Multiple Sclerosis (MS) affects around 400,000 people in the US and 2.1 million people worldwide. It is a neurological disorder that affects the central nervous system (brain and spinal cord), and nerves that should communicate with the rest of the body. Because of that, there is a lack of information flowing through neurons, which makes it hard for a body to move.
The most frequent symptom of MS is fatigue. The problem with this is that it can mask some sleep disorders that fatigue can be attributed to, like insomnia, restless legs syndrome, parasomnia and sleep apnea. To make things even worse, poor sleep quality can lead to worsening of the MS symptoms, as quality sleep is needed for muscle restoration, sharp cognitive functioning, mood improvement, and many more.
Although people with MS experience some symptoms, it isn’t a deadly disease. However, it can lead to depression, lower quality of life and shortening of lifespan. There are many different treatments available that could help ease the symptoms a little bit and maybe even slow down the progression of the disease, but unfortunately, there is no cure.
What is Multiple Sclerosis?
MS is a neurological disorder that affects a person’s immune system. Because of not functioning the way it is supposed to, the immune system attacks myelin, a material that makes a layer around your neurons. Myelin serves as a protective layer of neuron’s bodies called axons, and it also contributes to the faster distribution of electrical impulses throughout the body. Myelination is a crucial feature of neurons in vertebrates that allowed them to conserve energy and space, and to increase conductivity by far. Due to MS, the myelin is broken down, causing nerve damage and scar tissue, which makes it difficult for signals to travel across the body and tell it to perform the needed functions.
Symptoms can vary between people, and not everyone is affected the same way. People who suffer from MS experience physical, mental, and emotional symptoms that can affect sleep. Also, a condition in some individuals may get worse with time, while others have periods of improvement and worsening. Most people experience:
- Difficulty walking
- Muscle weakness or numbness
- Sexual dysfunction
- Generalized pain
- Lack of bowel and bladder control
- Lack of balance and coordination
- Problems with vision
- Difficulty focusing
- Impaired memory
- Reduced mood
A lot of people also experience some problems with their sleep. That can lead to a series of sleep disorders like:
- Sleep apnea
- Restless legs syndrome
It was estimated that the prevalence of MS in the United States in 2012 was around 15 in 10,000 people. While the cause of MS is still not known, some people are at a higher risk of developing it:
- Women are two to three times more likely to develop MS than men
- Caucasian people are twice as likely to suffer from it that people of the other racial backgrounds
- People who live in the northern hemisphere are more prone to developing MS than people who live near the equator
- Smokers are at a higher risk than those who don’t smoke
- People with some viral infections may be more inclined to MS, or the infection can worsen the symptoms
- Specific genes are correlated with the disease, around 200 of them
- Obesity also increases the chances of MS
There is research being done in different fields to try and understand MS a little better. Immunology, epidemiology, and genetics are all studied to find a cure for MS, or maybe even prevent it in the first place.
Environmental factors also impact the development of MS. It is shown that people who live further from the equator are more likely to have it. To confirm that it is the environment that is responsible for that, it is recorded that people who migrate from the area of a higher risk to the place in the tropics before the age of 15, acquire the chance of MS of a new location.
There is growing evidence that vitamin D plays a role in MS as well. Low levels of vitamin D have been identified as a risk factor for MS. As exposure to sunlight is the biggest source of vitamin D, researchers believe that it fits with a narrative that people who live further of the equator are more prone to having MS. People in the tropics are exposed to more sunlight, and they naturally have higher levels of vitamin D produced.
People usually start to see the symptoms of MS between the age of 20 to 40. Because some of the signs are similar to some other disorders, medical professionals need a series of tests to determine whether you indeed have MS. The doctors will go through your medical history, a neurologist will need to examine you, and you’ll go through various tests including magnetic resonance imaging (MRI), spinal fluid analysis, and evoked potentials test that measures the activity in your brain. For a specialist to make a diagnosis, they need to find evidence of damage in at least two different areas of the central nervous system (CNS), to find evidence that this damage occurred at different times, and to rule out any other possible diagnoses.
Unfortunately, there is still no cure for MS. There are, however, different treatment options for easing the symptoms, including prescription drugs and therapy.
Lower levels of vitamin D have shown to increase the risk of MS, and moving to a sunnier place may help with the symptoms. The research with vitamin D supplements show different results, and while some showed some benefits, others didn’t find that link. There is more research needed to detect if vitamin D supplements do indeed help.
The primary goal of prescription drugs is to slow down the destruction of myelin and nerve damage, thus preventing the worsening of the symptoms.
Physical therapy has shown benefits in improving muscle strength and balance. It also improves coordination, so moving around and everyday life tasks can become a lot easier. Some patients find using a cane or a walker to help them move around very useful. Also, talking to a psychologist can help people who struggle from MS-related mental drainage and depression.
Sleep Disturbances in Patients With Multiple Sclerosis
Many of the MS symptoms cause sleep disturbances, and problems with sleep can additionally increase the severity of MS symptoms. Patients with MS are three times more likely to suffer from fragmented sleep and are twice as likely to report inadequate sleep. The improvement is needed in the detection of sleep disturbances in people with MS, and also the education of patients to report sleep problems.
