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Is Your MS Fatigue Caused by Hidden Sleep Apnea?

Recent research highlighted in a poster by the American Academy of Neurology arrived at a conclusion that might surprise a good many of us living with MS:1

  • Undiagnosed obstructive sleep apnea (OSA) is common in people with MS (PwMS) who report fatigue.
  • Incidence of OSA in PwMS appears to increase with age.
  • OSA incidence in PwMS increases with higher scores on the Expanded Disability Status Scale (EDSS), but is still common in those with low EDSS scores.
  • OSA is more common in people with a high body-mass index (BMI), low BMI does not preclude OSA.
  • Accurate identification of specific causes of fatigue in PwMS might improve treatment outcomes.

If you have extreme daytime fatigue or sleepiness, MS may not be entirely to blame.

Sleep apnea is common in people with MS

According to Dr. Tiffany Braley (MS Focus Magazine),
“For reasons not yet fully understood, MS patients are at a higher risk for both OSA and CSA [central sleep apnea] than those without MS. Early research suggests MS patients may be at higher risk for these conditions because of changes in brainstem function caused by MS. The brainstem controls muscles that keep the airway open when we sleep, as well as our drive to breathe when we are not awake. In MS, demyelinating lesions can form in the brainstem, disrupting the pathways that control upper airway muscles and respiratory drive.” 2

Is sleep apnea disabling, by itself?

Yes. OSA is considered a condition protected by ADA in the workplace.3

People who have untreated OSA may not be able to perform their jobs, operate machines, or make critical judgments and decisions while at work.

They may also suffer from other comorbid conditions caused by untreated OSA. These include mood disorders, cardiovascular problems, or metabolic conditions like diabetes or kidney disease, among others, and can be as disabling as MS.

Also, people with untreated sleep apnea are nearly 2.5 times more likely to experience a motor vehicle accident. When treated, they reduce their risk of crashes by 70 percent.4

Body-mass index as a factor in sleep apnea

Having MS may mean dealing with physical limitations that make a sedentary lifestyle more likely.

One of the problems of sedentary living for anyone of any age is the likelihood of weight gain and obesity. Both can create the right conditions for developing OSA.

Aging may also bring unwanted weight gain, especially for women following menopause.

Another factor for women with MS may be pregnancy. With the added water weight gain that comes with pregnancy, the odds increase for developing snoring, upper airway resistance, and full-blown sleep apnea. Up to 20 percent of pregnant women develop sleep apnea.5

Age as a factor in sleep apnea

Sleep apnea also becomes a bigger problem as we age, regardless of our general health status. This is due to the loss of “patency,” or tone, in the muscles that operate the muscles of the upper airway. This makes them more likely to collapse during sleep.

However, people of all ages (including children) suffer from sleep-breathing disorders. The notion that sleep apnea is an old person’s disease is just as erroneous as the notion that MS is an old person’s disease.

Catch sleep apnea in the act!

If you’re concerned about daytime fatigue, you may consider visiting your doctor and requesting a sleep study to rule out a sleep disorder.

Ask your MS specialist about this. Many primary care physicians don’t even ask about sleep health. An MS specialist will be more inclined to follow through on a referral if you complain of both sleep problems and daytime fatigue or sleepiness (which can be hard to differentiate).

You may undergo a simple screening or a lightweight home test, depending upon your insurance requirements. However, you might also be asked to take part in a nocturnal polysomnogram (NPSG) at a sleep clinic. Most overnight tests are comprehensive and will catch OSA in the act.

Here’s a tip: If a loved one complains that you snore loudly or gasp in your sleep, and you find yourself waking up several times a night for no apparent reason, these are good indicators that you might need to be screened for this stealthy sleep disorder.

Treating sleep apnea is not only possible, but can be effective for treating other problems. Lowering blood pressure, reducing blood-sugar elevations at night (for those with metabolic conditions), elevating mood, and supplying more daytime energy are some of the benefits of treating OSA.

Remember, not every symptom is caused by MS. Fatigue may be the result of a hidden concern like sleep apnea. Fortunately, OSA is treatable.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Cascone, A. et al. The Relationship between Obstructive Sleep Apnea and Age, Gender, EDSS, Disease Duration, and BMI in People with Multiple Sclerosis Who Report Fatigue: More than Size Matters (S49.002). Neurology Apr 2019, 92 (15 Supplement) S49.002. https://n.neurology.org/content/92/15_Supplement/S49.002.
  2. Braley, T. Sleep Apnea and MS. MS Focus Magazine. Accessed August 2019. https://msfocus.org/Magazine/Magazine-Items/Sleep-Apnea-and-MS.
  3. Sleep Disorder. Job Accommodation Network. Accessed August 2019. https://askjan.org/disabilities/Sleep-Disorder.cfm.
  4. Risk of motor vehicle accidents is higher in people with sleep apnea. American Academy of Sleep Medicine. March 10, 2015. https://aasm.org/risk-of-motor-vehicle-accidents-is-higher-in-people-with-sleep-apnea/.
  5. Dominguez, J., Krystal A., Habib, A. Obstructive Sleep Apnea in Pregnant Women: A Review of Pregnancy Outcomes and an Approach to Management. Anesthesia & Analgesia: November 2018 - Volume 127 - Issue 5 - p 1167-1177.

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