A big part of cognitive difficulties stems from fatigue. This is why it is important to address fatigue in a comprehensive manner. Fatigue may be caused by sleepiness because of poor sleep hygiene, sleepiness from a sleep disorder (such as obstructive sleep apnea), medication induced sleepiness, exhaustion from inefficient use of the strength you have and MS related fatigue.
Occupational therapists can work with you to develop a plan for energy conservation and more efficient use of your energy resources. Staying cool (such as with cooling vests or even a cold drink of ice water) can help reduce the chances of fatigue from overheating. A sleep study (polysomnogram) may be needed to diagnose a separate sleep disorder, such as obstructive sleep apnea. Obstructive sleep apnea is a condition where you gasp for air while sleeping and do not have a full night of sleep because of micro-awakenings from lack of breathing. Hints to this condition may be snoring, drooling and nighttime gasping for air. Often people with obstructive sleep apnea do no not realize that they are waking up throughout the night, but their partners may be aware of this (this is another reason why good communication is a great idea). A daytime nap study (called a Multiple Sleep Latency Test; MSLT) may help to diagnose narcolepsy (a sleep disorder where people fall asleep suddenly and which causes fatigue).
Besides associating the bedroom with sleep, and not eating or television watching, relaxation techniques may be useful to create an environment of sleepiness. Some people take a warmish shower or bath an hour before bedtime. As the body cools, we become sleepier and this can lead to falling asleep and, hopefully, to a better and more restorative sleep. Other people exercise an hour to an hour and a half before bedtime. Remember, however, not to exercise too close to bedtime as it can make you more alert and less likely to fall asleep.
Neurologists will complement these techniques with various anti-fatigue medications, such as:
- Modafinil (Provigil®)
- Vitamin B12
- CNS stimulants (the ADHS medicines, like Ritalin®)
At the University of Florida Jacksonville, we are studying a complementary and alternative (CAM) herbal medication called ashwagandha for the treatment of MS related fatigue. Once this study is completed, we will make the results available to you.
We also use the anti-dementia medications, such as anticholinesterase treatments and memantine to try to fight the memory problems associated with MS. This works for some people with MS, however others do not have as great a success. We then turn to other off label treatments, such as the use of pioglitazone. Pioglitazone (Actos®) is an FDA approved medication for the treatment of diabetes which has interesting properties which suggest that it may be useful in treating the cognitive symptoms of MS.
Finally MS researchers are focusing on the invisible symptom of cognitive problems. This is a right step in the direction of conquering one of the most disabling and under-recognized MS symptom.