Multiple sclerosis – how to manage sleep and fatigue problems in MS

Managing Pain and Sleep Issues in MS
Managing Pain and Sleep Issues in MS

Sleep problems like insomnia are a big part of multiple sclerosis

Please check out this video which gives some great tips for getting better sleep when you have MS.

Chiari malformation – What are the signs, symptoms, causes and treatments of Chiari malformations?

Chiari malformation - - what are the signs and symptoms?
Chiari malformation – – what are the signs and symptoms?

A Chiari malformation, previously called an Arnold-Chiari malformation, is where the lower part of the brain pushes down into the spinal canal.

There are four main types, but type 1, called Chiari I, is the most common.

In someone with Chiari I, the lowest part of the back of the brain extends into the spinal canal. This can put pressure on the brainstem, spinal cord, and obstruct the flow of fluid.

This page focuses on Chiari I malformations.


Are Chiari I malformations serious?

The severity of Chiari malformations can vary from person to person, but generally:

Chiari I malformations aren’t considered life-threatening

some people experience painful headaches, movement problems and other unpleasant symptoms (see below), but many people won’t have any symptoms

there’s a chance of developing syringomyelia (where a fluid-filled cavity called a syrinx develops in the spinal cord), which can damage the spinal cord if not treated promptly

surgery can usually stop the symptoms getting worse and can sometimes improve them, although some problems may remain

Talk to your doctor about what the condition means, what the implications may be for your health and what treatment you may need.

Symptoms of Chiari I malformations

Many people with a Chiari I malformation will not have any symptoms. Sometimes they’re only found after an (MRI) scan of the brain is carried out for another reason.

If symptoms do develop, they can include:

headaches – these are usually felt at the back of the head and may be brought on or made worse by coughing, straining, sneezing or bending over

neck pain

dizziness and balance problems

muscle weakness

numbness or tingling in the arms or legs

blurred vision, double vision and sensitivity to light

swallowing problems

hearing loss and tinnitus

feeling and being sick

difficulty sleeping (insomnia) and depression

If you develop syringomyelia, you may also experience problems using your hands, difficulty walking, pain, and problems with bladder or bowel control.

If you’ve been diagnosed with a Chiari malformation, you should contact your doctor for advice if you develop any new symptoms or your symptoms worsen.

Treatments for Chiari I malformations

Treatment for Chiari I malformation depends on whether you have any symptoms and how severe they are. You might not need any treatment if you don’t have any symptoms.

Painkillers can help relieve any headaches and neck pain.

If your headaches are severe or you have problems caused by the pressure on your spinal cord (such as movement difficulties), surgery may be recommended.


The main operation for Chiari malformation is called decompression surgery.

Under general anaesthetic a cut is made at the back of your head and the surgeon removes a small piece of bone from the base of your skull. They may also remove a small piece of bone from the top of your spine.

This will help reduce the pressure on your brain and allow the fluid in and around your brain and spinal cord to flow normally. Read an NHS leaflet about decompression for Chiari malformation (PDF, 111kb).

Other procedures that may be necessary include:

Endoscopic third ventriculostomy (ETV) – a small hole is made in the wall of one of the cavities of the brain, releasing trapped fluid. See treating hydrocephalus for more information.

Ventriculoperitoneal shunting – a small hole is drilled into the skull and a thin tube called a catheter is passed into the brain cavity to drain trapped fluid and relieve the pressure. See treating hydrocephalus for more information.

Untethering – some children with a type 1 Chiari malformation have a tethered spinal cord, which means it is abnormally attached within the spine. Untethering involves separating the spinal cord and releasing tension in the spine. Read an NHS leaflet on tethered spinal cord (PDF, 193kb).

Spinal fixation – some people with Chiari I will have a hypermobility syndrome, such as Ehlers-Danlos syndrome, and may require surgery to stabilise their spine.

The aim of surgery is to stop existing symptoms getting any worse. Some people also experience an improvement in their symptoms, particularly their headaches.

However, surgery sometimes results in no improvement or symptoms getting worse. There’s also a small risk of serious complications, such as paralysis or a stroke.

Talk to your surgeon about the different surgical options and what the benefits and risks of each are.

