Might Fatigue, Falls, Cognitive Dysfunction, and Depression in MS Be Treated by CPAP in the Future?
Positive airway pressure—represented as either CPAP, for continuous PAP; BiPAP, for bilevel application of PAP therapy; and APAP or AutoPAP, for automated PAP—consists of using a mask to deliver pressurized air generated by a small machine during sleep.
PAP, a noninvasive therapy, is considered the gold standard treatment for those with various kinds of sleep-disordered breathing (SDB) concerns; namely, sleep apnea (obstructive, central, or mixed apnea).
How might PAP therapy help people with MS?
Sleep apnea and MS are conditions which share a number of common symptoms.
Also, it's understood that people with MS are considered to be higher-risk candidates for SDB (such as sleep apnea).
By identifying and treating a previously undetected case of sleep apnea using PAP therapy, a person with MS may find the relief they need for the following symptoms.
According to researchers in the published article, "Recent studies that have included a relatively small number of participants have highlighted the potential beneficial role of treatment of SDB with continuous positive airway pressure (CPAP) to reduce fatigue in people with MS."
With fatigue being the most common symptom across the board for all people with MS, it seems worth it to explore this option further.
Why? PAP therapy is nonpharmacological (it doesn't require a person to take a pill or a shot). It's also extremely effective and very safe to use.
The researchers looked at links between cognitive function and OSA in people with MS.
One small study found an association between functions (such as attention span, verbal memory, response inhibition, working memory, and sleep quality parameters) and certain measures of SDB. These include blood oxygen desaturations and respiratory disturbances.
How this can correlate to MS is simple: The odds of a person with MS also suffering from sleep apnea are considerable.
Since using PAP therapy has been shown to improve these problems with cognitive function in people with sleep apnea, it makes sense.
When left untreated, cognitive dysfunction can become disabling and lead to job loss and loss of independence. However, someone with MS who also identifies and treats their sleep apnea with PAP therapy is far more likely to experience great improvements in these areas, allowing them to stay in the workforce and live independently.
Another common symptom in people with MS, depression occurs in about 20 percent of people with MS (annually), but its lifetime prevalence has been shown to be as high as half of all people with MS.
From the Australian study comes a recommendation to research the relationship between MS and depression as scientists already know there is a two-way link between sleep and the brain that can result in higher depression risk for those who have poor sleep.
Unfortunately, insomnia and disrupted sleep are big problems for many people with MS; however, on the bright side, use of PAP therapy for those with both MS and sleep apnea has been shown to improve these symptoms dramatically.
While the previous concerns are related to functions regulated by brain behaviors, falls suggest a physical characterization of neurological disorder among people with MS.
As many as 60 percent of people with MS fall at least once within a random six-month period, often seeking medical care as a result.
The causes of these falls point to problems with loss of balance, use of assistive devices, leg weakness, impaired gait, and vision problems, as well as the aforementioned fatigue and cognitive dysfunction.
It is thought by the researchers in the Australian study that poor sleep might be partly to blame for these reasons for increased fall risk.
For instance, young people with MS have significantly greater problems with "postural sway," a measure of balance, when they become sleep deprived. For those who experience daytime sleepiness, scores from the Epworth Sleepiness Scale of >10 show an independent risk factor for falling.
Other small studies show an increased risk for altered gait patterns and postural instability in people with MS who also experienced sleep apnea. While scientists still need to identify the mechanisms that link poor sleep to fall risks, it's suspected that a combination of MS and sleep apnea may, together, lead to this fall risk increase overall.
Since it is possible to successfully treat sleep apnea using PAP therapy, researchers think that, for those who suffer from both MS and sleep apnea, use of this therapy could provide a significant decrease in fall risk.
Do you have to have both sleep apnea and MS to benefit from PAP therapy?
Currently, use of PAP therapy is only indicated as a treatment for SDBs. However, research also shows that the likelihood that a person with MS also has sleep apnea is fairly high.
Many people with MS experience fatigue, cognitive dysfunction, dangerous falls, and depression. It might be only from the MS, but chances are good these problems are caused by a combination of these disorders (except for a tenuous connection between posture problems and sleep apnea).
If you have both condition, the odds are likely you'll have a more severe experience with them. The good news: a single therapeutic approach, PAP therapy, may be the most effective, non-drug approach for addressing all of these concerns.
This study suggests more research might bear out the possibility of using PAP as a first-line therapy for addressing several of these MS symptoms, regardless of one's sleep health or SDB status. We can expect to see more research in this arena as a result.
If you believe you have poor sleep, a sleep study might be useful to rule out (or in) a previously undetected case of sleep apnea as a means for getting satisfactory treatment that can address all of these symptoms, whatever the cause.
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