Sleep and quality of life in multiple sclerosis

Abstract

In multiple sclerosis (MS), an autoimmune inflammatory disease of the central nervous system (CNS), the myelin sheet insulating the axons is destroyed. This diminishes the electric conduction within the CNS. The exact pathologic mechanism responsible for the development of demyelinating plaques and axonal damage is still unclear. MS is probably a heterogeneous disease where different pathogenetic mechanisms are of importance (1, 2). We know from clinical evidence that demyelinization is mediated by autoreactive T-cells, and furthermore, certain hereditary and environmental factors seem to make certain individuals more susceptible to MS than others. In the MS population, sleep disturbances are three times more common as compared to the general population and MS patients are twice as likely to have reduced sleep quality (3, 4). MS-related sleep disorders can be subdivided into primary sleep disorders and secondary sleep disorders. The most common primary sleep disorders seen in patients with MS are insomnia, nocturnal movement disorders, sleep-disordered breathing, narcolepsy, and rapid eye movement behavior disorder (5-7). Secondary sleep disturbances can result from a clinical variety of symptoms seen in MS. Sleep disturbances, depression, and fatigue are often co-existing in MS and thereby influence and intensify each other. Identification of them is very important, because appropriate treatment will improve the symptoms itself, improve quality of sleep, and diminish fatigue. Altogether this reduces disability and will provide patients with a better quality of life (QOL). MS has a substantial negative effect on QOL, even when compared with other chronically ill patients (8). This is probably due to its unpredictable and most often progressive disease course. As a healthcare provider for MS patients, it is important to aid patients in maintaining social activity, employment, and regular exercise. All these factors are important for the improvement of patients' well-being. As attitudes toward MS and ways of coping with this unpredictable disease are vital to the experienced QOL, psychological support toward the acceptance of having MS is essential. Through maintaining a reasonable QOL institutionalization of those with MS may be delayed. © 2008 Humana Press, Totowa, NJ.