Do MS Symptoms Fluctuate During the Day and At Night?

Multiple sclerosis, or MS, is a medical condition in which the immune system attacks healthy cells in the brain and spinal cord. It is a lifelong disease with symptoms that can interfere with sleep at night and responsibilities and activities during the day. MS patients may experience symptoms that fluctuate, with some worse at night and others worse during the day. For example, muscle spasms and stiffness tend to get worse at night, while heat-related symptoms worsen during the day.

Learn more about symptoms of MS, how they shift from day to night, and more.

Person with multiple sclerosis and support dog

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Do MS Symptoms Fluctuate Throughout the Day?

There is no standard set of MS symptoms that people with the disease experience during the day and at night. Everyone experiences symptoms differently, and specific symptoms can change over time.

However, there are certain symptoms that tend to get better or worse at night compared to during the day. Different lifestyle behaviors during the day and night can also make symptoms seem better or worse.

For example, MS fatigue generally gets worse throughout the day as energy is used for daily activities. It is generally not a problem at night because most people want to sleep and don't mind feeling as tired as they might during the day.

Common MS Symptoms

Common Daytime Symptoms

Fatigue is a common symptom of MS, affecting about 80% of people with the disease. This symptom is often worse during the day than at night and progressively worsens as the day continues. Additionally, some aspects of MS tend to worsen during the day, not because of increased severity, but because of how they affect daily life.

MS symptoms that are more of a problem during the day include:

  • Fatigue: This common MS symptom can worsen as the day progresses and as energy is used for daily activities.
  • Heat sensitivity: People with MS are sensitive to heat and can experience increased symptoms and severity due to heat. This is more of a problem during the day because the natural body temperature and weather are warmer during the day. Additionally, moving around during daily activities increases the body temperature even further.
  • Bladder challenges: Many people with MS face urinary incontinence (unable to hold urine or unwanted wetting). This can become more of an issue during the day if away from home or far from a restroom.
  • Social challenges: Many people with MS face challenges related to others not knowing about the disease and how it impacts life. Friends and family members may not understand the abilities and limitations, making social activities difficult.
  • Exercise and mobility limitations: Since exercise increases body temperature and many people with MS are sensitive to heat, this becomes a challenge, especially when it is sunny and hot outside. Mobility can also become more difficult due to the heat.

Common Nighttime Symptoms

Some symptoms such as muscle stiffness, pain, and spasms worsen at night. Additionally, some symptoms don't necessarily worsen at night but present unique challenges because they interfere with sleep. For example, pain just as intense during the day may keep MS patients awake at night, making other symptoms worse due to sleep loss.

MS symptoms that tend to be a greater problem at night include:

  • Muscle spasms and stiffness: Movement throughout the day can help to loosen muscles and bring relief, but they get worse again during sleep when they are still.
  • Pain: Nerve and muscular pain, common types of MS pain, may worsen at night and interfere with sleep. Nerve pain can get worse at the end of the day and into the night due to activities throughout the day, while muscular pain can get worse throughout the night and into the early morning due to being still while sleeping.
  • Nighttime urination: Up to 50% of people with MS face nocturia, the need to get up and urinate in the middle of the night. This can interfere with sleep, leading to sleep deprivation and worsening other MS symptoms, such as daytime fatigue.
  • Insomnia: Many people with MS have insomnia, which is difficulty falling asleep, staying asleep, or getting restful sleep. This can be caused by physical symptoms of MS such as pain or mental challenges such as anxiety.
  • Night vision: The ability to see can be completely lost, impaired, or blurred, or there may be vision distortion. These symptoms can get worse at night.

Tips for Achieving Physical and Mental Balance With MS

Despite the challenges of fluctuating MS symptoms, there are ways to cope and live well. It can help track symptoms and how they change throughout the day and night. Finding patterns can help identify what can be adjusted to improve symptoms or prevent them from worsening.

Stay Ahead of Temperature Fluctuations

Temperature changes can often be predicted, making heat-related symptoms slightly easier to predict and manage. For example, people with MS can spend time outdoors in the morning or evening before or after the day's heat.

Another option is cooling therapy, which involves placing cool clothing on the body or using devices to lower body temperature. This can be done before and during exercise to prevent the body temperature from increasing too much.

Take Your Medication Early

Keeping track of MS symptoms in a symptom tracker or diary can help identify patterns and trends about when specific symptoms are worse. This information is helpful in planning when to take medications. For example, if the pain worsens in the afternoon, pain medications can be taken before that time.

