleep better, “while also providing additional benefits for overall psychological well-being and quality of life,” they wrote.
However, “despite the positive findings, the wide prediction interval suggests caution,” the researchers noted. “Future studies should aim to refine intervention strategies, investigate underlying mechanisms, and incorporate subjective and objective sleep measures to understand better and improve treatment efficacy,” they concluded.
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