Fatigue and Sleepiness in Multiple Sclerosis

Denise,

I hope my next article will be helpful in answering your question. I cannot offer specific medical advice to you but I can tell you in the most general educational sense that the Sleep Apnea of Multiple Sclerosis may sometimes be associated with brain or spinal cord related problems which can influence the type of apnea, excessive daytime sleepiness, quality of sleep or all of these issues. Sleep Apnea in the general population in the vast majority of cases is not associated with brain or spinal cord problems.

Dear Dr. Gross,

Thank you for your quick response to my question.  I find the postings on this site to be helpful, for the medical information as well as the personal stories others relate.  It is important sometimes to know we are not alone, plus sometimes I can pick up some handy tips on how to manage a symptom.

I am not sure if my sleep apnea is related to the MS, but the lack of sleep has got to be aggravating all the symptoms I have, and I believe is a major factor in the number of falls and broken bones I have had in the last few years.  I continue to work with the doctor who runs the sleep/awake clinic and hope for positive results soon.

Thank you,

Denise Coleman

Denise,

Speaking only in the general educational sense, not commenting on your specific case:

1- Again check out my upcoming article. (I don't like the word "blog". It sounds like someone going "blah, blah, blah" or someone with a fog horn.)

2- Narcolepsy can coexist with Sleep Apnea and with Multiple Sclerosis. Any one person can have various forms of Sleep Apnea along with various forms of MS. Increasingly, we are identified "form fruste" Narcolepsy wherein the patient doesn't fulfill classic Narcolepsy symptoms but has a sleepiness tendency with no identifiable cause.

3- Falls leading to bone fractures are not common in either Sleep Apnea or MS. In MS sub-types where there is gait unsteadiness, falling can occur. However, that unsteadiness predisposes to falls without the need to implicate sleepiness.

4- Falls leading to fractures are also not common in Narcolepsy. However, there is a frequently reported aspect of Narcolepsy called Cataplexy. This is sudden loss of muscle tone with collapse to the ground usually from a standing position. It is characteristically precipitated by a reaction to something that startles the person or something that generates an emotional response. A daytime sleep study can help determine whether narcolepsy features are present.

5- These three articles speak to the Narcolepsy/MS intersection. The last one also shows that MS is far from a purely genetic disease since it occurred in only one monozygotic twin (as is the case most of the time). Narcolepsy, like MS, also has a genetic link as it is most often noted in one rather than both identical twins.

Vetrugno R, Stecchi S, Plazzi G, Lodi R, D'Angelo R, Alessandria M, Cortelli P, Montagna P. Narcolepsy-like syndrome in multiple sclerosis. Sleep Med. 2008 Jun 10. [Epub ahead of print] No abstract available. PMID: 18550429 [PubMed - as supplied by publisher]

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No To Hattatsu. 1998 Jul;30(4):300-6.

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 Neurology. 1980 Jan;30(1):105-8. Links