Apnea and Other Sleep Problems Associated with Multiple Sclerosis
What Keeps You from Sleep?
Multiple sclerosis (MS) causes many symptoms that can disrupt your quality of life. It’s no surprise that MS is associated with physical fatigue, but sleep problems are not as widely known.
This neuroinflammatory disease can prevent you from getting your zzz’s. For many patients, the cause is more than physical discomfort. If you’re having problems sleeping, talk to your doctor about these possible causes.
Sleep apnea is a serious medical condition. It’s characterized by frequent pauses in breathing while you sleep. After the breathing pauses, your lungs catch up by taking deep gasps of air. In some cases, you might even snore violently or choke from oxygen deprivation.
The nerve spasms associated with MS are the causes of related sleep apnea. Apnea should be addressed by a sleep specialist immediately to prevent long-term damage to the body.
Overactive bladder is a common condition that causes frequent urination. At night, this is called nocturia, a sleep problem experienced by many patients with MS. When you have nocturia, you may wake up frequently in the middle of the night with strong urges to urinate. Most of the time, you may not even have to release very much urine. Nocturia may be treated with the help of overactive bladder medications to help calm down the muscles.
Periodic limb movements in sleep (PLMS) is characterized by involuntary movements during periods of rest. These can be as small as toe movements, or as large as leg bends at the knee. Because PLMS movements can be large, the motion is likely to wake you up in the middle of the night. Unfortunately, MS medications can’t relieve PLMS, but a sleep specialist might be able to help.
Like sleep apnea, hypersomnia causes you to feel excessively tired during the day. What sets hypersomnia apart is that the tiredness isn’t related to interrupted sleep at night. In fact, MS patients who have hypersomnia take frequent naps during the day, no matter how much shut-eye they get. Often the naps come at inappropriate times, such as during work. These naps lure you into deep sleeping spells that can be difficult to wake from. Hypersomnia can also cause irritability and anxiety.
Narcolepsy is a disorder that disturbs sleep-wake cycles. A “sleep attack” causes uncontrollable drowsiness, and may come at any time. As with MS, an autoimmune reaction within the brain may cause narcolepsy.
Narcolepsy is more common in patients with MS than it is in the general population. Most narcolepsy occurs due to low levels of a neurotransmitter called hypocretin, which is produced by the hypothalamus. A 2003 study found that hypersomnia and narcolepsy may occur when MS lesions appear in that region of the brain.
Stress and Depression
Stress and depression are other symptoms of MS that can also keep you up at night. Anxiety may be a precursor to stress, which can make it difficult to fall asleep. Tiredness and depression often go hand-in-hand, but you may still find sleep hard to come by.
Relaxation before bedtime can help you cope with these problems so they don’t disrupt your sleep. Antidepressants can also treat insomnia and fatigue from MS.
Ruling Out Other Causes
While many sleep problems are associated with MS, it’s important to receive an evaluation from a doctor. Sleep apnea, overactive bladder, and hypersomnia may be stand-alone conditions that aren’t necessarily caused by MS. Other possible causes include underactive thyroid (hypothyroidism), obesity, and bladder infections. Making this determination is important in terms of finding the right medications.
Never self-medicate for any sleep problem, as this can interfere with your MS treatment plan.
Achieving a Good Night’s Sleep
According to the National Multiple Sclerosis Society, 80 percent of MS patients suffer from fatigue. It’s a common symptom, but it doesn’t have one specific cause for everyone. Getting a better night’s sleep can help you fight related fatigue, as well as battle the physical toll MS can take on your body.
Consistency is one of the best measures to take: go to bed at the same time with no distractions, and wake up around the same time every morning. Also talk to your doctor about medications that can help address the specific sleep problems associated with MS.
- Barun, B. (2013, December). Pathophysiological background and clinical characteristics of sleep disorders in multiple sclerosis, Clinical Neurology and Neurosurgery, 115, (1): S82-S85. Retrieved February 16, 2014 from http://www.clineu-journal.com/article/S0303-8467%2813%2900382-X/abstract
- Fatigue (n.d.). National Multiple Sclerosis Society. Retrieved December 16, 2013 from http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/symptoms/fatigue/index.aspx
- Hypersomnia (2013, December 5). National Institute of Neurological Disorders and Stroke. Retrieved December 16, 2013 from http://www.ninds.nih.gov/disorders/hypersomnia/hypersomnia.htm
- Kato, T et al. (2003). Hypersomnia and Low CSF Hypocretin-1 Concentration in a Patient with Multiple Sclerosis Showing Bilateral Hypothalamic Lesions. Internal Medicine, 42:743-745. Retrieved February 15, 2014 from https://www.jstage.jst.go.jp/article/internalmedicine1992/42/8/42_8_743/_article
- Multiple Sclerosis: Hope Through Research (2013, July 5). National Institute of Neurological Disorders and Stroke. Retrieved December 16, 2013 from http://www.ninds.nih.gov/disorders/multiple_sclerosis/detail_multiple_sclerosis.htm
- Narcolepsy fact sheet. (2013, July). National Institute of Neurological Disorders and Stroke. Retrieved February 15, 2014 from http://www.ninds.nih.gov/disorders/narcolepsy/detail_narcolepsy.htm
- Sleep Disorders and MS (2003). National Multiple Sclerosis Society. Retrieved December 16, 2013 from http://www.nationalmssociety.org/multimedia-library/brochures/managing-specific-issues/index.aspx