Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48 Page 49 Page 50 Page 51 Page 52 Page 53 Page 54 Page 55 Page 56 Page 57 Page 58 Page 59 Page 60 Page 61 Page 62 Page 63 Page 6426 msfocusmagazine.org If you have MS, chances are that you have experienced at least some problems with your sleep. Up to 60 percent of people with MS experience at least one sleep disturbance. One of the most common sleep problems experienced by everyone – those with MS and without – is a disorder known as obstructive sleep apnea (OSA). Obstructive sleep apnea occurs when the upper airway partially or totally collapses during sleep, leading to a diminished or complete blockage of airflow, despite an effort to breathe. As the body strugglestorestoreairflowthroughtheblockage, you partially awaken and sleep is interrupted. Another, less known, form of sleep apnea is known as central sleep apnea (CSA). Unlike OSA, CSA arises because of a lack of effort to breathe during sleep. Both conditions can lead to poor sleep quality and decreased blood oxygen levels throughout the night. For reasons not yet fully understood, MS patients are at a higher risk for both OSA and CSA than those without MS. Early research suggests MS patients may be at higher risk for these conditions because of changes in brainstem function caused by MS. The brainstem controls muscles that keep the airway open when we sleep, as well as our drive to breathe when we are not awake. In MS, demyelinating lesions can form in the brainstem, disrupting the pathways that control upper airway muscles and respiratory drive. Several medications that are commonly used in MS may also worsen each of these conditions. Medications that are used for muscle spasticity, sedatives, and certain opioid-based pain medications may all contribute to obstructive or central apnea severity. Aside from MS, other physical characteristics that may put patients at higher risk for OSA include obesity, increased neck size, age of more than 50, and male gender. Certain anatomical features in the upper airway, including a large tongue and narrow palate can also contribute to OSA risk. Although people with MS may be at higher risk for OSA or CSA, OSA is far more common. Up to 50 percent of those with MS may suffer from OSA; yet most individuals with sleep apnea are undiagnosed, and therefore, untreated. It is therefore imperative that you know the symptoms and risk factors associated with OSA, and discuss them with your doctor, to prevent the many short- and long-term consequences of sleep apnea. Fatigue and cognitive impairment The consequences of sleep apnea, and OSA in particular, are far reaching. Some of the most common consequences that affect MS and non-MS patients alike include and increased risk of cardiovascular disease (high Symptom Management Sleep Apnea and MS By Tiffany Braley, M.D.