Multiple Sclerosis

Multiple sclerosis can disrupt sleep. Muscle spasticity, facial pain, or tingling sensations may make finding a comfortable sleeping position difficult. Many people with MS also have trouble controlling their movements and cannot change sleeping positions easily. Furthermore, they may often awaken to use the bathroom, leading to less sleep and reducing time spent in deep sleep. Medications and a lack of exercise due to disabilities can contribute to insomnia. Other MS symptoms such as anxiety, depression, restless legs, pain, urinary or bowel symptoms, and temperature dysregulation disrupt sleep.

Disordered sleep can, in turn, can worse multiple sclerosis. Fatigue, for example, can stem from abnormal melatonin levels and pro-inflammatory cytokines, both regulating sleep or an underlying sleep disorder.

What we offer at Sleep and Brain

At Sleep and Brain, we conduct a detailed clinical history and specialized physical examination to evaluate if a sleep disorder co-exists with multiple sclerosis. Disordered sleep may result from a specific brain or spinal cord lesion. We prudently assess for sleep disorders as exampled below:

  • Insomnia

    • Pain, discomfort, sleep disorders, nighttime urination, and napping due to fatigue can contribute to insomnia.

  • Circadian Rhythm Sleep Disorders

    • Abnormalities in melatonin production in people with multiple sclerosis can disrupt the body’s natural sleep-wake cycle and lead to insomnia, daytime sleepiness, or both.

  • Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD)

    • People with RLS experience tingling sensations that cause an irresistible urge to move their legs, while those with PLMD experience limb movements during the night. RLS and PLMD can lead to sleep onset and maintenance difficulties.

  • Sleep-Disordered Breathing

    • The most common type of sleep-disordered breathing is sleep apnea, in which a person suffers disrupted sleep due to multiple lapses in breathing. Sleep apnea can particularly occur in MS patients who have brainstem lesions.

  • Narcolepsy

    • MS lesions in the lateral hypothalamus, responsible for regulating wakefulness, can lead to narcolepsy.

  • REM Sleep Behavior Disorder

    • As we dream during rapid eye movement (REM) sleep, our bodies typically experience atonia or paralyzation of the muscles. In REM sleep behavior disorder, this function is faulty, leading patients to act out their dreams, sometimes in violent or dangerous ways. REM sleep behavior disorder seems to occur more often in MS patients with brainstem lesions.

Multiple sclerosis can result in sympathetic nervous system dysfunction. We may recommend sensitive home sleep testing with peripheral arterial tonometry to quantify your sleep patterns and evaluate sleep-disordered breathing and sympathetic arousal frequency.

Laboratory sleep testing, performed in your home, may be necessary to evaluate additional sleep disorders. Many individuals with multiple sclerosis, for instance, experience restless legs syndrome.

We offer sophisticated testing to elucidate areas of brain imbalance. A brain map pinpoint which brain areas are hyperactive and hypoactive and assess which networks between brain areas are improperly functioning. Together, the data allows us to determine if the brain imbalances support a diagnosis of anxiety, fatigue, sleepiness versus something else like concussion.

Understanding the cause of you or your child's sleep problems is essential to customize a treatment regime for both the sleep disorder and multiple sclerosis. Treating sleep problems may improve multiple sclerosis because, as mentioned, disordered sleep symptoms can mimic and exaggerate multiple sclerosis symptoms. We direct treatment toward the sleep disorder as exampled below:

    • Removing the tonsils, expanding the palate, and starting CPAP can help headaches and disordered sleep symptoms.

    • Iron and dopamine deficiencies can cause RLS and PLMD. We treat RLS with iron supplements, medication, and non-medication therapies.

    • Identifying and eliminating the cause of awakenings from sleep

    • Utilizing light therapy to advance or delay your sleep cycle

In addition to treating an underlying sleep disorder, we institute robust sleep hygiene interventions, as partly described below, to make going to bed a pleasant experience and reduce anxiety:

  • Ensuring your bedroom environment is conducive to sleep

  • Eliminating sources of sleep interruption like light and noise

  • Optimizing your diet as food can promote and hinder sleep

  • Assessing your nighttime habits and rituals

Our scientifically-based cognitive-behavioral therapy for insomnia therapy is a rigorous, 4-week program is vital to treat insomnia.

A state of hyperarousal, frequently marked by worry, is a critical factor of insomnia. CBT-I reduces negative thoughts about going to bed, a type of anticipatory anxiety that challenges healthy sleep schedules. Even after falling asleep, you may awaken with anxiety in the middle of the night. CBT-I reorients negative thinking and helps you return to sleep when your mind races with worry. We also utilize relaxation techniques as part of our CBT-I to reduce anxiety and make it easier to fall asleep quickly and peacefully. Guided imagery, deep breathing, and mindfulness meditation are just a few approaches to putting your mind at ease and improving your sleep and anxiety.

TMS Multiple Sclerosis MS Fatigue

Brain TMS has advanced into treating fatigue and sleep disorders such as insomnia. We personalize a TMS protocol based on your unique brain map.

Several medication classes treat anxiety, including anti-anxiety drugs, antidepressants, and beta-blockers. However, these medications mitigate symptoms rather than cure the underlying cause. We judiciously use medications to treat an identified underlying cause.