Causes of Chiari I malformations

The exact cause of Chiari I malformations is unknown. It tends to be present from birth, but is normally only found in adulthood when symptoms develop or when an MRI scan is done.

Many cases are thought to be the result of part of the skull not being large enough for the brain.

Chiari I malformations can also develop in people with a tethered spinal cord, a build-up of fluid on the brain (hydrocephalus), and some types of brain tumour.

Chiari malformations can sometimes run in families. It’s possible that some children born with it may have inherited a faulty gene that caused problems with their skull development.

But the risk of passing a Chiari malformation on to your child is very small. And remember: even if your children do inherit it, they may not experience symptoms.

Self-help for fibromyalgia – some really great tips

Fibromyalgia -where doesn't it hurt
Fibromyalgia -where doesn’t it hurt

Self-help for fibromyalgia

If you have fibromyalgia, there are several ways to change your lifestyle to help relieve your symptoms and make your condition easier to live with.

Your GP, or another healthcare professional treating you, can offer advice and support about making these changes part of your everyday life.

There are organisations to support people with fibromyalgia that may also be able to offer advice. Visit UK Fibromyalgia’s support group section for a list of support groups across the country. You may also find it helpful to talk to other people with fibromyalgia on this online community.

Below are some tips that may help relieve symptoms of fibromyalgia. You can also read more information about living with pain.


As fatigue (extreme tiredness) and pain are two of the main symptoms of fibromyalgia, you may find that you’re not able to exercise as much as you’d like. However, an exercise programme specially suited to your condition can help you manage your symptoms and improve your overall health.

Your GP or physiotherapist (healthcare professional trained in using physical techniques to promote healing) can design you a personal exercise programme, which is likely to involve a mixture of aerobic and strengthening exercises.

Aerobic exercise

Aerobic activities are any kind of rhythmic, moderate-intensity exercises that increase your heart rate and make you breathe harder. Examples include:




Research suggests that aerobic fitness exercises should be included in your personalised exercise plan, even if you can’t complete these at a high level of intensity. For example, if you find jogging too difficult, you could try brisk walking instead.

A review of a number of studies found that aerobic exercises may improve quality of life and relieve pain. As aerobic exercises increase your endurance (how long you can keep going), these may also help you function better on a day-to-day basis.

Resistance and strengthening exercises

Resistance and strengthening exercises are those that focus on strength training, such as lifting weights. These exercises need to be planned as part of a personalised exercise programme; if they aren’t, muscle stiffness and soreness could be made worse.

A review of a number of studies concluded that strengthening exercises may improve:

muscle strength

physical disability


quality of life

People with fibromyalgia who completed the strengthening exercises in these studies said they felt less tired, could function better and experienced a boost in mood.

Improving the strength of your major muscle groups can make it easier to do aerobic exercises.

Read more information and advice on health and fitness.

Pacing yourself

If you have fibromyalgia, it’s important to pace yourself. This means balancing periods of activity with periods of rest, and not overdoing it or pushing yourself beyond your limits.

If you don’t pace yourself, it could slow down your progress in the long term. Over time, you can gradually increase your periods of activity, while making sure they’re balanced with periods of rest.

If you have fibromyalgia, you will probably have some days when your symptoms are better than others. Try to maintain a steady level of activity without overdoing it, but listen to your body and rest whenever you need to.

Avoid any exercise or activity that pushes you too hard, because this can make your symptoms worse. If you pace your activities at a level that’s right for you, rather than trying to do as much as possible in a short space of time, you should make steady progress.

For example, it may help to start with gentler forms of exercise – such as tai chiyoga and pilates – before attempting more strenuous aerobic or strengthening exercises.


If you have fibromyalgia, it’s important to regularly take time to relax or practice relaxation techniques. Stress can make your symptoms worse or cause them to flare up more often. It could also increase your chances of developing depression.

There are many relaxation aids available, including books, tapes and courses, although deep-breathing techniques or meditation may be just as effective. Try to find time each day to do something that relaxes you. Taking time to relax before bed may also help you sleep better at night.

Talking therapies, such as counselling, can also be helpful in combating stress and learning to deal with it effectively. Your GP may recommend you try this as part of your treatment.

Read more about stress management.

