Americans are struggling with a sleep problem. More than a third of us aren’t getting the recommended seven hours per night, according to the Centers for Disease Control and Prevention, and 35 percent report poor sleep quality, according to the National Sleep Foundation. People with multiple sclerosis may fall into both categories. “Research suggests that 50 percent or more of patients with MS have some form of sleep disturbance,” says Abbey Hughes, a clinical psychologist and assistant professor at the Johns Hopkins University School of Medicine.
MS and Zzzs
Multiple sclerosis is an autoimmune disease in which the body mistakenly attacks the coating of the nerves and the nerve fibers themselves. That damage then jams or slows communication in the central nervous system, made up of the spinal cord, brain and optic nerves.
Miscommunication in the body leads to a long list of physical problems — such as extreme fatigue, muscle spasms, and bladder and bowel problems — which make it tough to get through each day. Those symptoms can also make it hard for MS patients to get through the night, as can other MS-related issues such as depression, anxiety, tremors, pain and burning sensations in the body, and temperature-control problems. “A lot of people with MS report feeling heat-sensitive and get overheated more easily if the bedroom isn’t cool,” Hughes explains.
[See: The Best Foods for Sleep.]
Other aspects of MS that can cause trouble sleeping include too much daytime napping and side effects from MS medications.
Lifestyle factors may also lead to sleep problems, such as drinking caffeinated beverages or alcohol, or looking at electronic screens (TVs, smartphones) late at night. “The type of blue light emitted by these devices stimulates wakefulness by suppressing our brain’s natural nighttime melatonin release. This problem may further exacerbate existing sleep difficulty in MS patients,” explains Dr. Tiffany Braley, an assistant professor of neurology at the University of Michigan who specializes in the diagnosis and treatment of sleep disorders in multiple sclerosis patients.
Types of Sleep Problems
People with MS often experience the following sleep disturbances:
— Insomnia, which includes difficulty initiating or maintaining sleep, frequent waking throughout the night or waking up early and not falling back to sleep. “Fifty percent of people with MS have insomnia problems,” Hughes says.
— Hypersomnia, which includes sleeping too much or having excessive daytime sleepiness. Hughes says that a third of MS patients struggle with hypersomnia.
— Obstructive sleep apnea, or OSA, which includes frequent pauses in breathing during sleep, caused by a blocked airway. “In MS, the airway can collapse at night because damage to the nerves can weaken the muscles,” Hughes says. Symptoms of OSA include snoring and gasping for breath.
— Central sleep apnea, which also includes frequent pauses in breathing during sleep. “In MS, this can be caused by damage to the central nervous system that affects areas of the brain that control sleep, such as sleep-related breathing and circadian rhythm (the sleep-wake cycle),” Hughes explains.
— Periodic limb movement, when the legs or arms twitch during sleep without a person knowing it.
— Restless leg syndrome, an irresistible urge to move the leg when the body is at rest. “It’s like an itch, and it makes it difficult for people with MS to fall asleep,” Hughes says.
— Narcolepsy, when a person suddenly falls asleep during the day.
[See: Is It Healthy to Sleep With Your Pets?]
Seeking Help
It’s important to seek help for sleep disorders since sleep deprivation can worsen MS symptoms, including MS-related fatigue, daytime sleepiness and cognition problems, according to Braley. ” Our recent research has shown that OSA may contribute to the cognitive problems so frequently experienced by MS patients,” she says.
Your first call should be to your primary care physician or neurologist. An evaluation can determine if your sleep interference is from an MS side effect such as spastic muscles, a medication side effect or an underlying condition such as depression or nighttime waking to go to the bathroom. Treating a secondary condition or switching medications may resolve sleep problems.
If there’s no easy fix, your doctor may refer you for a sleep study to pinpoint the cause of sleep trouble. Such studies involve staying overnight in a sleep lab, where you’ll be hooked up to machines that record brain and body functions while you sleep.
Some experts may recommend a type of sleep study that you do at home, with a portable device to measure sleep nuances. Braley generally advises against it. “Home sleep studies may be used to diagnose straightforward cases of moderate or severe obstructive sleep apnea, but are not as sensitive as in-lab studies. Therefore, milder forms of sleep apnea may be missed and if a patient’s home study is negative for sleep apnea, an in-lab study is still required to rule it out. Furthermore, home studies are not the diagnostic test of choice to evaluate for central sleep apnea or other sleep disorders, which may be more common in MS,” Braley explains.
Treatment
The type of treatment your doctor prescribes will be based on your underlying condition.
For example, sleep apnea treatment typically includes continuous positive airway pressure, or CPAP. This involves wearing a mask with a tube delivering a stream of forced air to keep the airway open during sleep.
Doctors may prescribe medication to quell periodic limb movements or restless leg syndrome, such as gabapentin (Neurontin) and pregabalin (Lyrica). “Both have been shown to effectively treat RLS in non-MS patients, and may have additional benefits for other symptoms which are common in MS, such as nerve pain,” Braley says.
Medications may also be the answer for MS patients with spastic muscles or nerve-related pain that keeps them awake. “On the most conservative side,” Braley notes, “routine stretching exercises can prevent or alleviate nocturnal spasms.”
Cognitive behavioral therapy for insomnia is helpful for MS patients with sleep-related anxiety. It helps people redirect negative thoughts associated with insomnia and promotes healthy sleep habits such as:
— Going to bed and waking at the same time each day.
— Restricting the bed to just sleep and sex.
— Keeping the bedroom temperature cool.
— Practicing relaxation techniques before bed.
[See: 8 Ways to Relax Now.]
What about sleep medication? “If it’s needed, it should generally be used for the shortest time possible. Sleep aids and sedatives also have the potential to worsen sleep apnea and should be avoided if the patient has suspected untreated sleep apnea,” Braley warns.
She says to avoid over-the-counter antihistamine-containing products (such as Advil-PM or Tylenol-PM), since research has shown that these can contribute to next-day fatigue and cognitive problems in MS patients. “But melatonin supplements are safe,” Braley says, “and may be used to help reset the body’s internal time clock with the care of a sleep specialist.”
No matter which treatment your doctor prescribes, it will have to work with your other medications and your ability to adhere to it.
“Setting sleep goals and maintaining a sleep diary can help,” Hughes suggests.
And there is hope. “[People] with MS most definitely have the potential to improve their sleep,” Braley says, “and in turn improve their daytime function and quality of life.”
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Getting Quality Sleep When You Have Multiple Sclerosis originally appeared on usnews.com
