Living Well with MS | S6E25

Episode Title: Top Sleep Tips for People with MS with Sleep Therapist Denise Iordache
Release Date: December 11, 2024
Host: Geoff Allix
Guest: Denise Iordache, Cognitive Behavioral Hypnotherapist specializing in sleep and stress

Overview

In this episode, host Geoff Allix interviews sleep therapist Denise Iordache about why restorative sleep is essential for people with Multiple Sclerosis (MS). They discuss the science behind sleep, its relationship to stress and MS symptoms, practical tips for improving sleep hygiene, and strategies to manage common sleep disruptions in MS—including mindfulness, journaling, and routine. Denise also shares actionable advice for both people with MS and the wider public seeking better sleep.

Key Discussion Points & Insights

1. Why Sleep Matters—Especially in MS

• Biological Need: Like food and water, sleep is vital for survival and well-being. Skipping sleep impacts cognitive, physical, and emotional health (03:12).
• Brain Regeneration: Sleep consolidates memory, supports learning, and prevents ‘brain fog’. Good sleep enhances learning and focus the next day.
• Body Recovery: Muscle and cellular repair occur during sleep, which is critical for MS, as the disease often affects mobility and muscle function.
• Emotional Regulation: Deep sleep helps regulate mood and decreases risk factors for anxiety and depression.

  “Having a good night’s sleep helps emotional regulation. It helps decrease the impact of anxiety and depression… you are more likely to entertain good, solid connections the next day with other humans.” — Denise (05:27)

2. How Much Sleep Do We Really Need?

• Individual Variation: Adults typically need 7–9 hours as per NHS guidelines, but personal needs vary.

• Self-Assessment Tip:

  “Ask yourself, how many hours on the weekend do I sleep or when I go on holiday? You are more likely to be in a more relaxed state… that’s probably what your body naturally needs.” — Denise (00:00; 07:36)

• Consistency is Key: You can’t ‘bank’ sleep on weekends and shortchange yourself during weekdays.

  “We do not have a magical bank where sleep goes and we put it there so we take it when we need it… We need to be consistent.” — Denise (07:36)

3. Circadian Rhythm and Light Exposure

• Definition: The circadian rhythm is our 24-hour internal clock, influenced mainly by light exposure (10:05).
• Importance of Natural Light: Exposure to daylight in the morning helps regulate sleep–wake cycles, even if cloudy.
• Artificial Light at Night: Excessive artificial light in the evening may disrupt sleep, though research is ongoing (12:52).
• Tools and Hacks: Use daylight lamps in winter; blackout blinds in summer to mimic natural light cycles (14:12).

4. Optimizing Bedroom Environment for Sleep

• Practical Suggestions:
  • Assess mattress and pillow suitability.
  • Minimize disruptive noises (e.g., glass-on-glass bedside tables).
  • Reserve the bed for sleep and intimacy—avoid working, eating, or watching TV (15:17).
  • Adjust lighting and temperature to your personal comfort.
  • Consider using earplugs, blackout blinds, or dim night lights to support ease of movement at night.

5. Establishing a Sleep Routine

• Wind Down: Create a bedtime routine 45–60 minutes before sleep: relaxing activities, reading, meditation, warm baths, etc.

• Avoid:

  • Bright or blue light screens 1–2 hours before bed.
  • Caffeine, alcohol, and heavy, salty, or spicy foods close to bedtime (18:05).

• Routine Matters: Regular sleep–wake times are fundamental, with exceptions only as needed.

  “Sleep loves routine. The more routine you can provide, the easier it will get to fall asleep.” — Denise (18:05)

6. MS-Specific Nighttime Challenges & Solutions

• Frequent Waking: Common issues include increased need to urinate, spasticity, and pain.
• Medical Check: Always consult MS-knowledgeable healthcare professionals to assess bladder issues first (21:14).
• Preparation Tips:
  • Limit fluids 1–2 hours before bed (but stay well hydrated during the day).
  • Avoid salty/snack foods in the evening.
  • Routine exercise—even gentle stretching—improves sleep quality.
  • Use relaxation techniques (e.g., meditation or muscle relaxation) if waking in the night.
  • If unable to sleep after 20–30 minutes, get up and try a soothing activity in another room before returning to bed.

