Should All People with MS Be Tested for Sleep Disorders?
As a board-certified sleep technologist (RPGST), I risk being accused of “having a hammer and thinking everything is a nail,” as the saying goes, when I suggest that everyone with MS be screened for sleep disorders.
Demyelinating disease and sleep disorders
Several doctors I interact with point out that people with demyelinating disease commonly live with at least one sleep disorder.
Generally speaking, we all experience certain sleep stages which provide the time and opportunity to heal, but this only happens if we get a full night of undisturbed, quality sleep.1
Having MS plus one or more (potential hidden) sleep disorders means an ideal night’s rest isn’t likely possible (unless the sleep disorder is treated).
Poor sleep leads to fatigue
After all, the person with MS who sleeps poorly is going to suffer fatigue. That’s a given. They might also struggle more with symptoms and flareups. Without adequate sleep, the body and brain aren’t given adequate time and opportunity to repair MS damage. This is also a given (for anyone with a chronic illness, not just for people with MS).2
So it’s not surprising that sleep health professionals think that an overnight sleep study should be a mandatory post-diagnostic therapeutic protocol. How else are we to identify and treat hidden sleep disorders?
But having an opinion is one thing… is there research to support it?
What we know: people with MS have disturbed sleep
A simple peek into the World Wide Web shows research routinely proves a link between MS and sleep disorders (see Veauthier et al., Fleming & Pollak, and the American Academy of Sleep Medicine for a few examples).3-5
The question — whether a person with MS might have a sleep disorder — has already been answered, then: probably.
However, unlike insomnia or daytime sleepiness, which show apparent links to disturbed sleep, some sleep disorders aren’t always apparent.
Two types occur in people with MS:
- Obstructive sleep apnea (OSA) describes the disruptive and lengthy pauses in breathing which accompany snoring.
- Central sleep apnea (CSA) occurs when brain signals to the respiratory system fail to control breathing as one sleeps.
Restless legs syndrome (RLS)
RLS may masquerade as nocturnal leg cramps or paresthesia. Discomfort, tingling, pain, and other sensations at bedtime may not be MS, but this very common sleep disorder. It can lead to long-term sleep debt and daytime fatigue.
Periodic leg movement disorder (PLMD)
This tapping, twitching, or kicking of the legs in distinct patterns during sleep can quickly shortchange a person the stage 3 sleep their brain needs to repair myelin following a flareup.
REM behavior disorder (RBD)
Neurological illnesses are known to be proceeded by this parasomnia, in which one physically enacts their dreams. It’s not the same as sleepwalking (which doesn’t take place during REM sleep). Research confirms its ties to other brain disorders.
MS is the fourth most common cause of narcolepsy, an extreme daytime hypersomnia condition that can bring on “attacks” of irresistible sleep.6
Seasonal affective disorder (SAD)
People with MS often deal with fatigue, insomnia, and mood swings during the winter, but MS isn’t the only cause. SAD is a sleep and mood “hybrid” disorder that disrupts the circadian system, leading to poor sleep, depression and daytime sleepiness.
Why an overnight sleep study?
Some of these conditions can only be identified and confirmed through a formal sleep study.
The good news is that every single one of them is treatable.
While I mentioned I’m a sleep technologist earlier, I didn’t mention that I also have OSA (and, yes, MS).
Prior to my OSA diagnosis, I took modafinil and still ended up taking daily naps. Now that I’ve treated my OSA, I no longer use modafinil and maybe nap once a month. It’s been life-changing.
Naturally, I support the idea that people with MS be referred automatically for sleep studies. I’ve witnessed these realities on the job and first hand.
Recent objective evidence
You’ll not be surprised, then, that I was thrilled to read an article last June in Sleep Medicine which supported the idea of sleep assessments to help people with MS to improve their outcomes.7
From “Sleep quality can influence the outcome of patients with multiple sclerosis,” authors Buratti et al. concluded:
“Assessment of sleep quality could be used to obtain reliable prognostic information in patients with relapsing-remitting MS.”
Screening for sleep disorders
In other words, screening for sleep disorders in people with MS could improve their therapeutic options and improve—maybe even eliminate—some common symptoms of MS (such as cognitive fog or fatigue). An identified and treated sleep disorder allows the brain the rest it needs to heal and remyelinate.
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