Last updated on July 9th, 2025 at 03:26 pm

Here I provide some practical guidance on managing the discomfort of being unable to turn in bed and suggest ways to reduce unpleasant sensations in the legs from restless legs syndrome (RLS) and other conditions that can hinder sleep.

Key points

• Stretching, exercises, medication and various physical devices and aids can help relieve your discomfort if you have difficulty rolling over in bed at night.
• RLS is common in people with MS; it has been associated with poor attention and concentration, memory issues, decreased productivity, depression and anxiety.
• It is important to get treatment for RLS. Before doing so, please check if it is caused by MS or by another condition, such as renal dysfunction, low iron levels or pregnancy.
• Various drugs are effective in controlling RLS symptoms, and some lifestyle changes and activities may relieve mild to moderate RLS.
• Other unpleasant, painful sensations in the legs may disrupt sleep in people with MS and need to be managed.
• Addressing these and other causes of poor sleep is essential to improving the functioning and quality of life of people with MS.

Among the MS symptoms that contribute to fatigue and insomnia in people with MS, several conditions deserve special mention because of the extreme pain or discomfort they cause. They include being unable to turn in bed, restless legs syndrome (RLS) and other unpleasant or uncomfortable sensations in the legs. 

Pain from being unable to roll over

In November 2020, I was hit by a speeding motorcyclist while out jogging. Thankfully, I have made a reasonable recovery, with minor residual problems, and the horror of the accident is gradually receding from my memory. My post-traumatic flashbacks, typically triggered by the sound of a speeding motorbike, are now quite rare.

The one thing that still haunts me, however, is the chronic insomnia I experienced due to the pain and discomfort of not being able to roll over in bed. For about 6 months, I had to sleep on my back, unable to move because of a fractured pelvis and a neck brace. I can now appreciate what my patients go through when they have neuralgic pain or insomnia.

If you have problems rolling over in bed at night, there are things you can do to help yourself. 

1. Stretching and range of motion exercises: doing gentle stretching and range of motion exercises during the day can help improve flexibility and reduce muscle stiffness, making it easier to roll over in bed at night.
2. Physical therapy: please see a physiotherapist or physical therapist who can provide a personalised exercise programme and teach you techniques to address specific mobility issues and improve overall movement.
3. Medication: ensure you have been assessed and prescribed appropriate medications to manage muscle spasticity and spasms, and pain during the night.
4. Supportive devices: utilising supportive devices such as bed rails, grab bars, monkey ropes or specially designed pillows can provide additional assistance and stability when transitioning in bed.
5. Low-friction bed linen and pyjamas: using satin or low-friction linen and pyjamas can make the difference of being able to roll over in bed or not. 
6. Specialised beds: if all else fails, you may need to purchase a tilting bed that helps automate the process of rolling over. However, these beds are relatively expensive and are not generally covered by NHS budgets. 
7. A comfortable sleep environment: creating a comfortable and supportive sleep environment, including a supportive mattress and pillows, can help reduce discomfort and make it easier to roll over at night.
8. Remember that the current treatment strategy for MS is to maximise your brain health, and part of this philosophy is holistic management, including sleep.

Restless legs syndrome

RLS is experienced as an unpleasant or uncomfortable sensation in your legs and an irresistible urge to move them. The symptoms usually occur in the late afternoon and evening and are most severe at night in bed. An essential diagnostic tip is that moving your legs relieves discomfort, but it recurs once leg movements stop.

RLS in people with MS

RLS is very common in people with MS; it causes or exacerbates insomnia and is strongly linked to daytime sleepiness and fatigue, affecting your mood and your daytime functioning. People with RLS may have poor attention and concentration, memory issues, decreased productivity, depression or anxiety. Cederberg et al¹ have demonstrated that restless legs syndrome affects sleep quality and is associated with poor cognition in people with MS. RLS may go into remission for weeks or months; however, symptoms often reappear and become more severe over time. So, if you have RLS, bring it to the attention of your HCP so that you can get it treated.

A study conducted in Saudi Arabia² found that 30% of 109 people with MS fulfilled the diagnostic criteria for RLS, defined by meeting all four requirements of the International Restless Legs Syndrome Study Group diagnostic criteria; this compared with 8.3% with RLS in a group of 216 healthy controls. In my clinic, the percentage of people with MS experiencing RLS is lower than this – closer to 10% – but I may be wrong as I don’t use a validated screening tool when checking for this.

Other conditions associated with RLS

RLS is commonly experienced by people with end-stage renal disease who are on haemodialysis. Other conditions associated with RLS include neuropathy, sleep deprivation, vigorous exercise (e.g. in athletes), pregnancy and menopause. Alcohol, nicotine, caffeine, antiemetics, antipsychotics, antidepressants that increase serotonin and over-the-counter cold and allergy medications containing older antihistamines are also associated with RLS. 

If you have RLS, you should not assume that it is due to MS. You must have a medical history taken and a thorough neurological and physical exam (possibly including blood tests) to exclude other causes of RLS, such as renal dysfunction, low iron levels or pregnancy. A sleep study may also be indicated to check for another sleep disorder, such as sleep apnoea.

Treatment of RLS

There is no cure for RLS, but some symptoms can be treated. As mentioned earlier, moving your affected limb(s) may provide temporary relief. Sometimes, RLS symptoms can be controlled by treating an associated medical condition, such as peripheral neuropathy, diabetes or iron deficiency anaemia. Peripheral iron levels, particularly in the spinal fluid, can be lower than expected and don’t always respond to oral iron supplements; in such cases, intravenous administration of iron may help. 