Find an Exercise Routine

Resistance exercises such as weight lifting and bodyweight exercises may be better for people with MS than endurance exercises such as running or biking. This is because there are breaks to provide opportunities to cool the body and because they can be done in controlled, indoor environments. Yoga may also be a good option for people with MS, and it has the potential to improve physical and emotional symptoms. It is important for each person to find what works best for them, their abilities and preferences, and their symptoms.

Summary

Multiple sclerosis, or MS, is a lifelong illness with symptoms that can interfere with daily life and sleep at night. These symptoms can fluctuate depending on the time of day. For example, symptoms affected by heat tend to be worse during the day, while muscle tightness and pain worsen at night.

There are things people with MS can do to cope with symptoms during day and night time fluctuations. Keeping track of symptoms, what influences them, and patterns can help provide information to prevent symptoms from worsening. For example, if pain increases at night, medications can be taken before that time.

A Word From Verywell

Living with MS and symptoms that change can be confusing and challenging. However, some things can be done to prevent symptoms from worsening during certain times of the day or night. If you or someone you know is facing MS and fluctuating symptoms, help is available. Reach out to a healthcare professional for support.

Frequently Asked Questions

  • What's the best way to track MS symptom patterns?

    The best way to track MS symptoms and patterns is the way that works for the individual. Some people like to record their symptoms in a notebook or calendar, while others prefer an app that tracks symptoms electronically.

  • What does MS spasticity feel like?

    MS spasticity may feel different for different people. In general, it feels like extremely stiff, tight muscles. People with MS spasticity may also experience muscle spasms.

  • Is MS worse in the morning or at night?

    Symptoms of MS can be better or worse at different times of the day. For example, spasticity can worsen at night, while fatigue can worsen during the day and after activities. However, this is unique to each person.

16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Johns Hopkins Medicine. Multiple sclerosis (MS).

  2. MS Society. Understanding spasms and stiffness.

  3. National Multiple Sclerosis Society. MS signs and symptoms.

  4. National Multiple Sclerosis Society. Fatigue.

  5. Christogianni A, Bibb R, Davis SL, et al. Temperature sensitivity in multiple sclerosis: An overview of its impact on sensory and cognitive symptomsTemperature (Austin). 2018;5(3):208-223. doi:10.1080/23328940/2018.1475831

  6. Zecca C, Riccitelli GC, Disanto G, et al. Urinary incontinence in multiple sclerosis: prevalence, severity and impact on patients’ quality of lifeEur J Neurol. 2016;23(7):1228-1234. doi:10.1111/ene.13010

  7. Dehghani A, Khoramkish M, Shahsavari Isfahani S. Challenges in the daily living activities of patients with multiple sclerosis: a qualitative content analysisInt J Community Based Nurs Midwifery. 2019;7(3):201-210. doi:10.30476/IJCBNM.2019.44995

  8. Skjerbæk AG, Møller AB, Jensen E, et al. Heat sensitive persons with multiple sclerosis are more tolerant to resistance exercise than to endurance exerciseMult Scler. 2013;19(7):932-940. doi:10.1177/1352458512463765

  9. Sleep Foundation. Multiple sclerosis (MS) and sleep.

  10. Murphy KL, Bethea JR, Fischer R. Neuropathic pain in multiple sclerosis—current therapeutic intervention and future treatment perspectives. In: Zagon IS, McLaughlin PJ, eds. Multiple Sclerosis: Perspectives in Treatment and Pathogenesis. Codon Publications.

  11. Peyronnet B, Krupp LB, Reynolds WS, et al. Nocturia in patients with multiple sclerosisRev Urol. 2019;21(2-3):63-73.

  12. Multiple Sclerosis Association of America. Anxiety in MS: frequently overlooked and undetected.

  13. Multiple Sclerosis Association of America. Visual disorders.

  14. Multiple Sclerosis Trust. Diary of symptoms.

  15. Kaltsatou A, Flouris AD. Impact of pre-cooling therapy on the physical performance and functional capacity of multiple sclerosis patients: A systematic reviewMultiple Sclerosis and Related Disorders. 2019;27:419-423. doi:10.1016/j.msard.2018.11.013

  16. Rogers KA, MacDonald M. Therapeutic yoga: symptom management for multiple sclerosisJ Altern Complement Med. 2015;21(11):655-659. doi:10.1089/acm.2015.0015

By Ashley Olivine, Ph.D., MPH
Dr. Ashley Olivine is a health psychologist and public health professional with over a decade of experience serving clients in the clinical setting and private practice. She has also researched a wide variety psychology and public health topics such as the management of health risk factors, chronic illness, maternal and child wellbeing, and child development.