- Researchers found that a large proportion of Australians with MS experience poor sleep quality.
- Some prescription medications worsened sleep quality. Poor sleep quality and daytime sleepiness also made some MS symptoms worse, affecting people’s productivity at work.
- Sleep management is part of MS care. Improving sleep quality could help ease some MS symptoms and improve work productivity.
Sleep quality is how satisfied a person is with their sleep. It has several aspects, including sleep efficiency (total time asleep versus total time spent in bed), how long it takes to fall asleep, duration, number of times a person wakes up during the night, and the amount of time spent awake after first falling asleep.
People with MS often have poor sleep quality and it can affect their quality of life. Until now, we have not known much about what methods people with MS use to try to improve their sleep quality or daytime sleepiness. Poor sleep quality and daytime sleepiness can lower people’s productivity in the workplace. Some MS symptoms are linked to poor sleep quality and understanding how they interact may help explain their impact on productivity at work.
What did the researchers do?
MS Australia-supported researchers carried out two studies on sleep issues, using data from the Australian MS Longitudinal Study (AMSLS). One study analysed sleep quality and daytime sleepiness, self-reported sleep treatments and prescription medicine use in people with MS. The second study analysed the relationship between productivity at work and sleep quality and daytime sleepiness.
AMSLS participants were asked about the strategies they used to help them go to sleep and to stay asleep, their sleep quality, daytime sleepiness and work productivity. To explore the relationship between prescription medications and sleep, the researchers linked data from the Pharmaceutical Benefits Scheme (PBS) into their analyses.
What did the researchers find?
Across the two studies, 65-70% of AMSLS respondents reported poor sleep quality and about a fifth reported high levels of daytime sleepiness. Nearly three-quarters said they used various strategies to help them fall asleep or stay asleep:
- Just over half used sleep hygiene methods, such as limiting caffeine and screen time, and regular exercise.
- 40% used medications such as sleeping tablets, antidepressants, melatonin and cannabis.
- Just over a quarter used both sleep hygiene methods and medications.
About half of the AMSLS respondents were taking prescription medications with side effects that could impact on sleep. Antidepressants were the most commonly used prescription medication, followed by muscle relaxants, benzodiazepines and opiate painkillers. While most were not associated with changes in sleep quality or daytime sleepiness, benzodiazepines were linked with poorer sleep quality and selective serotonin reuptake inhibitors (SSRIs, a type of antidepressant) were linked with increased daytime sleepiness. But these effects were small and unlikely to be noticeable.
About half of the respondents said they had lower productivity at work. Poorer sleep quality and greater daytime sleepiness were both associated with greater losses in overall work productivity. In particular, they had a stronger impact on productivity in the workplace than on workplace absences.
Researchers also found that MS symptoms played a substantial role in the relationship between sleep issues and work productivity. Fatigue and cognitive symptoms had the biggest influence, followed by pain and sensory symptoms. Pain and sensory symptoms played the largest role in explaining the relationship between sleep issues and reduced productivity in the workplace due to MS. In the case of workplace absences, fatigue and cognitive symptoms played the largest role.
What does this mean for people with MS?
While benzodiazepines and SSRIs did not have meaningful effects on sleep quality or daytime sleepiness respectively, they could combine with other factors to produce a substantial overall negative effect on sleep. People with MS who are taking these medications and concerned about sleep problems should discuss their possible side effects with their clinicians.
As many people with MS are diagnosed during their employment years, how sleep quality affects productivity at work can have a major impact on them. This research suggests that in people with MS, poor sleep quality and greater daytime sleepiness aggravate some MS symptoms which in turn lower work productivity. Managing sleep is an important part of MS care, as improving sleep may help reduce fatigue, cognitive symptoms, pain and sensory symptoms, improving work productivity and overall quality of life.
For information and resources on managing sleep, please see the Sleep Health Foundation of Australia here.
