People with multiple sclerosis (MS) have a higher risk of sleep apnea, which disrupts sleep and may contribute to fatigue.

MS is an autoimmune condition where the immune system attacks the protective covering of the nerves in the central nervous system, which comprises the brain and spinal cord. This causes the progressive loss of muscle function. Up to 60% of people with MS experience at least one sleeping disorder.

Sleep apnea is common among those with MS. In sleep apnea, a person temporarily stops breathing while sleeping. This can occur often throughout the night, leading to insufficient oxygen flow and sleep quality issues.

This article explores the possible link between MS and sleep apnea. It also discusses whether sleep apnea causes fatigue in people with MS.

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Experts do not yet completely understand the relationship between MS and sleep apnea.

The Multiple Sclerosis Foundation describes how changes in brainstem function in those with MS may play a role. The brainstem controls muscles that keep the airways open and allow breathing during sleep. In MS, demyelinating lesions, which affect the nerve coverings, can develop on the brainstem, impairing how those muscles work.

A person with MS may be at higher risk of sleep apnea if they experience difficulties with swallowing and producing speech. They may also be at risk if they have brainstem lesions observable on an MRI.

These factors indicate that MS is affecting a person’s brainstem.

Sleep apnea reduces sleep quality and contributes to fatigue in people with MS.

A 2019 study concluded that obstructive sleep apnea (OSA) is prevalent among those with MS and increases the risk of fatigue and more severe disability.

Cognitive impairment is common in people with MS, with up to 70% experiencing problems with thinking, information processing, memory, and verbal expression. These difficulties are also common in those with OSA, suggesting that sleep quality issues are a major cause.

Learn more about MS fatigue.

A person with sleep apnea has breathing that starts and stops during sleep. They may gasp after periods of not breathing and have frequent and loud snoring. Someone with apnea may only be aware of these symptoms if another person observes them as they sleep.

They may also experience:

  • excessive daytime tiredness that interferes with daily functioning
  • dry mouth
  • headaches
  • waking up frequently to urinate throughout the night

If a person with MS suspects they have sleep apnea, they should seek a doctor’s advice.

People with MS may be at higher risk of sleep disturbances for the following reasons:

  • People with MS may lack vitamins and nutrients that help regulate sleep.
  • Medications for MS, such as disease-modifying drugs, corticosteroids, and stimulants, may impair sleep.
  • There may be reduced physical activity due to disability.
  • People with MS may nap during the day due to fatigue.
  • A person may experience stress, anxiety, or depression.
  • Individuals may experience other MS symptoms, such as urinary or bowel issues, pain, restless legs, and temperature dysregulation.

Doctors often recommend using a continuous positive airway pressure (CPAP) machine for sleep apnea. This involves a person wearing a mask over the nose or mouth during sleep, and the machine delivers a continuous stream of air to their airways to keep them open. The CPAP is usually effective in reducing sleep apnea and improving sleep quality.

There is no cure for MS, but several therapies are available that may slow the disease’s progression or reduce the severity of the condition and how often someone relapses. Some treatments also work to reduce symptoms relating to MS.

Read about natural treatments for MS.

Lifestyle modifications may help decrease the risk of sleep apnea.

Maintaining a moderate weight is important in reducing the risk of sleep apnea or OSA.

It is also important to limit alcohol intake and stop smoking, if applicable. Alcohol can relax the muscles of the mouth and throat and cause OSA. Smoking causes throat and upper airway inflammation, which may affect breathing and cause sleep apnea.

Steps to improve sleep include:

  • going to bed and waking up at the same time each day
  • limiting the consumption of caffeine to the morning
  • limiting alcohol use
  • creating a relaxing bedtime routine
  • limiting fluids right before bed
  • making the bedroom cool, quiet, and dark
  • not watching TV or using a digital device in bed

Sleep disturbances, such as sleep apnea, are common in people with multiple sclerosis. Developing lesions on the brainstem may make people more susceptible to developing sleep apnea. Other factors, such as medication side effects, may contribute to disturbed sleep.

Sleep apnea reduces the quality of a person’s sleep and can lead to daytime fatigue and cognitive challenges. Treatment with a CPAP machine may help people sleep better.

Making certain lifestyle choices, such as avoiding alcohol and smoking and maintaining a moderate weight, can help reduce a person’s risk of sleep apnea.