Is your MS fatigue caused or made worse by a sleeping disorder?
There are about 80 different types of sleep disorders, and about 25% of people (that’s 70 million Americans) suffer from them. The inability to fall asleep or to stay asleep, called insomnia, is the most common. Multiple Sclerosis (MS) is well represented in the Sleep Disorders department.
On her “good” nights, she awoke as frequently as every hour; on the worst ones she lay awake until breakfast.
Sleep problems are common in MS, but are somewhat under recognised. In a study from the UK, as many as half of the patients with MS (of varying severity) studied had some sleep-related problem. The commonest was insomnia, usually related to spasm, pain, immobility, bladder problems, or medication. It has also been felt that periodic leg movements may be more common in MS. Besides these relatively common problems, there are more than a few case reports of some unusual or rare sleep disorders in MS.
MS patients have pain, depression and anxiety all of which can cause insomnia However, most Insomnia is Psychophysiological- that is related to a pattern of sleep difficulties that is not specifically due to a physical trigger or a recurrent identifiable cause. This is true in MS too.
Sleep disorders are twice as prevalent among MSers than non-MSers. These disorders can be sleep-related movement disorder, nocturia (frequent visits to the bathroom), tinnitus (ringing in the ears), obstructive sleep apnea or OSA (tissues of the throat interfere with breathing), central sleep apnea or CSA (brain slows down regulation of breathing), REM sleep behavioural disorder (person acts out dreams during sleep), and narcolepsy (falling asleep unexpectedly and at inappropriate time). Throw in the usual MS symptoms, such as numbness, tingling, spasms, pain, and it’s no wonder that sleep becomes an issue for many of us.
Sometimes, unco-ordination in breathing, which is more common in MS than in those without it, can worsen the upper airway obstruction which is the major cause of OSA. In MS, the central control of breathing can be impaired due to plaques in the brain stem. This can cause Central Sleep Apnea. MS patients, like many others can have combinations of OSA and CSA when tested in an overnight Polysomnogram (PSG).
All of these can be operative in Multiple Sclerosis, the most common being OSA which is the leading cause of Excessive Daytime Sleepiness in the vast majority of people with or without a concurrent disease.
Improving your sleep
Is there anything we can do to make these sleep problems better? Try some of the following tips.
- Do not nap during the day.
- Do not consume caffeine within 4-6 hours of bedtime
- Do not smoke or use nicotine products close to bedtime or during the night.
- Do not drink alcoholic beverages within 4-6 hours of bedtime.
- If the need to use the bathroom is keeping you up at night, reduce fluid intake in the evening. It is still important to drink the recommended amount of fluids during the day. Also go to the bathroom immediately before you go to bed.
- Do not go to bed hungry or soon after a heavy meal. If you are hungry, eat a light snack or drink a glass of warm milk.
- Exercise regularly, preferably during the day. Avoid vigorous exercise 3 hours before bedtime.
- Set your alarm to wake up at the same time every day, even on days when you’re off work and on the weekends.
- If you have sleepless nights and lie in bed until it seems like the sun is coming up get back up if you have not fallen asleep after 10 to 15 minutes. Find something to do that is relaxing to you, such as putting together a puzzle, reading, or writing a letter to a friend.
- Rather than watching TV, which is a passive activity, do something active so that natural tiredness can build up–although you should avoid physical activity when trying to become sleepy.
- I’ve been told “Remember that your bed is only for sleeping. Any of the above activities should be done in another room, not your bedroom. Return to the bedroom only when you feel tired.” But personally I much prefer to stay warm in bed as I try things to tire me out.
Finally these relaxation techniques can help you fall asleep or improve your sleeping patterns:
- Repetitive mental exercises. Close your eyes, and silently repeat a word or short phrase. Let your breathing become slow and steady. Repeat the phrase for 10 minutes until you feel more relaxed.
- Visualization. Imagine that you are in a peaceful environment, such as lying on a beautiful beach, relaxing and taking in the rays.
- Progressive muscle relaxation. You can mentally put each part of your body to sleep by tensing and relaxing your muscles. People with spasticity should be careful because this exercise could trigger muscle spasms.
Here’s hoping there’s a way to make things better. If you have your own technique please leave a comment and share it with others.
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[...] process – we learn something new every day. Today, we read an interesting article from A Voice for MS that quoted a UK study which found sleep disorders are twice as prevalent among those with [...]