Nonpharmacologic Interventions Improve Sleep Quality in Multiple Sclerosis

Nonpharmacologic interventions such as cognitive behavioral therapy (CBT) can significantly enhance sleep quality in people with multiple sclerosis.

Researchers conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to clarify inconsistencies in individual study results and to provide estimates of the magnitude of improvement associated with nonpharmacologic interventions for improving sleep in people with MS. Studies involving adults with MS with a clinically diagnosed sleep disorder were included, and only nonpharmacologic interventions aimed at improving sleep outcomes were considered. A random-effects model and the Q statistic were employed for statistical analysis.

A total of 9 studies published from 2016 to 2023 were included, with sample sizes ranging from 15 to 72 participants. Primary outcomes included sleep quality indices, and secondary outcomes included severity of the sleep disorder, fatigue impact, anxiety, depression scales, and biomarkers such as cortisol and melatonin.

Study interventions included:

• MBSR: Mindfulness-based stress reduction techniques focused on cultivating present-moment awareness to reduce distress.
• Exergaming: Conducted under the supervision of a physiotherapist twice weekly for 8 weeks.
• Combined: Interventions focused on sleep hygiene education, physical activity, CBT focused on dysfunctional sleep-related thoughts, and occupational therapy.
• Education: A 6-week intervention program focused on insomnia education and relaxation techniques.
• Aerobics: Supervised aerobic exercise.
• ABCD model: A program focusing on a model aimed at identifying, challenging, and changing negative cognitions.
• Behavioral coaching: One-on-one video sessions with a behavioral coach.

Bias assessment of the included studies showed a moderate to high methodological quality, but the several studies fell short on the intent-to-treat analysis.

The effect of study interventions vs controls on sleep quality in 8 of the studies ranged from 0.45 (95% CI, –0.12 to 1.02) for MBSR techniques to 4.22 (95% CI, 3.39-5.05) for the ABCD model.

Overall, 6 of the interventions demonstrated significant results (exergaming, combined, education [2 studies], ABCD model, and behavioral coaching). The pooled effect size across all studies was 1.68 (95% CI, 0.71-2.65; P <.001), indicating a significant overall effect of the interventions.

Study limitations included relatively short follow-up periods of the observed studies.

“Additionally, exploring the combined use of pharmacological and non-pharmacological interventions may offer valuable insights and enhance management strategies for sleep disorders in MS,” the researchers concluded.