Despite the prevalence of sleep disorders in the general adult populations, recently published studies provide compelling data that the pervasiveness of sleep disorders is exacerbated in individuals with multiple sclerosis (MS).
Up to 40 percent of MS patients may have chronic insomnia.
There are several reasons why someone with MS may have a hard time getting a good night’s sleep. These symptoms can all disrupt sleep:
Some medications frequently used by patients with MS, including stimulants, serotonin reuptake inhibitors and beta-interferon, may also contribute to insomnia.
Additional evidence suggests that people with MS are at high risk for sleep apnea and restless leg syndrome.
Inability to get a good night’s sleep can cause daytime sleepiness and fatigue in MS patients.
Fatigue is one of the most common and important symptoms of MS.
Assessment and treatment of sleep disorders is a significant component of MS fatigue management, with doctors and nurses addressing sleep disrupting symptoms and medication issues, psychologists helping with psychological factors and sleep hygiene, and sleep medicine consultations when indicated.
Considering the scope of the problem, there has been surprisingly little research published on treating insomnia in MS.
There have been no published pharmacotherapy trials for MS insomnia.
Currently, there are two studies at the EvergreenHealth Neuroscience Institute exploring a relatively new therapeutic approach that modifies the sleep/wake regulatory mechanism controlled by the neuropeptide, orexin. One of these studies is in MS.
Orexin, also called hypocretin, regulates arousal, wakefulness, and appetite.
The most common form of narcolepsy, in which the sufferer briefly loses muscle tone (cataplexy), is caused by a lack of orexin in the brain.
However, the timely blockade of orexin may promote sleep.
Suvorexant (Belsomra®) which is approved the FDA for the treatment of insomnia, is a selective antagonist for orexin receptors (OX1R and OX2R).
Suvorexant has been shown to improve sleep efficiency in healthy, non-elderly adults with primary insomnia and it may not pose a risk of physical dependence or rebound insomnia as do the benzodiazepines and non-benzodiazepine soporifics.
Suvorexant is currently under study as a treatment for insomnia in the setting of Parkinsons Disease at the Booth Gardener Parkinsons Care Center at EvergreenHealth.
The MS Center at EvergreenHealth recently launched a study of this orexin antagonist in a 5-week, placebo-controlled, double blind crossover trial.
Appropriate patients have MS diagnosis, meet DSM-5 criteria for insomnia and have significant levels of fatigue.
The study utilizes self-report measures of sleep quality and fatigue and a wearable device to record sleep latency, sleep disruptions, total hours of sleep and daytime physical activity.
We hope to gain preliminary evidence of the effectiveness and safety of suvorexant for people with insomnia, fatigue and MS.
For more information about this study, please call 425.899.5385.
Research is just one component of the services available at the EvergreenHealth MS Center. We offer comprehensive care for people living with MS, from diagnosis through treatment.
Call us at 425.899.5350 to learn more.