Racing Thoughts and MS: Tips for Achieving Better Sleep
Last updated: September 2023
No doubt all people with multiple sclerosis (MS) have had to manage anxiety as part of their condition. Either it’s the anxiety of not knowing where MS will take them and the surprises that come with medication side effects or unexpected symptoms, or it’s the worry that so much of one’s life will be disrupted by the disease.
If you’ve ever struggled to fall asleep or woke up in the middle of the night to racing thoughts, you should know you're not alone.
What are racing thoughts?
Racing thoughts are described as those rapid thought patterns we engage in when we experience anxiety. We can have them at any time of day or night, and they can be triggered by personal or external challenges that may or may not be related to MS.1
Many people experience racing thoughts as a result of anxiety about the future of our country, our ongoing challenges with using social media, and concerns about the changing face and rising costs of healthcare. Medical problems can also be a source of anxiety that leads to racing thoughts.1
For instance, people with untreated sleep apnea often awaken with racing thoughts and a rapid heartbeat after dreams of being suffocated. Others with mental health conditions like obsessive-compulsive disorder (OCD) or attention-deficit/hyperactivity disorder (ADHD) may not have anxiety1 yet still experience racing thoughts as a symptom.1,2
Those who aren’t getting enough quality sleep, night after night, can expect to experience racing thoughts as a biological outcome of sleep deprivation.
Also, medicines that cause hyperarousal and hypervigilance as side effects (for people with MS, steroids are a chief villain) can cause a person to struggle to turn the brain off at night (or struggle to push aside anxious thinking during the day).
When are racing thoughts a problem that requires attention?
According to the Calm Clinic, “Thoughts are simply thoughts. When they have become a problem is when one of the following occurs:2
- Racing thoughts are preventing you from sleeping
- Racing thoughts are causing significant distress
- Racing thoughts are making it harder to focus
- Racing thoughts are about topics that cause you shame
- Racing thoughts occur with other anxiety symptoms
"It's not the thoughts that are dangerous, but how you react to them.”2
As a sleep health educator, I have to agree. When racing thoughts lead to sleep loss, it’s time to make an effort to put them in their place.
What can be done about racing thoughts and sleep issues with MS?
If your racing thoughts are tied to your medical condition (whether it is MS, ADHD, other mental health issues, sleep disorders, or a combination of various conditions), the best solution is to treat the condition (or conditions) to find relief.
Often, people with a health condition who are proactive with therapy not only receive the physical benefit of the therapy but also the psychological benefit of taking action to help themselves.
If your racing thoughts are the result of anxiety, treatment, again is an appropriate response.
Cognitive behavioral therapy (CBT) is an effective non-drug approach for addressing generalized anxiety. Many of these techniques can be practiced easily at any time, anywhere. CBT-I, or CBT for insomnia, is also widely accepted as the best way to treat insomnia caused by racing thoughts. Forms of CBT may also work in conjunction with a short course of medicines for those who need them.3
Sleep tips to find relief from racing thoughts
If your racing thoughts only occur at bedtime, or upon awakening in the middle of the night, you can certainly also try these options for relief if you think your problems are temporary:
Keep a bedside journal
Write down what’s giving you angst. The simple act of writing these thoughts down can feel like you are putting them in a jail where they have to stay until you can wake up and address them in the daylight. Trust me, I know this from first-hand experience!1,2,4
Exercise during the day
Physical activity can relieve daytime anxiety enough to prevent its return at bedtime. The body is more likely to crave sleep at night when it is exercised during the day, as well. Even better, exercise outside first thing in the morning. This is a delightful way to improve your mood and establish a healthy circadian rhythm, both of which can help you defend against racing thoughts.5
So you know you already know how to breathe, but did you know that practicing certain kinds of breathing patterns can relax both the body and the mind? Yogic breathing (inhaling to fill the diaphragm, exhaling to close the diaphragm) is tremendously effective if done quietly and intentionally as you recline in bed.2,4
Another form of meditation breathing requires you to slowly count as you inhale, hold your breath, and exhale. (When I worked with patients in the sleep lab, this was super effective for those learning to use CPAP for the first time.) Start with inhaling gently for 4 counts, holding for 4 counts, and exhaling for 4 counts. Change up your counts for the pace that is most comfortable for you. Repeat.2,4
Just say, “Whatever”
Our attention to racing thoughts is something we do have control over. When they bubble up, your awareness of them gives you the opportunity to respond by saying, “So what?” or "Whatever" out loud. Try it sometime. It’s almost like exorcising demons when you give a voice to your determination to eliminate these disruptions. You’ll feel empowered afterward. Acknowledging racing thoughts actually doesn't magnify them, it gives you ownership over them.
Run some interference
At bedtime, your goal should be to relax. Taking a warm bath, reading a pleasant book or magazine, listening to calming music or a humorous or soft-spoken podcast are all great ways to run interference against racing thoughts.1
Make art, or something else
It doesn’t have to be fabulous and for sale. You can color in a coloring book. Bake from scratch. String beads. Pore over a jigsaw puzzle. Strum a guitar. Play Sudoku. Repeat a dance move over and over. Write a poem. Sit at a potter’s wheel. Fold origami paper.
There’s something meditative, relaxing, and focused about creative practices that helps us to shut out racing thoughts. Do these things at bedtime, not with any goal in mind, but to simply center yourself and immerse in a positive, pleasant, quiet activity.
Play white noise
For those who have MS that comes with a side of tinnitus (ringing ears), consider using a white noise machine. It can help distract your brain from more conscious thought patterns while blocking the sounds that continue unabated in your head as you settle in to sleep.
What does advocacy mean to you as someone living with multiple sclerosis? Please select all that apply: