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CMSC INforMS: Obstructive sleep apnea, sleep disorders may contribute to multiple sclerosis fatigue

Friday, January 15, 2016  
Posted by: Elizabeth Porco
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Obstructive sleep apnea (OSA) and sleep disorders may contribute to multiple sclerosis fatigue. Sleep problems and lack of sleep is a common problem in multiple sclerosis (MS) patients with nearly 50 percent of MS patients experiencing sleep disturbances, this according to Multiple Sclerosis Trust.

Poor or lack of sleep can have a negative impact on just about anyone’s life but more so in MS patients as it can contribute to relapses and contribute to worsened symptoms.

Patients with multiple sclerosis may experience a slew of sleeping problems including difficulty falling asleep, difficulty staying asleep and even having a hard time going back to sleep once awoken. Understanding and uncovering the underlying cause of sleep problems can aid in treatment options and in turn improve sleep.

Sleep disorders undiagnosed in individuals with multiple sclerosis

A previous study, the largest of its kind, examined the prevalence of undiagnosed sleep disorders in people with multiple sclerosis. Furthermore, the study uncovered that sleep disorders are the root for the most common symptom in multiple sclerosis – fatigue.

The study looked at 2,300 individuals in Northern California with multiple sclerosis. What they found was that over 70 percent of participants were positive for one or more sleep disorders. The research outlines the importance of diagnosing sleep disorders in multiple sclerosis patients as a means to reduce fatigue.

Steven Brass, associate clinical professor and director of the Neurology Sleep Clinical Program and co-medical director of the UC Davis Sleep Medicine Laboratory, said, “A large percentage of MS subjects in our study are sleep deprived and screened positive for one or more sleep disorders. The vast majority of these sleep disorders are potentially undiagnosed and untreated,” he said. “This work suggests that patients with MS may have sleep disorders requiring independent diagnosis and management.”

Brass and his team surveyed over 11,000 patients and 2,375 met the criteria and were included into the study. The 10-page survey asked detailed questions about sleep history and assessed sleep disorders like obstructive sleep apnea, daytime sleepiness, insomnia and restless leg syndrome.

Based on the findings Brass explained, “This study shows that sleep disorder frequency, sleep patterns and complaints of excessive daytime sleepiness suggest that sleep problems may be a hidden epidemic in the MS population, separate from MS fatigue.”

The research outlined the importance of diagnosing MS patients with sleep disorder as a means of improving fatigue.

Obstructive sleep apnea (OSA) is highly prevalent in people with multiple sclerosis

An alternative study examined the prevalence of obstructive sleep apnea in multiple sclerosis patients and found it was quite high. Results from the study revealed that one-fifth of MS patients were diagnosed with OSA and others were at an elevated risk for developing OSA. OSA was found to be a predictor of extreme fatigue even after adjusting for other known factors like depression, age, gender, sleep duration and body mass index.

Lead author and principal investigator, Tiffany J. Braley, said, “OSA may be a highly prevalent and yet under-recognized contributor to fatigue in persons with MS. Our study suggests that clinicians should have a low threshold to evaluate MS patients for underlying sleep disturbances.”

“Obstructive sleep apnea is a chronic illness that can have a destructive impact on your health and quality of life. People with multiple sclerosis who are found to have a high risk of OSA should be referred to a board certified sleep medicine physician for a comprehensive sleep evaluation,” added Dr. M. Safwan Badr, President of the American Academy of Sleep Medicine.

Causes and warning signs of sleep disorders in MS

If you have not been diagnosed with a sleep disorder, there are warning signs to pay close attention to which may be a contributing factor for your excess fatigue. Warning signs of a sleep disorder include:

  • You wake up tired and not refreshed
  • You need an alarm clock to wake up
  • You fall asleep during the day even if you don’t want to
  • You have difficulty falling asleep or staying asleep
  • You kick off the bed covers
  • You get up frequently at night
  • You snore

In multiple sclerosis there a numerous causes for sleep disorders including muscle spasms, urinary frequency, depression or anxiety, and even some medications may keep you awake at night. Bladder problems, too, are quite common in multiple sclerosis patients so that can be another contributing factor to sleep disorders.

Restless leg syndrome and sleep apnea – as previously discussed – are two other common conditions which can contribute to sleep disorders in multiple sclerosis patients so managing both conditions can help bring upon relief.

Treatment options for managing sleep disorders in MS

The first step to treatment of sleep disorders in MS is uncovering the underlying cause. Whether it is psychological or physical, becoming aware of the cause can lead to better, more effective treatment. For example if sleep apnea is the cause to poor sleep wearing a continuous positive airway pressure (CPAP) device can aid in that.

Some treatment may involve sleeping pills but this may only offer temporary relief. Furthermore, experts only recommend sleeping pills as the last resort as they can offer side effects and be habit-forming.

Another form of treatment may to undergo a sleep test where you are monitored overnight and hooked up to devices which track your sleep and brainwaves to better understand the underlying cause to the sleep disorder.

Some natural tips you can utilize to improve your sleep include the following:

  • Setting up a regular sleep schedule
  • Not drinking coffee, water or alcohol prior to bed
  • Don’t watch TV or use electronic devices while in bed
  • Keep your room at a cool temperature and completely dark
  • If you have difficulty falling asleep, get up and complete a 10 minute activity to tire yourself out
  • Avoid exercising prior to bed
  • Ensure your bed, linens and pillows are comfortable
  • Listen to relaxing music

By following these natural tips and speaking to your doctor you can get better relief and get back to sleeping normally once again.

By: Bel Marra Health | Sleep 

  • CMSC Disclaimer 
    The industry news information and articles are for informational purposes only, and are not intended to represent any trends, partnerships, commitments, or research of the Consortium of MS Centers or any of it's members in any way whatsoever, nor should any party be libel in any way to the reader or to any other person, firm or corporation reading this industry news section. Although the CMSC site includes links providing direct access to other Internet sites, CMSC takes no responsibility for the content or information contained on those other sites, and does not exert any editorial or other control over those other sites. CMSC is providing information and services on the Internet as a benefit and service in furtherance of CMSC's nonprofit and tax-exempt status. CMSC makes no representations about the suitability of this information and these services for any purpose.

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