A 31-year-old woman recently diagnosed with relapsing-remitting MS via typical independent neurological and neuroradiological examination presented to the outpatient clinic of the National Center of Rehabilitation (Greece, Athens). Initial symptoms included mild dysarthria, instability, numbness, and impairment of fine movements of the left upper limb. Following diagnosis, the patient underwent DMT with injectable interferon β-1a, resulting in complete resolution of the presenting symptoms.

At the first meeting in the rehabilitation outpatient clinic, the patient reported remission of physical symptoms but complained of ongoing restlessness, anxiety, insomnia, and mild weakness in the left hand. Radiological examination with magnetic resonance imaging revealed multiple brain lesions and a minor lesion in the cervical spinal cord. The clinical examination determined an Expanding Disability Status State score of 1.0. The patient had no significant comorbidities and led an active lifestyle.

The relaxation technique used in this study was adapted from Jon Kabat-Zinn’s mindfulness-based body scan technique [20]. This method involves a guided segmental mental scan of the entire body to achieve relaxation and promote body awareness. During the practice, participants are instructed to lie down with their eyes closed and systematically shift their attention from the toes to the head.

The research period spanned 5 weeks, with the first week dedicated to the preintervention period to collect baseline biometric data using a wearable device (Fitbit Sense 3) and administer 4 self-report questionnaires: the Pittsburgh Sleep Quality Index (PSQI) [23], Depression Anxiety Stress Scale-21 [24], Fatigue Severity Scale [25], and Multiple Sclerosis Quality of Life scale (MSQOL-54) [26]. From the second to the fifth week, the participant engaged in the mindfulness-based body scan technique daily before bedtime. The intervention involved listening to a prerecorded relaxation technique freely translated and narrated by one researcher (II). At the conclusion of the research period, the participant completed the same questionnaires and returned the smartwatch.

The Fitbit Sense 3 measured various biomarkers in real time, including resting heart rate (RHR), heart rate variability (HRV), respiratory rate (RR), body temperature, nighttime sleep, daytime wake period, sleep quality, and stress score. Stress scores were computed using the variables HRV, exertion, and sleep data. Sleep scores considered HRV, bedtime wakefulness, and sleep stages. Data were extracted from the Fitbit online platform and analyzed using SPSS version v26 (IBM Corp, 2020 release). The Mann-Whitney U test was used for evaluating the significance of differences in measures between time points and Kendal τ was used for the correlation analysis.

After assessing the patient’s proficiency with technological equipment and obtaining written informed consent, the Scientific Council of the National Rehabilitation Center of Greece approved the research protocol.

This case study aimed to investigate the effects of the mindfulness-based body scan technique on a patient with MS when administered before bedtime, focusing on sleep quality, anxiety levels, and overall QoL. The evaluation of parameters involved both objective and subjective measures. The findings can be examined from two perspectives. First, despite the patient reporting improvements in sleep quality according to the PSQI, these subjective improvements were not reflected in the objective biometric data analysis. Second, an interesting observation was the apparent diminishment of the association between the sleep score and stress score over the course of the intervention.

Our study findings echo those of previous research, indicating disparities between subjective self-reported and objective measures of sleep quality. A 2023 study comparing mindfulness training to sleep hygiene in 53 patients with MS experiencing chronic insomnia yielded similar discrepancies between self-reported and objective measurements of sleep quality [6]. Furthermore, a systematic review and meta-analysis conducted in 2019, encompassing 49 studies and 4506 participants, found similar challenges in objectively measuring the effects of mind-body therapies on sleep quantity indices, despite significant improvements in subjective sleep quality and reductions in insomnia severity [27].

To address limitations identified in previous research, our study expanded beyond examining the impact of the relaxation technique solely on sleep. We integrated additional biometric parameters related to the patient’s emotional state, such as HRV, RHR, and the stress score, to explore how the mindfulness-based body scan technique influences sleep quality in individuals with MS. Notably, our EPD data analysis revealed that the daily stress score variable did not significantly affect the sleep score during the intervention, contrasting with the observed correlation during the baseline period. This suggests that the relaxation technique, when performed before night rest, may effectively counteract the adverse effects of daily stressors on sleep quality, thereby enhancing the perception of restful sleep. This finding is important as patients with MS have a significantly higher incidence of anxiety and depressive disorders compared to the general population [28].

Mindfulness-based stress reduction has been found to decrease stress and mood dysregulation, enhance positive goal-setting, and improve emotional capacity [22]. Meta-analyses have confirmed that this technique enhances perceived sleep quality and reduces insomnia severity in diverse populations [27,29].

While existing studies consistently demonstrate the positive effects of relaxation techniques on sleep quality, the translation of these improvements into clear subjective measures presents challenges. Possible reasons for this discrepancy include limitations in sample size, insufficient study duration, and the complexity of the sleep-stress relationship. Moreover, unexplored parameters and inherent biases in questionnaire findings may contribute to inflated perceptions of improvement. Our study does not escape these limitations, as it pertains to only one participant and relies on self-report questionnaires. Thus, while the benefits of relaxation on sleep quality are well-established, addressing these challenges is crucial for accurate assessment and understanding of their impact.

The mindfulness-based body scan technique demonstrated beneficial effects on both sleep quality and QoL questionnaires in our patient with MS. While we interpret the questionnaire results with caution owing to their subjective nature, the reported feelings of well-being during the intervention are noteworthy. Of particular significance is the observed dissociation between stress levels and sleep quality, suggesting that the mindfulness-based body scan technique may help insulate individuals from anxiety-related thought patterns, thereby promoting a calmer state of mind that is conducive to better sleep. Although these findings are based on a single patient, they provide a foundation for future research. Larger-scale studies involving diverse MS populations are warranted to confirm the validity and generalizability of these results. If replicated, the mindfulness-based body scan approach could offer valuable insights for managing the psychological symptoms of patients with MS and may inform future treatment strategies.