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Saturday, January 12, 2013

Treating Sleep Problems in Multiple Sclerosis: An Update

In the current edition of journal Acta Neurologica Scandinavica, researchers presented a comprehensive up to date literature review on the clinical assessment and management of sleep disorders in multiple sclerosis. Multiple sclerosis (MS) is a condition in which people develop multiple areas of abnormal patches (also known as plaques or sclerosis) in the brain and/or spinal cord (depending on the stage of the illness).

There are many others conditions that co-occur with MS, including sleep disorders. The most common sleep disorder in MS is insomnia but others are present as well such as hypersomnia (conditions that causes excessive sleepiness), sleep-related movement disorder (e.g., restless leg syndrome), sleep-related breathing disorders (e.g., sleep apnea), parasomnias, and circadian rhythm disorders. Sleep apnea is a disorder in which the person does not breathe for periods of time while sleeping. Parasomnias are abnormal and unnatural behaviors, feelings, perceptions, or dreams that occur while sleeping, falling asleep, awakening, or between sleep stages. Circadian rhythms are internally controlled biological processes (e.g., sleep) over a 24-hour period.

It is important for doctors to assess for and treat these sleep disorders because they can negative affect the quality of life and functioning for patients with MS. In fact, in their literature review, the authors found that sleep apnea caused by obstructions in MS patients was associated with significant morbidity and mortality (disease and death).  This is why when patients with MS complain of fatigue and daytime sleepiness, a sleep study is recommended by the authors as a matter of routine. However, fatigue in MS can have many other causes such as depression (which is also common in MS) or as a result of the MS-disease process itself.

Common treatments for insomnia and obstructive sleep apnea include techniques that do not involve medications. For insomnia, one example of this is cognitive behavioral therapy (CBT), in which the patient is taught how to change their feelings by altering the way he/she thinks. This, in turn, can improve sleep. In obstructive sleep apnea, a common treatment in continuous positive airway pressure (CPAP) in which a mask is fitted over the face at night so a continuous pressurized airflow can be provided to the body. The authors note, however, that in some cases, a different treatment approach (e.g., steroid treatment) may be needed for patients in which a lesion (abnormal area) is present in the brain that is associated with the particular sleep disorder. Determining if this is the case requires detailed investigation.

Suggested reading:
Say Good Night to Insomnia

Related blog post: Improving Sleep in Intensive Care Units

Reference: Lunde HM, Bjorvatn B, Myhr KM, Bø L. (2013). Clinical assessment and management of sleep disorders in multiple sclerosis: a literature review. Acta Neurol Scand Suppl., 196, 24-30. The article is freely available here.

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