In order to protect the brain and spinal cord’s nerves, the fatty insulating layer known as the myelin sheath breaks away in multiple sclerosis1. Toxic inflammation occurs when the body’s immune system mistakenly attacks its own nervous system.
It is possible that if the condition continues, it will interfere with the transmission of messages between nerves, resulting in involuntary muscular spasms and other symptoms. Damage to a certain part of the body can cause a wide range of symptoms.
Multiple sclerosis is estimated to affect roughly 1 million Americans, and approximately 60 percent of those sufferers experience sleep issues4. Although it can strike at any age, young adulthood is the most usual time for the disorder to begin, and women are more likely than males to be affected.
The symptoms of MS may come and go, and the disease itself does not always shorten life expectancy, despite its long-term nature. Multiple sclerosis treatment aims to enhance overall well-being, which includes a more restful night’s sleep.
How Does MS Affect Sleep?
Stress and despair, in addition to multiple sclerosis symptoms, can adversely affect sleep. Mood and energy problems, as well as an increase in MS symptoms, can all be the result of inadequate sleep. This could also result in cognitive decline in the future4. Many things must be taken into consideration when treating MS and sleeplessness.
When it comes to MS and sleep, physical health has a significant impact. At night, it may be hard for MS patients to find a position that is comfortable due to symptoms such as muscle stiffness and painful face feelings. A common complaint among those suffering with MS is an inability to change sleeping positions as frequently as they would want. If you’re confined to one position for too long, you run the risk of developing bedsores, which can be extremely uncomfortable.
Patients with multiple sclerosis are more likely to undergo frequent overnight urination than the general population would expect. Having to get up several times in the middle of the night to use the bathroom is a sleep disruptor that reduces both the amount of time spent sleeping and the quality of sleep. Due to MS-related difficulties, medication and lack of exercise might have a negative impact on one’s ability to sleep.
The majority of persons with MS (60% to 90%) complain of fatigue (70% to 90%), which might manifest months or years before an official MS diagnosis (80% to 90%). An tiredness that makes daily tasks difficult is known as “fatigue,” which is a generic phrase. Even a few hours of sleep may not be enough to alleviate this.
Even though fatigue is regarded as one of the most debilitating MS symptoms,9 many individuals assume it is a natural side effect of MS symptoms. There are a variety of possible explanations for fatigue in MS, including sleep disorders, elevated melatonin or pro-inflammatory cytokines, both of which have been implicated in sleep regulation.
Pain, anxiety, stress, and sadness are all common symptoms of multiple sclerosis and can worsen each other’s effects. In addition, taking a nap in the middle of the day may make it more difficult to get a good night’s sleep at night.
What Sleep Disorders Are Common in People With MS
There is an increased risk of sleep disturbances in MS patients, in addition to the general discomfort induced by the disease’s symptoms11. Insomnia, restless legs syndrome, sleep-disordered breathing, narcolepsy, and REM sleep behavior disorder are the most frequent sleep disorders in people with multiple sclerosis. Lesions to specific regions of the brain or spinal cord are the likely cause in many cases, therefore symptoms may differ from person to person depending on the location and intensity of one’s lesions.
Insomnia: Insomnia is the inability to get asleep, stay asleep, or sleep well. Multiple sclerosis (MS) sufferers may suffer from insomnia due to a variety of reasons such as physical and emotional pain, sleep problems, and the need to pee frequently at night.
Insomnia and daytime sleepiness can result from Circadian Rhythm Disorders, which alter the body’s natural sleep-wake cycle. MS patients may have abnormalities in melatonin production12, which may be a factor in the increased occurrence of circadian disturbances and fatigue.
There are two types of restless leg syndrome (RLS) and one kind of periodic limb movement disorder (PLMD): RLS sufferers report tingling sensations that create an irrepressible urge to move their legs, whereas those with PLMD experience twitches or other movements while they sleep. Distractions from both circumstances may trigger overnight awakenings that contribute to poor sleep quality and tiredness.
Sleep Apnea is the most frequent form of sleep apnea, in which a person’s sleep is disrupted by repeated pauses in breathing. MS patients with brainstem lesions are more likely to experience sleep apnea. Continuous positive airway pressure (CPAP) can be used in most circumstances to help regulate breathing.
An bout of excessive daytime sleepiness, which may be followed by muscle paralysis or hallucinations, is common in people with narcolepsy. Narcolepsy and MS have been linked to abnormalities in the lateral hypothalamus, which controls wakefulness, according to research.
Atonia, or paralysis of the muscles, is common during rapid eye movement (REM) sleep, when we are dreaming. People who suffer from REM sleep behavior disorder (or RSD) have problems with this function, which causes them to act out their dreams, often violently or dangerously. MS patients with injury to the brainstem are more likely to develop REM sleep behavior disorder.
Health care providers are the best source of information when it comes to sleeping disorders. The polysomnography, or sleep test they can perform, will check for indicators of a sleep disturbance and work with you to build an appropriate treatment plan if an issue is discovered.
How Can People With MS Cope With Sleep Issues?
It is possible to improve the quality of sleep for people with MS by making lifestyle adjustments. Starting with good sleep hygiene can be a great place to start. Good sleep hygiene refers to day and nightly habits that help maintain a regular sleep-wake cycle. A healthy sleep routine consists of:
Preserving a peaceful environment in the bedroom
keeping the bed as a private place to sleep and have sex
Sleeping and rising at the same time every day
A nightly routine that includes relaxing activities like reading or taking a warm bath should be established.
Screens should be turned off an hour before going to sleep
Participating in regular physical activity15 in the early hours of the day
Taking care of one’s health by eating healthily
Incorporating regular morning exposure to natural light
Limiting intake of alcoholic beverages, caffeinated beverages, and tobacco products
Sleeping earlier in the day is preferable.
People with MS need to pay particular attention to a few specific areas of their bedtime routine. Because many MS patients are sensitive to heat16, keeping the bedroom at a slightly cooler temperature is especially crucial to facilitate sleep and avoid exacerbating their symptoms. Even if you don’t drink coffee or alcohol before bedtime, you may want to cut down on your fluid consumption in the hours before you get into bed, and go to the bathroom shortly before you go to sleep.
Sleeping on a pressure-relieving foam mattress can help minimize the risk of bedsores17, as can using a pillow to cushion sensitive regions. Asking a sleeping partner to assist you in changing your sleeping position may help you obtain a better night’s sleep. If you’re having trouble sleeping, it’s a good idea to chat to your bed companion about a solution.
When anxiety and depression are keeping you awake at night, you may benefit from cognitive behavioral treatment for insomnia (CBT-I). It’s possible that your doctor can prescribe medication for relieving nighttime symptoms if it’s still difficult for you to sleep. You may also be prescribed medicines like vitamin D or melatonin to assist balance your sleep-wake cycle, despite the lack of clear evidence.
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