Sleep disorders are common in multiple sclerosis. Poor quality sleep can lead to daytime complaints of malaise, fatigue, muscle aches, weakness, poor memory and cognitive problems. There are many diverse causes of sleep disorders and bringing the problem to the attention of your physician is important. Spending time and effort in determining the cause or contributing factors of poor sleep quality may result in and improvement of the overall quality of life, a decrease in medication use, and a sense of enhanced physical energy and cognitive abilities.
Commonly seen sleep disorders can be classified as difficulty falling asleep (insomnia) or awakening frequently throughout the night (sleep interruptions) secondary to other problems.
Below is a list of common conditions associated with insomnia that can be treated once identified.
Insomnia
Behavioral:
Poor and irregular sleep habits cause the body’s sleep-wake cycle to be poorly regulated.
Stress, Depression, Anxiety, Panic:
Poor sleep caused by these symptoms results in an increase of them, setting up a cycle that may need to be broken with
treatment.
Drug dependency:
Addiction to drugs and/or alcohol is a common risk when insomnia is ongoing. This must be addressed and treated.
Medications, Fatigue treatments, Caffeine:
Caffeine and many medications, including those that treat fatigue, stimulate the brain and are notorious for promoting
insomnia. Careful consideration of continued use of these substances is warranted.
Shift work:
There are known protocols for inducing sleep if the person
works irregular hours, and these steps should be implemented.
Gastric reflux:
Symptoms of acid or gastric reflux occur when a person lays down to go to sleep. The epigastric distress will awaken the
person thus bringing on insomnia. A health care provider can recommend the appropriate treatment.
Sleep Interruptions
Nocturia:
Excessive urination at night results in frequent sleep interruptions. Treatments can include the use of medications to limit bladder overactivity and limiting evening fluid intake. The use of the antidiuretic hormone, DDAVP, can limit how much urine is made at night, thus lessening the frequency of urination.
Spasms / Spasticity:
Intense spasms or spasticity can occur during sleep. Medications such as baclofen, Zanaflex™, or clonazepam can alleviate this situation, thus improving comfort and sleep quality.
Restless legs syndrome:
This is a common inherited movement disorder among the general population, characterized by excessive leg kicking or “running in bed”. The person’s spouse usually complains about being kicked all night and being unable to sleep. The patient usually complains of leg weakness or fatigue in the morning. Medications often used to treat Parkinson’s Disease, such as Sinemet®, are extremely successful for this condition.
Obstructive Sleep Apnea:
This condition occurs when a person is observed to stop breathing periodically during sleep. When the airway is obstructed to this degree, the individual experiences a loss of oxygen to the brain or other organs. Sharing a room with a snorer can be quite disruptive and results in a multitude of problems, including fatigue. Snoring is a definite sign that a person is at risk for sleep apnea. Treatment is necessary when a person is observed to stop breathing periodically at night. The body’s protective systems will awaken the person briefly, causing sleep interruptions. A patient’s sleep disturbance may be related to excessive snoring by their spouse. Treatment approaches are best determined by the results of a sleep study and the opinion of a sleep specialist.
In summary, if you have a sleep disturbance impacting your daytime well being it is prudent to “diagnose the cause”, then “treat the cause”.