Better sleeping habits

Fibromyalgia can make it difficult to fall asleep or stay asleep (known as insomnia). If you have problems sleeping, it may help to:

get up at the same time every morning

try to relax before going to bed

try to create a bedtime routine, such as taking a bath and drinking a warm, milky drink every night

avoid caffeine, nicotine and alcohol before going to bed

avoid eating a heavy meal late at night

make sure your bedroom is a comfortable temperature, and is quiet and dark

avoid checking the time throughout the night

20 Natural Sleep Remedies

A lot of the areas featured in this blog may involve insomnia to some degree.

These include autism, multiple sclerosis, fibromyalgia and rheumatoid arthritis.

So I am delighted to share this infographic which looks at some of the natural remedies for sleep disorders.

However I do have a favour to ask of you my lovely readers. Have you tried any of these remedies? If so which ones and how did they work? It would be great if you would share your experiences in the comments box below.

Many thanks

20 Natural Sleep Remedies

From Visually.


Over three quarters of us experience problems sleeping – Read our interview with sleep expert Sammy Margo for some great tips

Sammy Mango
Sammy Mango

We’ve all heard the theories of what can help and hinder you having a good night’s sleep, but how much of what we all believe is fact and how much is fiction?

A new survey released today put a number of truths and untruths around sleep to respondents to see how clued up the public is about sleep:

Only 12% believe the theory that eating cheese before bed gives you nightmares – Certain cheeses do give you nightmares, Stilton cheese for example has proved to give people vivid dreams

One in seven think going to the gym in the evening helps you sleep – This is a myth, as the body will be overheated meaning people would have trouble going to sleep. Going to the gym during the day though would definitely help you have a better quality night’s sleep

One in seven believe you can catch up on sleep at weekends – This is a myth, the only way people can catch up on their sleep is by having early nights

One in eight believe watching TV helps you sleep – Yes and no. It can help you sleep and relax you, though the blue light can disrupt somebody’s sleep

One in ten believe drinking alcohol will give you a better night’s sleep – Drinking alcohol will help you sleep but it will prevent you from having a good quality night sleep

Almost 60% believe caffeine keeps you awake – yes it does keep you awake, but it also differs from person to person. People are advised to not drink it after 11pm

Almost a quarter of people believe everyone needs eight hours of sleep a night – This varies from person to person, the average amount of sleep is between 6-8 hours

In fact, the research by Intel saw almost 30% say they need more than eight hours sleep, while almost a quarter say they need less than seven hours.

The survey also saw over 80% say they have experienced sleep problems, with one in five saying it is an ongoing problem. Over a third of Brits (38.8%) are also saying that they believe their bad sleep quality and duration are factors affecting their health.

When it comes to what people believe are the best ways to get a good night’s sleep, regular exercise, a warm bath, a healthy diet, listening to relaxing music and avoiding technology topped the list – but do all these methods work?

Sleep expert Sammy Margo (Author of the Good Sleep Guides for adults and children, and qualified chartered physiotherapist) talks us  through sleep fact and fiction and reveals the nation’s 2016 surprising resolutions.

Patient Talk – So what constitutes a good night sleep for a child and adult?

Sammy Margo- A good night sleep for a child an adult is fundamental and important for your general health and wellbeing. A goodnight sleep is all about a blend of quality and quantity sleep. And some recent research carried out by intel using 2000 respondents looked at understanding what is considered to be a good night’s sleep. And many people believe that a good night’s sleep is somewhere in the region of 8 hours sleep. But in fact that’s not quite true, this varies from person to person. The average amount of sleep is between 6-8 hours but the reality is that it’s very personal, so, if I say to you “how do you feel when you wake up in the morning?” and you feel fabulous and you’ve only had 4 hours of sleep that suits you, however if I say to you “how do you feel in the morning?” and you’ve actually only had 8 hours of sleep and you feel rubbish it may be that you’re not getting the quality and quantity sleep that you need.

Patient Talk – What are the benefits of a good night’s sleep both in terms of health and wellbeing?

Margo –  The benefits of a good night’s sleep both in terms of health and wellbeing range from the fact that you feel great, you look good, you perform well at work, you’ve got a good memory, you’re sharp, you’re happening. Your weight is well under control, it can be because the hormones are affected, your sleep hormones affect your weight. Generally over rule your life is a better place to be. We also know that there is a strong correlation and there’s a huge amount of research around depression and insomnia or insomnia and depression, we’re not sure which comes first, the chicken or the egg but we know that there is a strong correlation between the two.

