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MS research update - How common are sleep problems in MS? - 8 September 2014

Summary

Previous research has found that people with MS have more sleep problems than the general population. This study aimed to look at how common sleep problems were and if they were related to levels of depression, anxiety and quality of life.

137 people with relapsing remitting MS (RRMS) in Lithuania took part in the study. The participants completed several questionnaires to gather information on sleep and several other factors, including depression and anxiety that may have an impact on sleep.

The results showed that sleep problems were common, affecting 45% of participants. Women had more sleep problems than men. Women felt more sleepy and drowsy in the daytime and they had less adequate sleep, despite sleeping for more hours a night and also snoring less than men. Sleep problems were also significantly more common in men and women over the age of 45.

The study also found a relationship between sleep problems, depression, anxiety and quality of life. However the study design meant it could not be determined if the sleep problems caused the depression and anxiety or the other way around.

The authors suggest that further research is needed, especially to investigate sleep disorders in people with progressive MS.

Background

Previous research has found that people with MS have more sleep problems than the general population. Depression and anxiety are also common in people with MS. Because the link between sleep, mood and quality of life is not clear in MS, this study aimed to look at how common sleep problems were and if they were related to levels of depression, anxiety and quality of life.

How this study was carried out

137 people with relapsing remitting MS (RRMS) in Lithuania took part in the study. 99 women and 38 men were studied and all were aged between 18 and 74.

The participants completed several questionnaires to gather information on sleep and several other factors that may have an impact on sleep. These were:

  • A questionnaire to collect socio-demographic information such as age gender, place of residence, education and disease duration.
  • The Medical Outcomes Study Sleep scale (MOSS) – collects information on sleep and sleep problems.
  • Hospital Anxiety and Depression Scale (HADS) – determines the levels of anxiety and depression the person is experiencing. The participant is asked to rate how they are feeling on a scale of 0-3 in response to statements like 'Worrying thoughts go through my mind', 'I can laugh and see the funny side of things' and 'I feel tense or wound up'.
  • SF-36 – assesses health related quality of life. It is divided into eight sections covering aspects of physical and mental health. A higher score indicates a higher quality of life.

What was found

Sleep problems were found in 45% of participants, these included difficulty dropping off to sleep, insomnia and breathing problems. Women had more sleep problems than men. Women felt more sleepy and drowsy in the daytime and they had less adequate sleep despite sleeping for more hours a night and also snoring less than men. Sleep problems were also significantly more common in men and women over the age of 45.

The study also found a relationship between sleep problems, depression, anxiety and quality of life.

What does it mean?

The results showed that sleep problems were common in people with RRMS, the authors conclude that this fits in with previous research in this area. Although there was a relationship between sleep problems and depression and anxiety but the design of the study meant it could not determine if the sleep problems caused the depression and anxiety or the other way around.

The authors suggest that further research is needed, especially to investigate sleep disorders in people with progressive MS. They recommend that health professionals include evaluations of sleep and treatment of sleep problems in their contact with people with MS, as this may help improve depression, anxiety and quality of life.

Leonavicius R, Adomaitiene V.
Features of sleep disturbances in multiple sclerosis patients.
Psychiatr Danub. 2014 Sep;26(3):249-255.
abstract
Read the full text of this paper

More about sleep

Poor sleep is common in people with multiple sclerosis. Poor sleep quality and quantity can impact on daily life, causing daytime sleepiness, decreased concentration and memory, worsening depression, and the inability to work effectively. A lack of sleep can also lead to low energy levels or make fatigue and other symptoms of MS worse.

There can be many reasons why getting good quality sleep can be difficult. Some are well known: a new baby can mean you are up and down throughout the night or worries playing on your mind can make it difficult to 'switch off' resulting in trouble dropping off or a restless night.

Some MS related symptoms can also make sleeping difficult or interrupted. These include: spasms, pain (neuropathic or musculoskeletal), high levels of daytime fatigue and nocturia (the urge to urinate frequently at night). In such cases sleep quality can often be improved by treating the symptoms. Many treatments are available, including medications some of which have the dual advantage of treating the symptom as well as having a sedative effect, such as gabapentin used to treat neuropathic pain and spasms in MS.

Sleep quality can also be improved by following a routine, as your body and mind will become used to these regular habits.