Most common sleep disorders in people with MS are:
- Fatigue affects as much as 90% of people with MS. It is different than usual sleepiness, as it can’t be relieved with sleep. People tend to wake up feeling fatigued, and they don’t feel the refreshment that rest should provide.
- Insomnia can be due to muscle pain and discomfort, depression, or some other MS-related symptom. Sleep onset insomnia is described as difficulty falling asleep, while sleep maintenance insomnia is characterized by the inability of a person to stay asleep — individuals with MS experience both of these.
- Restless legs syndrome (RLS) is described as a strong urge to move lower limbs, due to pain, discomfort or a sensation that resembles stabbing of needles. Walking or stretching can help relieve these sensations, but because people with MS can sometimes have a hard time moving, these symptoms can be severe.
- Obstructive sleep apnea (OSA) is a breathing disorder that can potentially be very dangerous. Due to the blockage of the upper airway, there can be a complete stoppage of airflow called apnea, or it can be partially, and it’s called hypopnea. Snoring is the most common symptom and researches thing that OSA is highly undiagnosed and that it affects 1 in 15 people.
- Hypersomnia is the condition opposite of insomnia. People who experience it sleep for too long, or they can spend too much time in certain sleep stages. People with hypersomnia can nap too much during the day, which can lead to insomnia.
- Narcolepsy is characterized by suddenly falling asleep during the day. These episodes can last from a few moments to more than 30 minutes. This can be very dangerous as it could happen while driving or operating heavy machinery, and it can lead to severe accidents. There is currently no cure for narcolepsy.
- Nocturia is a condition where a sleeper has to go and urinate multiple times during the night. That can lead to fragmented sleep and disrupted sleep cycle. As one of MS symptoms is reduced bladder control, it can be a trigger for nocturia.
Depression is another symptom of MS, and it can additionally worsen sleep problems. If you think that you are suffering from a sleep disorder, you should visit a doctor. They will most likely do an overnight sleep study called polysomnography, to determine if everything is okay with your sleep.
MS and Fatigue
Fatigue is the most prevalent symptom of MS, and as much as 90% of people with MS report experiencing it at some point. They usually experience general tiredness throughout the day, or they can feel exhausted after some activity, such as walking.
There are a few theories about the case of MS-related fatigue. One is that the weakened immune system is responsible for it. Cytokines are molecules that are responsible for cell communication during the inflammation. People with MS have been observed to have higher levels of cytokine, which could be a potential cause of fatigue.
Other theories focus on the brain, and its inability to properly communicate with the rest of the body. Because of that, it needs to spend more energy, which could be at least a partial cause for general tiredness.
MS and Sleep Apnea
Obstructive sleep apnea (OSA) affects people with MS a lot more than healthy people. While the prevalence of OSA in the general population is estimated to be around 3%, it goes up to 20% in the MS patients.
One of the causes for that is higher obesity rate in people with MS. Because of the general tiredness, they are less likely to move and exercise, and that is one of the causes for adding extra weight. Extra fat can block the upper airway and cause OSA.
Even if people with MS are not overweight, they are still more prone to central sleep apnea. Because of the lack of brain communication, throat muscles may cause dysfunction, and that can lead to the cessation of airflow.
Snoring and waking up short of breath are the most common symptoms of sleep apnea, so people who are regularly experiencing them should consult their doctor.
MS and Restless Legs Syndrome (RLS)
RLS is characterized by the strong urge to move your legs during rest to relieve pain or discomfort that you feel inside them. It is much more prevalent in people with MS than in the general population, and women are more likely to develop it.
Some individuals with MS also experience periodic limb movement disorder, which is described as involuntary muscle twitching during sleep.
Sleeping Tips for People With Multiple Sclerosis
Improving your sleeping habits can help you ease some of the symptoms and get better quality sleep.
- Set a regular bedtime routine and stick with it. Going to bed and waking up at the same time can help your body rest better.
- Create a sleep environment that fits you well. Your bedroom should be dark, quiet, and cool. You can consider getting one of the sleep product to make your sleep easier like: low profile beds, bed rails, rope ladders, grab handles, floor pads, waterproof mattress and bedding, weighted blanket, or CPAP machine. Most of these should help you with getting out of bed or changing position, or they should help you keep in place, and not falling out of bed. Low profile beds and floor pads will make sure that even if you do fall out, you don’t hurt yourself. A weighted blanket can help relieve some of the symptoms related to RLS, while CPAP machine is a therapy used for treating sleep apnea.
- Try to eat healthily and to exercise regularly. These will help ease some symptoms, and also make sure that you don’t gain extra weight. Limit fluid intake in the evening if you have a problem with frequent bathroom nighttime visits.
- Manage your naps. They can be very helpful to get additional rest and feel less tired, but make sure you don’t do it too late in the day, and also don’t nap for longer than 30 minutes.
- Don’t be afraid to seek professional help. Whether you need counseling to help with your depression or some other medical advice from your doctor, don’t be shy and ask them anything. They’ll surely do everything in their power to give you the best possible information.