Understanding the Relationship Among Fatigue, Sleep Hygiene Behaviors, and Symptoms of Multiple Sclerosis

Published on: 


Multiple sclerosis (MS) is a neurological disorder that affects approximately 2.3 million adults globally. Symptoms of MS negatively affect overall well-being and quality of life (QOL) and arise from inflammation and demyelination that occur in the central nervous system (CNS), specifically the brain.1

One of the most commonly reported symptoms of MS is fatigue. Data suggest­­ that up to 90% of patients with MS experience fatigue. Factors that contribute to MS-related fatigue include anxiety, depression, disordered sleep, and certain medications. In addition, fatigue can result from the MS disease process.1

More than 80% of patients with MS experience both fatigue and poor sleep. This is particularly concerning as fatigue and poor sleep are often associated with episodes of depression, anxiety, and difficulty concentrating. Furthermore, reduced sleep quality in patients with MS is associated with increased disability and cognitive decline. These effects can negatively impact QOL and the ability to perform work-related tasks. To the authors’ knowledge, at the time this study was conducted, no previous studies had analyzed the connections among fatigue, sleep hygiene behaviors, and symptoms of MS.1


Patients in the study were community-dwelling adults in the midwestern United States who were 18 to 70 years of age and had a definitive diagnosis of either relapsing-remitting or secondary-progressive MS. Participants expressed the willingness to record symptoms and lifestyle habits in a web-based diary and were required to have reliable computer and Internet access.1



Patient Demographics

Thirty-nine patients participated in the study. The majority of patients were female (85.2%), white (81.5%), and employed (55.6%). Eighty-one percent of patients had relapsing-remitting MS and 19% had secondary-progressive MS. The mean time since diagnosis was 11.3 years and the mean Expanded Disability Status Scale score was 3.8, implying a lower level of disability.1

Correlation Analysis

Forgetfulness, anxiety, and difficulty concentrating all had strong correlations with poor sleep quality on the Pittsburgh Sleep Quality Index (PSQI) (P <.05), whereas fatigue, pain, and heat intolerance were not associated with poor sleep on the PSQI. The results also showed that the use of technology (eg, watching television, listening to the radio, talking on the phone) affected sleep quality1:

  • Watching television correlated with fatigue (P = .009), forgetfulness (P <.001), anxiety (P <.001), pain (P = .02), and difficulty concentrating (P = .003), but not with heat intolerance.
  • Listening to the radio was correlated with fatigue (P = .031), forgetfulness (P <.001), anxiety (P <.001), pain (P = .0002), and difficulty concentrating (P = .0001), but not with heat intolerance.
  • Talking on the phone was correlated with fatigue (P = .0104), forgetfulness (P = .0145), anxiety (P = .0008), pain (P <.0001), and heat intolerance (P = .03), but not with difficulty concentrating.

With regard to symptoms and demographic variables, fatigue frequency was significantly different when stratified by sex (P <.007).1


In this study, the symptoms of forgetfulness, anxiety, and difficulty concentrating were shown to be correlated with poor sleep quality. In terms of behaviors during bedtime, watching television, listening to the radio, and talking on the phone negatively affected sleep quality.1

To confirm these findings, additional research is needed in a larger sample of patients, and well-validated tools for the assessment of clinical depression and anxiety should be used. A better understanding of the underlying relationships among use of electronic devices, stress, sleep, and depression in adults with MS is needed.1


1. Newland P, Lorenz RA, Smith JM, Dean E, Newland J, Cavazos P. The relationship among multiple sclerosis-related symptoms, sleep quality, and sleep hygiene behaviors. J Neurosci Nurs. 2018;51(1):37-42. doi: 10.1097/JNN.0000000000000409.