Patient Talk – What problems may arise from a poor night’s sleep?

Margo – A poor night’s sleep may well mean that you can’t concentrate, you’re irritable, you don’t feel great, you feel edgy. But over a long period of time these may well result in more severe consequences. And bearing in mind that we spend 1/3 of our lives asleep and 2/3 of us are struggling to get a good night’s sleep, and there are many health conditions associated with this we really need to take sleep very seriously.

Patient Talk – What are the main causes of a poor night’s sleep?

Margo – the main causes of a poor night’s sleep are often related to anxieties, concerns, worries, that’s the mental side of things. But also may be due to poor sleep hygiene, such as not having a bedtime routine, not sleeping in a decent bed, with a pillow not being in a good position, being uncomfortable, aches and pains, and other medical conditions or snoring. There are so many causes of a poor night’s sleep and these really need to be addressed.

Patient Talk – How should a person prepare for a good night’s sleep?

Margo – As a sleep expert one of the most important things that I encourage is setting yourself aside time for a bedtime routine. Many of us are so busy leading 24/7 lifestyles we’re sedentary, were mentally overactive and physically underactive, so definitely setting aside time for a bedtime routine which includes a hot drink, a warm bath, listening to some audio be it on the radio or audio book, and then dimming the lights and going to sleep. That really is how to prepare for a good night’s sleep. However, for some people buying these activity and sleep tracking devices such as the basis peak (?) can help you understand your statistics for your daytime and night time. And by using one of these devices this will actually allow you to accumulate data so that you can then move on to impacting on different aspects of your life. So for example if you’re a coffee drinker and you reduce the amount of caffeine that you’re drinking and you check in with your basis peak you may well understand that caffeine impacts your sleep in a major way and you can do something to change it. So anything that you can measure, any data that you can measure and correlate you can then have an impact on and it’s a really useful tool to use.

Patient Talk – What’s your views on napping during the day?

Margo – I’m a big fan of napping during the day. And this is something that’s culturally done in Spain and in Japan. However, what I will say is this is a bit of a tricky one when you’re a busy working person, it’s virtually impossible. And the way our culture works, although I have to say it’s changing, is that were not geared up to nap during the day. I am a big fan, so if you’re planning on napping, nap between 12 and 2, um somewhere in the region of 30 min to an hour is absolutely fine for a nap. Try not to nap too close to your bedtime because that may well disrupt your night’s sleep and you need to do it on a regular basis in a regular position so I’m a huge fan, there’s lots of different styles of naps and think about doing it but obviously for those you who are working it’s very difficult to nap.

Patient Talk – What myths are there about sleep that you would like to see, so to speak, put to bed?

Margo – There are certain myths that I need to put to bed and I’m going to read them to you, and this is based on research that’s been carried out by intel, so this research found that only 12% believe the theory that eating cheese before bed gives you nightmares. But in fact certain cheeses do give you nightmares, stilton cheese for example has been proven to give people vivid dreams. And this research carried out by intel, says that 1 in 7 people think that going to the gym in the evening helps get you to sleep but this is a myth as the body will be overheated meaning that people would have trouble going to sleep. Going to the gym during the day though would definitely help you have a better quality night’s sleep. And 1 in 7 people believe that you can catch up on sleep on the weekends but this is a myth, the only way people can catch up on sleep is by having early nights. 1 in 8 believe watching tv helps you sleep, yes and no, it can help you sleep and relax you, though the blue light can disrupt somebody’s sleep. 1 in 10 believe drinking alcohol will give you a better night’s sleep, drinking alcohol will in fact help you sleep but it will prevent you from getting into the deep quality, the deeper stages of sleep. And almost 60 % believe that caffeine keeps you awake. Yes it does, it does keep you awake, but it also differs from person to person, people are advised not to drink after 11 am. And almost ¼ of people believe that everyone needs 8 hours of sleep. This varies from person to person, the average amount of sleep is between 6-8 hours. These are some of the myths that we’ve had to shatter based on the research of 2000 respondents carried out by intel.