Sleep Hygiene and Symptom Burden in Multiple Sclerosis: A Cross-Sectional Study

Sleep disturbances are common in multiple sclerosis (MS) and contribute to increased symptom burden. Behavioral sleep hygiene practices are potentially modifiable factors influencing sleep and related symptoms, yet their role in MS remains insufficiently explored. This cross-sectional study comprised 175 MS patients. Sleep hygiene was assessed using a behavioral checklist covering a regular sleep schedule, avoidance of daytime naps, limitation of evening caffeine intake, reduced evening screen exposure, and optimization of the sleep environment. The instruments included the Fatigue Severity Scale (FSS), the Modified Fatigue Impact Scale (MFIS), the Athens Insomnia Scale (AIS), the Epworth Sleepiness Scale (ESS), and the Hospital Anxiety and Depression Scale (HADS). Higher sleep hygiene adherence was associated with lower daytime sleepiness (ESS: r = -0.18, p = 0.020), anxiety (HADS-A: r = -0.16, p = 0.034), and depression (HADS-D: r = -0.15, p = 0.047). Patients with higher adherence (score ≥ 3) demonstrated significantly lower MFIS, AIS, ESS, and HADS-D scores compared with those with lower adherence (all p < 0.05). Multivariate regression showed that sleep hygiene adherence was independently associated with lower MFIS (β = -3.24, 95% CI: -6.06 to -0.41, p = 0.025), ESS (β = -0.85, 95% CI: -6.06 to -0.41, p = 0.016), HADS-A (β = -0.67, 95% CI: -1.23 to -0.11, p = 0.019), and HADS-D scores (β = -0.62, 95% CI: -1.17; -0.08, p = 0.026). Better adherence to sleep hygiene practices may be associated with a lower symptom burden in MS.