Better ZZZ Might Lead to Surer Strides

Problems with gait are fairly common in people with MS. Poor gait describes problems with walking caused by:

• Inability to control a variable stride length
• Shortened stride length leading to a stiff gait
• Stiffness and spasticity in the leg muscles, leading to “foot drop”
• Weakness and feelings of heaviness in the legs
• Problems with muscle control in the feet, such as contractures
• Balance issues, which may lead to favoring or veering to one side

Problems with walking generate from miscommunication between the brain and the muscles, especially in the hips, legs, and feet. These can spasm, stiffen, weaken, or experience delays in function due to mixed neurological messages.

A recent study published in Neurology, however, suggests a hidden cause for poor gait in people with MS: poor sleep.

Could poor gait be caused by disrupted sleep?

A small observational study published in April 2019 by El-Salem, et al. proposed that sleep deficits might lead to unstable gait in people with MS.¹

The authors wrote that, “despite the fact that disturbances of sleep are among the most common and disabling manifestation of MS, to our knowledge, no study has examined the association between sleep quality and mobility measures.”

Meanwhile, they acknowledged the results of prior research, which point to links between poor sleep and the cognitive changes, fatigue and depression characteristic of MS.

The researchers studied the gait and sleep quality of 38 subjects with relapsing-remitting MS. They used conventional gait measuring tools and the Pittsburg Sleep Quality Index (PSQI), a common sleep questionnaire. The PSQI provides only subjective (self-reported) measures of sleep quality, so they also objectively measured movement during sleep using wearable monitors.

Results showed that 100 percent of subjects reported poor sleep quality, which was confirmed by data collected from the wearables. Two important measures of sleep quality—sleep efficiency and waking after sleep onset (WASO)—were significantly correlated to problems with stride length and variability in test participants.

The researchers concluded that a measurable link exists between poor sleep and gait problems among people with MS. Their recommendation? “Sleep assessment should be considered for MS individuals… Interventions to improve sleep quality and consequently gait performance are probably essential and warrant further investigation.”

Why this small study matters

People with MS don’t typically sleep well in the first place. Reasons for poor sleep include varying problems with medications, pain, spasticity, and other issues of the central nervous system.

But if we could find ways to sleep better, the El-Salem, et al. study shows it could be one way to improve walking ability.

An unspoken, but important consideration needs to be addressed as well: Other recent research shows that more than half of people with MS experience bad falls when observed over a 3-month period.²

Bad falls may be the reason we end up needing assistive devices. If good sleep could prevent some of these, why not make it a priority?

How to sleep better when you have MS

Some sleep problems require the insights of a sleep health professional. But, before we plan for a trip to the sleep lab, why not first rule out poor sleep hygiene as the villain behind our sleep disturbances?

Sleep hygiene describes all the ways we can help ourselves achieve more and better sleep. People with MS might consider these practices especially helpful:

• Bedtime relaxation (stretching, breathing, warm baths, massage, meditation)
• Making your bedroom a comfortable, sleep-inducing environment (keeping it cool, quiet, dark, clean)
• Medication management (taking medications at times of the day when they can’t disrupt sleep or lead to daytime sleepiness and fatigue, whenever possible)
• Going to bed and rising at the same time every day
• Daily exposure to bright natural light; avoiding blue spectrum light from electronics at night
• Exercising early in the day, which is a natural way to strengthen circadian rhythms
• Stress reduction (keeping a journal, mental health counseling, attending a support group live or online, finding time to create or play)
• Managing pain (especially at bedtime)

If sleep hygiene doesn’t work

If you suffer from chronic sleeplessness, disturbing dream or nightmare behavior, or daytime fatigue, these could be signs of an underlying sleep disorder.

Common sleep disorders for people with MS include insomnia, obstructive sleep apnea, restless legs syndrome, periodic leg movement disorder, circadian rhythm disruption, idiopathic hypersomnia, and even REM behavior disorder (in which one enacts dream narratives).

Concerns about any of these potential sleep disorders should be directed to your neurologist, who can give you the necessary referral for a sleep study in the event you might need one.