Everyone experiences a normal level of fatigue every day, be it from overwork, exercise, stress or just the length of a day’s activities. But for those suffering with multiple sclerosis (MS), fatigue seems to be a particularly tough hurdle to clear. In fact, 90% of all MS patients report fatigue as an issue. This had led many physicians to all but ignore the fatigue as being something outside of the normal symptoms of the disease. But in fact, fatigue is not a part and parcel primary symptom of MS as was once thought.
Understanding MS
Multiple Sclerosis (MS) is an autoimmune disease of the central nervous system that affects the communication pathway from your brain to your body. Among the common symptoms are fatigue, numbness and tingling, weakness, walking difficulty, muscle spasms, pain, vision issues and many others. Some symptoms, like fatigue, however are not necessarily a direct cause of the disease. In fact, research shows that sleep deprivation caused by obstructive sleep apnea, pain, muscle spasms, depression and frequent urination may be the cause of fatigue in MS, making fatigue a “secondary symptom”.
Treatable fatigue causes
Fatigue definitely reduces quality of life and one’s future outlook. But when it is combined with other symptoms of MS, it can seem at times that there is no hope for improvement. One must remember, however, that pain is often associated with lack of sleep, as is depression, muscle spasticity, and fatigue.
It is a vicious circle moving in both directions. Lack of sleep causes pain. Pain keeps people awake at night, makes sleep discontinuous. Suffering pain fatigues the body and mind. Depression causes poor sleep, which causes pain, and pain and poor sleep contribute to depression.
The University of Michigan has conducted several studies implicating “sleep disturbances, often related to frequent urination, pain, spasticity, depression, or medications, and primary sleep disorders, such as obstructive sleep apnea (OSA), as common, treatable causes of fatigue in patients with MS.”
Let’s review below information related to each of these, as well as some simple steps one can take to deal with them so they don’t trigger MS flares by triggering the immune system.
Sleep, fatigue and MS
The journal Sleep reported the findings of a study which looked at 30 MS patients and 30 control subjects and found that “decreased sleep efficiency correlated with fatigue, tiredness, and lack of energy in MS patients but not with sleepiness or any symptom among controls.”
In addition, the journal Multiple Sclerosis International published a study looking at sleep and fatigue among 121 MS patients. Their findings were similar to the above study, “…for many individuals with MS, fatigue is associated with poor sleep quality…. Treatment of diagnosed sleep problems should be pursued to reduce fatigue and improve quality of life in people with MS.”
Poor quality sleep directly hampers the body’s ability to repair itself, and contributes greatly to pain levels and day-time fatigue. I previously wrote about the pain-sleep connection here, indicating how over 51% of patients feel they have no control over their pain, 77% report feeling depressed because of their pain, and 86% report an inability to sleep well.
The issue here is not found as a side-effect of MS, but as a contributor to making its symptoms worse by triggering the immune system. That is, by not controlling the ability to sleep soundly and well, the pain and fatigue and depression mount.
I wrote here of five simple ways to get a good night’s sleep. These suggestions are the basic foundation and least that should be done to help this secondary symptom leave the playing field.
Ways to reduce Obstructive Sleep Apnea (OSA)
A study published in the Journal of Clinical Sleep Medicine found that “56% of 195 MS patients were at increased risk for OSA but only 21% had been diagnosed with the condition.” This means that a good portion of MS patients do have or are at risk of OSA, but its diagnosis has not been made, most likely because fatigue complaints are commonly viewed as a normal symptom of MS and further studies on sleep are not being carried out.
Obstructive sleep apnea is a tough one to overcome without a proper diagnosis and some external assistance. The first self-help solution for OSA is for the patient to lose weight (if they are overweight). With weight gain the throat opening becomes smaller as the neck size increases, and so losing weight will reduce this fix-able structural problem.
Another solution used with mixed results is surgery to open the air passageways in the throat, as well as using a CPAP machine, mouth guard or chin strap. After a diagnosis, options can be discussed with the sleep professional.
Pain and MS
Pain is a hallmark of MS, with roughly 80% of patients suffering it daily. And pain is a known cause of sleepless nights. It keep you up or wakes you up, or both. Many MS patients are on protocols of pain and anti-inflammatory or spasticity medications, and these, too, can keep one awake at night.
The best route to keep pain from being an additional burden on sleep is to reduce it naturally, especially at night. Exercising is one way to do this even though it sounds like the opposite approach. I wrote about exercise helping with pain here. Another means clinically proven to reduce pain and spasms in MS patients is engaging in whole body vibration (WBV). With WBV, the whole body undergoes a therapeutic shaking out while standing, sitting and lying down, and now they even have a device that works with wheelchairs. You can read more about this here.
And of course diet plays a role in pain and inflammation and fatigue. Sugar and alcohol sap energy and create a pain response. But if you cook with aromatic spices, you can reduce pain and inflammation naturally and deliciously. Spices like turmeric, capsaicin, and ginger can play a vital role in pain relief, of which I have written more about here.
Conclusion
MS is a difficult disease to manage on its own. Those suffering it need not believe that fatigue is a direct result of MS. They should understand that studies confirm that a high proportion of fatigue that presents with MS is actually a secondary symptom. That is, it is caused by poor sleep. What’s more, that poor sleep is becing caused by things like worry, depression, pain, muscle spasms, and medication used to keep MS patients awake during the day.
By changing, understanding and taking a role in improving sleep quality and duration with a better sleep environment, changing diet, reducing pain and spasm and getting help for depressive thoughts, fatigue need not be another barrier to a fulfilling life for those with MS.
References
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910465/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964892/
http://www.aasmnet.org/jcsm/viewabstract.aspx?pid=29334
