b'Symptom ManagementMore recent research offers insight intosleep problems were more likely than non-MS howsleepandMS worktogethertoaffectparticipants to emphasize problematic fatigue, perceptions of cognitive decline. To examinetiredness, and lack of energy, as opposed to this relationship, data from a large dataset ofsleepinessa more commonly recognized women nurses from the Nurses Health Studysignal for sleep problems.were analyzed. The NHS is an observationalFurthermore,inpeople withMSonly, long-term study in which nurses are surveyedreduced sleep efficiency was linked to increased about lifestyle factors and health status everysymptoms of fatigue, suggesting that people two years. In this study of 63,866 nurses (524with MS may be more sensitive to reduced with MS), women with MS were more likelysleep efficiency compared to people without than those without MS to report obstructiveMS. Data from a recently completed trial of sleep apnea, insomnia, and sleepiness.three fatigue interventions on self-rated fatigue Furthermore, insomnia and sleepiness werethat also tracked daily MS symptoms showed each found to partially mediate relationshipsthat previous nights sleep duration was between MS and the self-reported abilityinversely linked to fatigue intensity and fatigue to follow instructions/conversations/plots,interference. People with MS with known or and memory impairment four years later.suspected obstructive sleep apnea have also Obstructive sleep apnea accounted for morebeen shown to exhibit higher levels of fatigue than one-third of the total effect between MSin various other studies. Although more work and the ability to follow instructions four yearsis needed, early trends suggest restless legs latersuggesting sleep disorder as a potentialsyndrome is also linked to MS fatigue.key factor in the relationship between MSPandcognitivedecline. AsinterventionstoPaaiinnaannddsslleeeeppddiissoorrddeerrssdelay cognitive decline in MS may be of thePain affects approximately 50 percent highest yield in early symptomatic stages,of people with MS. Furthermore, sleep these ndings highlight a potential windowdisturbances are closely associated with pain of intervention for sleep-based methods toin MS. Numerous studies have identied pain prevent perceived cognitive decline in MS.as a predictor of poor sleep quality in MS. Faattiigguueeaannddsslleeeeppddiissoorrddeerrss Sleep problems have also been shown to FFatigue affects up to 90 percent of peoplemediaterelationshipsbetweenpainand with MS, and is reported to be one of thedepression in MS. The same data from the mostimportantsymptoms.Anextensivepreviously referenced fatigue trial also showed bodyofworkhasassociatedfatiguewiththat night to night variability in sleep predicts sleep disturbances in people with MS. In apain severity in people with MS, suggesting survey study of 195 people with MS, 46 percentthat pain and sleep may share a bidirectional reported symptoms of insomnia based on arelationship that requires further study. commonly used screening tool, which showedAdditional research that demonstrates sleep strong associations with fatigue. In a separateproblems as a predictor of pain could uncover studyamongpeoplewithMSandpeoplenew sleep-based targets for pain for people without MS, people with MS who had suspectedwith MS.msfocusmagazine.org 16'