A third of Americans aren’t getting enough shut-eye, according to the Centers for Disease Control and Prevention. Not surprisingly, these folks report feeling tired during their day. But if you’re one of the 400,000 people who has multiple sclerosis, sleep disturbances are likely to be twice as frequent, more severe and can lead to debilitating fatigue — the kind that dramatically interferes with work and home life.
MS affects nerve fibers in the brain and spinal cord. Each fiber is surrounded by a layer of protein called myelin, which protects the nerves and helps electrical signals from the brain travel to the rest of the body. In MS, the myelin becomes damaged and disrupts the transfer of these nerve signals, causing a wide range of problems including blurred or double vision, numbness or tingling, spasticity and loss of balance. Sleep disorders are common.
“It’s not only insomnia,” points out Dr. Enrique Alvarez, assistant professor of neurology at the University of Colorado School of Medicine in Denver. “People with MS are affected by nocturnal leg spasms, restless leg syndrome, narcolepsy, REM sleep behavior disorder and sleep disordered breathing (apnea). Any one of these conditions can interfere with slumber and contribute to profound fatigue during waking hours.”
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The National Multiple Sclerosis Society website says, “Fatigue is one of the most common symptoms of MS, occurring in about 80 percent of people with the illness.” But getting a good night’s sleep to combat fatigue can be especially difficult because of the physical and chemical changes associated with MS.
“A hallmark of MS is nervous system lesions in the brain, and those can affect circadian rhythm, otherwise known as the biological clock. This ‘clock’ controls when we sleep and when we wake,” explains Dr. Anne Cross, professor of neurology at Washington University School of Medicine in St. Louis.
“There’s also an association between brain lesions and sleep apnea,” Cross says. “But to be clear, in both these instances, there’s no scientific proof of cause and effect, only an association.”
There’s another Catch-22 when it comes to MS and a good night’s sleep. Extreme fatigue often triggers MS patients to take longer and more frequent daytime naps. “These extended and numerous naps can interfere with a good night’s sleep,” says Alvarez. “It’s OK to take one nap, but best to keep it shorter than an hour and to include the time spent napping when calculating how much sleep a patient actually gets.”
A sedentary lifestyle also contributes to disturbed sleep. The results of the National Sleep Foundation’s 2013 Sleep in America Poll showed an association between exercise and better sleep. According to the poll, exercisers reported better sleep than non-exercisers. Even a 10-minute walk can improve slumber. Researchers at Pennington Biomedical Research Center in Baton Rouge, Louisiana, reported findings from a study involving 464 women who were non-exercisers. After six months, a group that walked about 10 minutes a day had significantly improved overall fitness. “MS sufferers often avoid exercise because of pain, depression or fatigue,” Alvarez says.
When it comes to exercise and promoting a better night’s sleep, timing is everything. “If exercise activates you mentally or physically, it’s best to do it in the morning. If it makes you tired, than it’s OK to do it later in the day,” Cross says.
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For MS patients, it’s not uncommon for chronic pain to interfere not only with exercise but also with a restful night. “It’s difficult to fall and stay asleep when dealing with pain, and doctors often prescribe medication to reduce it,” Alvarez says. “But medication can also be a factor in keeping people awake at night. For example, drugs given to treat daytime fatigue, if taken too close to bedtime, can contribute to insomnia.”
Alvarez suggests, “If patients are concerned about drugs affecting their sleep, it’s a good idea to speak with their doctor. But they should not stop taking any medications before they do.”
This applies to drugs for depression. “MS sufferers have higher rates of the blues than the general population. Sleep problems such as difficulty falling asleep and early-morning waking are common symptoms of depression,” Alvarez points out.
MS has a number of symptoms, some of which are shared by other disorders, so be sure to see your doctor or neurologist for a proper diagnosis.
Factors contributing to poor sleep quality in MS patients can also differ by gender. It appears that depression is more of an issue for women, whereas pain is more often the contributing factor in men, according to a 2016 study of 153 MS patients reported in the journal Brain Disorder.
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A sleep disrupter affecting both genders is bladder control. MS damages nerves that send messages to muscles, including those affecting the bladder. Sufferers with this condition may wake up once or several times during the night with an urgent need to empty their bladder. Urinating right before bedtime can help reduce such awakenings. Other helpful sleep habits offered by The Better Sleep Council include:
— Create a regular sleep pattern. Go to bed and get up at the same time every day — weekends too. This helps your biological clock stay on track.
— Reduce anxiety. Worry can keep you awake. Before bedtime, write down a list of today’s worries and the pro-active actions to take the following day.
— Keep the bedroom cool, quiet and dark. All will help to induce and maintain sleep.
— Create a sanctuary devoted exclusively to sleep. The bedroom is not for reading, watching television or working on the computer or smart phone.
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What Can Sleep Patterns Tell Me About Possibly Having MS? originally appeared on usnews.com
