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Sleep Problems are Often Associated with Multiple Sclerosis

Treatments offer help to combat sleep issues and related fatigue.

By Ben Thrower, M.D.
Medical Director, MS Institute at Shepherd Center

If you have multiple sclerosis (MS), are you tired of being tired? Fatigue is one of the most common complaints for people with MS, and many list it as their most bothersome symptom. Fatigue may be a direct result of MS itself, but it may also result from medication side effects, other health problems or disrupted sleep.

In regard to sleep, a 2014 study published in the Journal of Clinical Sleep Medicine found a surprising 70 percent of people with MS suffer from at least one sleep disorder. Let’s look at the different ways in which sleep may be affected by MS.

Many MS symptoms have the potential for preventing a good night’s sleep. Bladder issues and spasms come to mind as prime candidates for messing up one’s sleep. A common bladder symptom seen with MS is the small, overactive bladder. This leads to frequent urination along with a sense of urgency. These frequent trips to the bathroom may lead to disrupted sleep and daytime fatigue.

Treatment might focus on medications (such as Detrol, Ditropan, Toviaz, Vesicare, Oxytrol and Myrbetriq) to help the bladder relax and give more time between voiding. Another option is a medication at bedtime called Desmopressin, or DDAVP. Taken by mouth or as a nasal spray, this drug tells the kidneys to back off on urine production through the night.

Muscle spasms can also lead to disrupted sleep. These frequently involve the legs and may range from curiously annoying to dramatically painful. The first line of defense against muscle spasms is a good stretching program. If that is not enough, then we look at medications such as Baclofen, tizanidine or clonazepam. These medications are sometimes sedating, making them ideal for use at bedtime.

People with MS may describe symptoms sounding like restless leg syndrome (RLS). Sorting out true RLS from spasticity-related symptoms is not always easy. If drugs like Baclofen, tizanidine and clonazepam are not of help, then Requip, a drug for RLS, may be in order.

As mentioned, the majority of people with MS report at least one sleep disorder. The authors of the 2014 study found obstructive sleep apnea in 38 percent, moderate to severe insomnia in 32 percent and RLS in 37 percent. Among the study participants, only a small minority was under medical care for their sleep disorder.

Obstructive sleep apnea can be diagnosed with an overnight sleep study and is usually treated with a CPAP, a device worn over the nose and mouth.

In the absence of nocturnal symptoms that may disrupt sleep or obstructive sleep apnea, some people with MS may require a sleep aid. As with any medication, the risks and benefits of drugs like Ambien, Lunesta and Restoril need to be discussed.

So, as we think about how to fight fatigue in MS, don’t forget about a good night’s sleep.

For more information on treatment available at the Andrew C. Carlos MS Institute at Shepherd Center, click here.

BEN THROWER, M.D., is the medical director of the Andrew C. Carlos MS Institute at Shepherd Center in Atlanta. He previously served as the medical director of the Holy Family Multiple Sclerosis Institute in Spokane, Wash. In Spokane, he was the chair of the Inland Northwest Chapter of the NMSS. In 2000, he was awarded the Norm Cohn Hope Chest Award by the National MS Society, recognizing his work with the MS community. In 2005, he was the first physician inductee into the Georgia Chapter of the National MS Society Volunteer Hall of Fame. Dr. Thrower is a clinical instructor of neurology at Emory University and participates actively in clinical research. He serves on the board of directors of the Georgia Chapter of the National MS Society and has served on the board for the Consortium of Multiple Sclerosis Institutes.

About Shepherd Center

Shepherd Center provides world-class clinical care, research, and family support for people experiencing the most complex conditions, including spinal cord and brain injuries, multi-trauma, traumatic amputations, stroke, multiple sclerosis, and pain. An elite center recognized as both Spinal Cord Injury and Traumatic Brain Injury Model Systems, Shepherd Center is ranked by U.S. News as one of the nation’s top hospitals for rehabilitation. Shepherd Center treats thousands of patients annually with unmatched expertise and unwavering compassion to help them begin again.