Insomnia and MS: The Steroid Connection

You awaken to discover you have lost sight in one eye. Or you can no longer lift your legs. Maybe you’re experiencing a severe spasm of the ribcage (the MS “hug”) which continues to bring crushing pain every time you draw a breath.

These are all potential symptoms of an MS relapse.

Steroid treatment

If these (or other MS symptoms) last for more than a few days, you may need to visit your MS neurologist. They may request an MRI to identify new disease progression. Or, they may skip the MRI and suggest steroid treatment instead.

Steroids are used to fight acute inflammatory issues of the immune system. Using steroids to manage relapses can speed recovery. (However, while some believe steroids can limit the damage caused by active lesions or delay the emergence of future relapses, research is inconclusive on these outcomes.)¹

If using steroids can help restore your sight or the use of your legs, or provide relief for unbearable pain due to spasticity, why not go this route?

As anyone who has ever used steroids can confirm, they have side effects – a major one being insomnia.

How steroids cause insomnia

Steroids – both intravenous (methylprednisolone) and oral (prednisone) – are known to exhaust the adrenal glands.

These organs are responsible for managing our “fight or flight” stress responses. They also supply the body with the hormones necessary to regulate both sleep and wakefulness.

Too much stress on these organs leads to a hypervigilant body and racing mind, making it hard to relax and fall asleep.

Or, should you be lucky enough to fall asleep while taking steroids, you may still experience unpleasant dreams or night sweats that are also side effects.²

Oral vs. intravenous steroids

Both types of steroids can cause sleeplessness, primarily due to the very reason they are so effective: their aggressive anti-inflammatory properties. However, oral steroids may be more likely to lead to acute insomnia.

In one 2017 study published in the Journal of Neurology, oral and intravenous steroids used to treat acute MS relapses were compared for both efficacy and safety. While no distinct differences were found between either option, insomnia was “significantly associated with the oral route of steroid administration.”³

Do you need steroid treatment?

Some MS specialists automatically turn to steroids to treat sudden and severe relapses, while others may use other approaches. In fact, in some cases, a flare may not require treatment at all.

The timing of interventions also matters. Choosing the steroid route only works if less than 2 weeks have passed following the appearance of severe symptoms. Starting steroids after that time may make no difference.

If insomnia or other side effects of steroid use are concerning to you, you have the right to ask for alternatives.

Steroid alternatives

If you’re in a relapse, but do not want to take steroids, consider these other approaches.

• Try Acthar® Gel. This treatment for inflammation contains adrenocorticotropin (ACTH), which helps the body produce and use its own naturally occurring corticosteroid hormones to fight inflammation. It’s injected once daily, either into the muscle or under the skin, over a 2- to 3-week period.⁴
• Rest. When your MS flares up, it’s a sign the body is undergoing an inflammatory response which could be related to stress, overheating, or simply overdoing things. Take your flare as a sign you need to settle in and give your body a chance to recover and heal from inflammation.
• Practice good self-care. Sometimes we can fall into bad eating habits, become sedentary, or make less-than-healthy choices like smoking or drinking. Returning to a healthy diet, drinking more water, exercising or stretching more, quitting smoking, and avoiding alcohol can all be beneficial for riding out a relapse.

If you must use steroids

• Don’t be afraid to use a sleep aid. It’s not uncommon to be given a sedative prescription while using steroids. After all, sleep is critical to the healing process; even healthy adults need at least 7 hours of consecutive sleep each night in order to recover from ordinary stresses. People with MS also need at least that much to recover from damage caused by relapses.
• Ask about taking steroids early in the day. You’re less likely to feel the sleepless effects when you take your entire daily dose in the morning.⁵
• Practice good sleep hygiene and prioritize sleep by:
  • ensuring adequate time to sleep each night
  • practicing relaxation techniques to improve your ability to fall asleep
• Strive to make your bedroom a sleep sanctuary. Ultimately, it should be very quiet, as dark as possible, and comfortably cool.