Poor Sleep Hygiene Is Associated with Impaired Sleep Characteristics Measured By Actigraphy in Individuals with Multiple Sclerosis

Background: Sleep hygiene refers to behaviors and environments that contribute to quality nighttime sleep, such as going to bed and waking up at the same time, and avoiding behaviors or environments that interfere with quality nighttime sleep, such as watching TV in the bedroom. Better sleep hygiene has been associated with improved sleep quality in college students and in patients with low back pain, but the association between sleep hygiene practices and sleep quality has never been assessed in individuals with multiple sclerosis (MS).

Objectives: The purpose of this study is to examine the association between sleep hygiene practices, self-report sleep quality, and objectively measured sleep characteristics using actigraphy in individuals with MS.

Methods: Seventeen individuals with relapsing-remitting or secondary-progressive MS (46.4± 9.7 years of age) were recruited to participate. Participants completed the Sleep Hygiene Index (SHI) to assess sleep hygiene practices and the Pittsburgh Sleep Quality Index (PSQI) to assess self-report sleep quality. Participants wore an actigraph for one week on their dominant wrist to objectively assess sleep characteristics. Spearman correlations were used to examine associations between SHI, PSQI, and actigraph outcomes.  

Results: SHI was weakly correlated with the PSQI (r_s= .249; p=.335). SHI was moderately correlated with sleep efficiency (r_s = -.494; p= .044), total sleep time (r_s = -.466; p= .059), sleep latency (r_s = .401; p= .111), number of awakenings (r_s = .397; p= .115), and wake after sleep onset (r_s = .378; p= .135) measured from the actigraph.

Conclusions: This study suggests poor sleep hygiene is only weakly associated with poor self-report sleep quality in individuals with MS. However, poor sleep hygiene is moderately associated with objective measures of lower sleep efficiency, less total sleep time, longer amount of time needed to fall asleep, increased number of awakenings during sleep, and increased time spent awake while attempting to sleep. Sleep hygiene education should be investigated as a possible intervention to improve sleep characteristics in people with MS.