Fatigue during the day and sleepless nights are prevalent concerns for Multiple Sclerosis (MS) patients globally. Sleep disturbances in MS individuals can exacerbate symptoms and impair cognitive function (inability to think, remember, and solve). Insomnia, restless leg syndrome, and sleep apnea- common in the general population, are more prevalent in MS patients. Various factors contribute to sleep deprivation in MS, including medication side effects such as to corticosteroids, stimulants, and disease-modifying therapies. For instance, alemtuzumab, a disease-modifying therapy, has been associated with insomnia. Corticosteroids, frequently administered during relapses, often induce insomnia and daytime sleepiness. They are administered to MS patients commonly for relapses for 3-7 days at a time and fortunately, sleep irregularities persist only in the window of the week of administration. Stimulant medications used to manage fatigue in MS can also lead to restless nights such as modafinil, amantadine, and methylphenidate.
Fatigue during the day and inability to exercise due to immobility in MS patients further compound sleep disturbances. Dysregulation of neurotransmitters, particularly dopamine and norepinephrine pathways, contributes to the struggle. Also, neurohormone melatonin has an important role in managing sleeping and wake cycles; lower levels of melatonin are associated with MS relapses and a poor sleep quality. Insomnia affects approximately 90% of MS patients and can stem from nocturnal symptoms like muscle spasms, urinary frequency, and pain disrupting sleep patterns. Restless legs syndrome and neuropathic pain, prevalent in ½ of MS patients, also contribute to sleep disruption along with temperature dysregulation. Finally, an overlooked factor of a restful night of sleep is Vitamin D: Vitamin D deficiency, common in MS, correlates with sleep issues.
Emerging treatments for sleep disturbances in MS include short-term use of sedatives like benzodiazepines, although their long-term physiological effects are a concern. Continuous positive airway pressure (CPAP) therapy, utilized for sleep apnea, and bright light therapy, effective for seasonal affective disorder, offer relief for MS patients with irregular sleep cycles. As research continues to alleviate the issues caused by decreased sleep in MS patients, researchers are looking for new and innovative technology to improve their quality of rest.
Works Cited
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https://nms2cdn.azureedge.net/cmssite/nationalmssociety/media/msnationalfiles/brochur es/brochure-sleep-disorders-ms-basicfacts_final.pdf. Accessed 2 March 2024. “Common Sleep Disorders and Multiple Sclerosis - Multiple Sclerosis Centers of Excellence.” VA.gov,
https://www.va.gov/MS/Veterans/symptoms_of_MS/Common_Sleep_Disorders_and_Mul tiple_Sclerosis.asp. Accessed 2 March 2024.
De Milto, Lori. “Sleep tight.” Momentum Magazine,
https://momentummagazineonline.com/sleep-tight/. Accessed 2 March 2024.
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