Sleep Disorders or ADHD
Fatigued? A Sleep Disorder Could be to Blame
Sleep-disordered breathing such as obstructive sleep apnea could add to the fatigue of living with multiple sclerosis. Learn more about MS and sleep disorders.
By Madeline R. Vann, MPH
Medically Reviewed by Pat F. Bass III, MD, MPH
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If you have severe fatigue that makes managing your multiple sclerosis difficult, new research published in the journal Multiple Sclerosis International suggests a sleep study might be warranted. A sleep study will help determine if you're one of the many with MS and sleep-disordered breathing.
Sleep-disordered breathing includes conditions such as sleep apnea that interfere with breathing consistently and deeply during sleep. People suffer with fatigue and daytime sleepiness as a result. Treatments such as the use of a CPAP (continuous positive airway pressure) machine at night could reduce that fatigue and help you get the sleep you need.
MS and Sleep Problems
An earlier 2012 study done at the University of Michigan surveyed approximately 200 MS patients about their sleep and revealed that among people with MS.
"We found that 21 percent of patients carried a diagnosis of obstructive sleep apnea, and over half of all patients surveyed were found to have an elevated risk for obstructive sleep apnea,” explained Tiffany J. Braley, MD, study author, neurologist, and assistant professor of neurology at the University of Michigan Multiple Sclerosis and Sleep Disorders Centers in Ann Arbor.
Dr. Braley said that, while the relationship between the two conditions is not well understood, people with MS might be at greater risk for sleep-disordered breathing because of the effect of MS on the central nervous system, the impact of medications on sleep, and the relationship between obesity and increased rates of sleep-disordered breathing.
Braley and her team found that people with MS and fatigue were likely to have sleep-disordered breathing and that as MS progressed — particularly as it began to affect the brainstem — the risk of sleep disorders increased.
These findings are important because physicians don’t always think of sleep-disordered breathing as a possible cause of fatigue in MS patients. Instead, they might test for anemia or depression, or simply write off fatigue as MS-related.
The Surprise of MS and Sleep Disorders
Doctors aren’t alone in overlooking sleep disorders. Patients themselves might not think they have sleep problems.
“I can assure you that when my neurologist told me that I should have a sleep study, I said 'I don’t have sleep problems,' ” recalled Alan Mandel, 65, the Pittsburgh-based executive director of the site MS World.
Mandel learned that he had multiple sclerosis in 1995. In the early 2000s, he realized he was feeling profound fatigue during the day. His neurologist, Rock Heyman, MD, chief of the division of neuroimmunology and director of the Multiple Sclerosis Center at the University of Pittsburgh Medical Center, suggested the sleep study. To Mandel’s surprise, after a night wired up in the sleep lab, he went home with a diagnosis of sleep apnea and a prescription for CPAP.
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“It changed my life. It made the fatigue go way, way down,” said Mandel. He had to try some different masks, which are used with the machine during sleep, before he found one that fit his face correctly. He also repeated the sleep study about five years ago, which resulted in some adjustments to the CPAP machine’s settings.
Looking back, he said that finding out he had sleep apnea made sense in light of his wife’s periodic complaints about his snoring and noted that a CPAP machine benefits spouses, too — they, too, can sleep undisturbed by any snoring.
Mandel acknowledged that he still experiences some fatigue, but it has a different feel — more of a whole-body exhaustion compared to the fatigue caused by disordered sleep. For ongoing fatigue that's most likely due to multiple sclerosis, he can take medication such as modafinil (Provigil).
Assessing the Likelihood of MS and Sleep Disorders
One way to figure out if your fatigue is a part of multiple sclerosis or due to a sleep disorder is to assess your feelings when you first get up. Do you generally wake up feeling as if you slept well, or are you still tired?
“In my typical MS fatigue patients, they wake up rested, but run out of gas in an hour or two. When a patient has non-refreshing sleep, there is something impairing their sleep quality,” said Dr. Heyman, who agrees with the research recommendation that more MS patients be given referrals for sleep studies.
Besides fatigue and snoring, signs that you might have a sleep disorder include reports from your partner that you seem to stop breathing in your sleep, profound daytime sleepiness, dozing off in quiet moments, gasping upon awakening, or waking up with a sore or dry throat.
Figuring out what's causing your sleep issue might be an ongoing process, said Heyman. For example, a CPAP machine worked well for Mandel, but might not be the solution for everyone.
Your first step is working with your doctor to explore whether your fatigue could be due to problems with sleep. If necessary, push for a referral to a sleep specialist so that a simple sleep study can help answer that question and get your energy level back on track.
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