The sleep of MS patients is rather less discussed in practice – although sleep disorders are a problem not to be underestimated and are probably more common than is generally assumed. Therefore, I would like to devote a few lines to this topic.According to scientific literature, about 50% of MS patients report an impairment of sleep quality – which is indeed a surprisingly high number. When these patients are examined in a sleep laboratory, a disturbance of sleep architecture, particularly due to increased awakening reactions, is noticeable.
A variety of causes have been identified for this disturbance of sleep architecture. Nighttime pain, especially caused by spasticity, which can lead to awakening reactions, plays a major role. Therefore, it is worth – also to ensure undisturbed night’s sleep – to treat a spastic movement disorder adequately symptomatic (see also blog post on spasticity therapy).
Another factor that can significantly disrupt the continuity of sleep is bladder disorders, which often lead to nocturia. The treatment of bladder disorders is therefore not only a central component of symptomatic MS therapy for infection prophylaxis.
MS patients are often affected by depression. The depression itself causes changes in the sleep structure, especially through the occurrence of sleep initiation disorders. Consistent antidepressant treatment can therefore lead to a significant improvement in night sleep. However, it should be noted that certain antidepressants can also cause sleep disorders. The presence of sleep disorders must therefore be taken into account when selecting a medication.
In recent years, an increased prevalence of restless leg syndrome (RLS) in MS patients has been demonstrated. Lesions in the area of the spinal cord, as well as side effects of medication, are held responsible. As the disease progresses – particularly in patients with chronic MS – an increased occurrence of RLS is observed. RLS is a sleep-related movement disorder characterized by the typical symptoms of a compulsion to move the limbs at rest, worsening in the evening, and (partial) improvement of symptoms through movement. This urge to move and the unpleasant sensations in the extremities lead to sleep initiation and maintenance disorders, so RLS often contributes to fatigue symptoms.
Generally, if RLS is present, caution should be exercised with alcohol and nicotine, as this can intensify RLS. Medication treatment can be carried out with L-Dopa and dopamine agonists, as well as opioids. For MS patients, the use of Pregabalin (Lyrica) should also be advantageous. If RLS is suspected, it is always worth seeing a neurologist and possibly having a sleep medicine examination.
Finally, it should be noted that even unfavorably located inflammatory lesions in the area of the sleep/wake centers of the brain can lead to sleep disorders. Therefore, consistent immunotherapy of MS is also mentioned in the prevention of sleep disorders.
In summary, sleep disorders are a common problem in MS, especially in advanced disease. Sleep disorders can have a variety of causes, some of which are directly related to the underlying disease. Therefore, specifically address your sleep disorders with your neurologist and try to identify the cause of the sleep disorder, possibly with the help of a sleep medicine examination! The treatment and control of sleep disorders can contribute significantly to improving the quality of life for MS patients.