7. Mindfulness and Mental Strategies

• Mindfulness as a Sleep Aid:

  “It is the best thing... Mindfulness means being present in the here and now… if you practice during the day, you are training your mind not to be consumed by anxieties at night.” — Denise (26:07)

• Techniques:

  • Breathing exercises (e.g., box breathing: inhale for 4, exhale for 4, repeat).
  • Meditation and guided relaxation.
  • Regular practice during the day and before bedtime.

8. Journaling and Sleep Diaries

• Objective Data Gathering: Sleep and thought diaries allow for pattern recognition and self-discovery (29:43).
• Four-Column Sleep Diary:
  1. Hours slept
  2. How you feel in the morning
  3. What you did before sleep
  4. Sensations or thoughts upon waking
• Minimum Two Weeks: Fill diary daily to identify actionable trends.
• Self-Empowerment:

  “When you see it captured in black and white, you will be like, oh, okay, really? This is what I do every time. And you become your own detective.” — Denise (31:38)

9. Managing Racing Thoughts: Worry Time

• Scheduled Worry Time: Dedicate 10 minutes a day to write down worries.

  “When later in the night... those worries come back, you will say to yourself, okay, I’ve already assigned these yesterday at 3. It’s taken care of.” — Denise (32:34)

• Brain Dump: Transfers stress from your head to the paper, freeing your mind at bedtime.

10. Sleep and Weight Regulation

• Sleep Impacts Appetite: Lack of sleep disrupts hunger hormones (ghrelin and leptin), making you crave high-calorie foods and hindering weight management (34:00).

• MS & Weight: Getting enough quality sleep supports better hormonal balance and can help with maintaining or achieving a healthy weight.

  "When we don't sleep enough, we crave high calorie foods... if you had a good enough rest, you wouldn't be as likely to have those spikes in your appetite." — Denise (35:43)

Notable Quotes & Memorable Moments

• On Consistency: “We don’t have the capacity to basically collect sleep in a bank and use it when we need it. We need to be consistent.” — Denise (07:36)
• On Individual Needs: “We are all individuals, we are all unique. Some will function very well on 5, 6 hours; others will need 9 to 10… That is the key here: how many hours do you need to wake up feeling rested?” — Denise (06:21)
• On Mindfulness: “We are as humans artists of this. We can worry about everything and we don’t always have a logical reason.” — Denise (27:58)
• On Worry Time: “You’re not trying to trick your mind into not thinking about it. You’re telling it it has a specific, dedicated time.” — Denise (32:34)
• On Weight and Sleep: “Sleep helps regulate the hormones that tell us whether we are hungry or not… that’s why people who would be sleeping less or feeling sleep deprived, they are more likely to reach for the crisps, for the cookies, for the donuts.” — Denise (35:43)

Timestamps for Key Segments

• Understanding the Brain and Sleep: 03:12–06:08
• How Much Sleep Is Enough?: 06:08–07:36
• Consistency & Sleep ‘Banking’ Myth: 07:36–09:17
• What Is Circadian Rhythm?: 09:51–12:46
• Light, Artificial Light & Blackout Blinds: 12:46–15:02
• Optimizing the Bedroom Environment: 15:02–18:00
• Setting a Sleep Routine & Wind-Down Strategies: 18:00–20:46
• MS-specific Sleep Disruptions & Solutions: 20:46–25:15
• Mindfulness for Sleep and Beyond: 25:15–29:16
• Journaling and Sleep Diaries: 29:16–32:28
• Scheduled Worry Time & Sleep–Weight Link: 32:28–36:20

Final Thoughts

Denise emphasizes that above all, self-awareness, consistency, and gentle experimentation with routines and strategies are key to uncovering what works for you. Practical changes—backed by science and mindfulness—can make sleep more restorative, supporting physical, emotional, and neurological health for people with MS and for everyone.

Resources & Further Reading:
Find recommended relaxation techniques, app suggestions, sample sleep diary templates and further reading in the episode’s show notes at overcomingms.org/podcast.