In my experience, the best treatment for RLS is one of the gabapentinoids, i.e. gabapentin or pregabalin. Many neurologists still use dopamine agonists such as ropinirole, pramipexole and rotigotine. However, daily long-term use of dopaminergic drugs can eventually worsen symptoms and is associated with complications. Opioids may be effective if the gabapentinoids fail; my recommendation would be to use methadone, as it has the lowest risk of addiction. 

In the case of comorbidity such as spasticity in people with MS, benzodiazepines may be prescribed (clonazepam, diazepam or lorazepam). However, benzodiazepines are associated with tachyphylaxis, i.e. the body gets used to the effects, and the dose must be increased to maintain the same treatment effect. They are addictive and cannot be stopped suddenly.

Some lifestyle changes and activities that may relieve mild to moderate RLS are listed below.

1. Avoid or decrease the use of alcohol, nicotine and caffeine.
2. Establish or maintain a regular sleep pattern.
3. Try moderate, regular exercise rather than intermittent vigorous exercise.
4. Massage the legs.
5. Try a warm bath.
6. Apply a heating pad or ice pack.
7. Use foot wraps specially designed for people with RLS.
8. Try vibration pads on the back of the legs.
9. Do leg-stretching exercises of moderate intensity.
10. Try magnesium supplements.

Other causes of leg discomfort

People with MS have discomfort in their legs at night for many reasons, and not all restless legs are due to the RLS. A proper examination is needed before making specific treatment recommendations.

Spasticity

Spasticity and nocturnal leg jerks most commonly mimic RLS. Spasticity tends to go hand in hand with lower limb weakness and should be treated with antispasticity agents. These include baclofen, tizanidine, gabapentin, pregabalin, clonazepam or other benzodiazepines, tetrahydrocannabinol (THC), other CB1 agonists (nabilone), and – rarely nowadays – dantrolene, a direct muscle relaxant.

Pain syndromes

Myelopathic pain (i.e. pain resulting from spinal cord disease) is common in people with advanced MS and often causes leg discomfort. Pain syndromes must be managed with centrally acting pain medications such as duloxetine, tricyclic antidepressants and gabapentinoids. Tetrahydrocannabinol (THC; Sativex and Dronabinol) and other CB1 agonists (nabilone) are also effective. Many people with MS use cannabidiol (CBD) as monotherapy and claim it works. Currently, there is only one licensed form of CBD for epilepsy, and it can’t be prescribed for pain. Many patients, therefore, purchase CBD online; I cannot recommend this because of the risk of contaminants. In addition, CBD is associated with liver toxicity; therefore, liver function tests should be done to monitor for this problem. Many people with MS use street or medicinal cannabis, which, although legal for medicinal use, can’t be prescribed under the NHS. Private clinics in the UK, both physical and online, are filling the gap. I have little doubt that cannabis helps people with MS get a better night’s sleep, particularly those with pain and spasticity.

Cramps

People with MS are as likely, if not more likely, to experience leg cramps as people in the general population. Leg cramps are usually easily differentiated on history from other nocturnal leg movements and are managed accordingly. Below are some tips for managing leg cramps.

1. Regular stretching exercises can help prevent leg cramps.
2. Staying well hydrated is important. Dehydration can contribute to muscle cramps, so drinking adequate water throughout the day is essential, particularly during physical exertion or in hot weather.
3. Maintaining a proper balance of electrolytes such as potassium, calcium, and magnesium is crucial to prevent leg cramps. This is where diet and supplements can be important. 
4. Massaging the affected leg can relieve leg cramps. Apply gentle pressure to the cramped muscle and rub it using a circular motion. 
5. Medications may be required if cramps are common and affect your sleep. Some people with MS find some relief from simple over-the-counter analgesics such as ibuprofen or paracetamol/acetaminophen. Other medications must be prescribed, including quinine, calcium channel blockers and gabapentinoids. 

Periodic limb movements of sleep (PLMS)

PLMS are characterised by involuntary leg twitching or jerking movements during sleep. The movements are very sudden jerks and are due to myoclonus. They can occur every 15 seconds, sometimes throughout the night. Although many individuals with RLS also develop PLMS, most people with PLMS do not experience RLS. In general, PLMS responds to measures similar to those used for RLS, i.e. gabapentinoids, methadone and dopamine agonists. Dopamine agonists are best avoided because of the augmentation that occurs, i.e. the condition worsens. Other medications that may help include clonazepam, melatonin, anticonvulsants and selegiline. I have no personal experience of prescribing melatonin or selegiline for PLMS.

Conclusion

MS-related symptoms that cause pain or discomfort in bed and disrupt sleep contribute to daytime fatigue and impact physical and mental function. As a result, poor sleep reduces quality of life and can exacerbate other MS-related problems such as poor concentration, anxiety and depression. Any such hindrances to healthy sleep should be documented, investigated appropriately and treated accordingly to improve the functioning and quality of life of people with MS.

References

1. Cederberg, KLJ et al. Restless Legs Syndrome, sleep quality, and perceived cognitive impairment in adults with multiple sclerosis. Mult Scler Relat Disord 2020;43:102176.
2. Aljarallah S et al. Restless leg syndrome in multiple sclerosis: a case-control study. Front Neurol 2023;14:1194212.