  • Try to stay as physically active as possible during the day, but avoid getting overtired by doing too much, as being too tired can make it difficult to get to sleep.
  • Avoid unnecessary stress or stimulants (eg caffeine, chocolate, alcohol) in the late afternoon and evening.
  • Establish a bedtime routine such as having a warm bath or a warm drink before you go to settle down and try to follow the same routine every day of the week
  • Wind down before it is time to sleep. Avoid rushing around or vigorous exercise just before bedtime and write a to do list for the following day to clear your mind of distractions.

You can read more suggestions for improving sleep in the A-Z of MS.

Research by topic areas...

Assessment tools

Brooks JB, Jardim MR, Papais-Alvarenga RM, et al.
There is still a role for the blink reflex in the diagnosis and follow-up of multiple sclerosis.
Clin Neurophysiol. 2014 Aug 19. [Epub ahead of print] 
abstract

Strober L, Chiaravalloti N, Armstrong J, et al.
C-11Utility of the ten item personality inventory (TIPI) in multiple sclerosis (MS): what can 10 items tell us?
Arch Clin Neuropsychol. 2014 Sep;29(6):576. 
abstract

Causes of MS

Wesnes K, Riise T, Casetta I, et al.
Body size and the risk of multiple sclerosis in Norway and Italy: The EnvIMS study.
Mult Scler. 2014 Sep 2. [Epub ahead of print] 
abstract

Disease modifying treatments

Miller AE, Wolinsky JS, Kappos L, et al.
Oral teriflunomide for patients with a first clinical episode suggestive of multiple sclerosis (TOPIC): a randomised, double-blind, placebo-controlled, phase 3 trial.
Lancet Neurol. 2014 Sep 2. [Epub ahead of print] 
abstract

Hu X, Seddighzadeh A, Stecher S, et al.
Pharmacokinetics, pharmacodynamics, and safety of peginterferon beta-1a in subjects with normal or impaired renal function.
J Clin Pharmacol. 2014 Sep 4. [Epub ahead of print] 
abstract

Other

Ghafari S, Khoshknab MF, Norouzi K, et al.
Spousal support as experienced by people with multiple sclerosis: a qualitative study.
J Neurosci Nurs. 2014 Oct;46(5):E15-24. 
abstract

Turekca S, Schultheis M, Sunderaraman P.
Comparison of driving performance, cognition, and physical symptoms in individuals with multiple sclerosis and healthy controls.
Arch Clin Neuropsychol. 2014 Sep;29(6):570. 
abstract

Other treatments

Adamczyk-Sowa M, Pierzchala K, Sowa P, et al.
Influence of melatonin supplementation on serum antioxidative properties and impact of the quality of life in multiple sclerosis patients.
J Physiol Pharmacol. 2014 Aug;65(4):543-50.
abstract
Read the full text of this paper (PDF)

Physical activity

Lamers I, Cattaneo D, Chen CC, et al.
Associations between upper limb disability on the different levels of the international classification of functioning, disability and health in people with multiple sclerosis.
Phys Ther. 2014 Sep 4. [Epub ahead of print]
abstract

Feys P, Bibby BM, Baert I, et al.
Walking capacity and ability are more impaired in progressive compared to relapsing type of multiple sclerosis.
Eur J Phys Rehabil Med. 2014 Sep 2. [Epub ahead of print]
abstract

Leone C, Patti F, Feys P.
Measuring the cost of cognitive-motor dual tasking during walking in multiple sclerosis.
Mult Scler. 2014 Sep 1. [Epub ahead of print] 
abstract

Cohen JA, Krishnan AV, Goodman AD, et al.
The clinical meaning of walking speed as measured by the timed 25-foot walk in patients with multiple sclerosis.
JAMA Neurol. 2014 Sep 1. [Epub ahead of print] 
abstract

Provision of care

Knies AK, Golla H, Strupp J, et al.
A palliative care hotline for multiple sclerosis: a pilot feasibility study.
Palliat Support Care. 2014 Sep 5:1-8. [Epub ahead of print]
abstract
Read the full text of this paper

Symptoms and symptom management

Brown D, Galusha J, Hughes S, et al.
Impact of sleep quality, depression, daytime sleepiness, and fatigue on cognition in multiple sclerosis.
Arch Clin Neuropsychol. 2014 Sep;29(6):559-60. 
abstract

Sandry J, Wylie G, DeLuca J, et al.
The temporal onset of cognitive fatigue in multiple sclerosis.
Arch Clin Neuropsychol. 2014 Sep;29(6):558. 
abstract

Work

Cadden M, Merritt V, Ukueberuwa D, et al.
Comprehensive examination of factors contributing to employment status in multiple sclerosis.
Arch Clin Neuropsychol. 2014 Sep;29(6):559. 
abstract

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