Poor Sleep Common in MS, Linked to Fatigue, Depression, and Anxiety, Study Reports

Poor Sleep Common in MS, Linked to Fatigue, Depression, and Anxiety, Study Reports

Poor sleep quality is very common among patients with relapsing-remitting multiple sclerosis (RRMS) or clinically isolated syndrome (CIS), and is associated with a lower quality of life, and greater fatigue, depression and anxiety, according to a real-world study in patients treated with Betaferon (interferon beta-1b).

The study, “Sleep quality, daytime sleepiness, fatigue, and quality of life in patients with multiple sclerosis treated with interferon beta-1b: results from a prospective observational cohort study,” was published in the journal BMC Neurology.

Sleep issues, which can affect quality of life, disease severity, and flare-ups, are common in MS patients. Accordingly, fatigue, which is closely related to sleep disturbances, occurs in nearly 80 percent of MS patients.

Although the precise causes of impaired sleep and increased fatigue have yet to be found, scientists believe that restless legs syndrome — discomfort in the legs and an irresistible urge to move them — may play an important role. The type of MS treatment is also thought to be a key factor, but evidence supporting this link is still lacking. Studies conducted to date have been small and included patients on various treatments, which may introduce variability in medication effects.

Aiming to address these questions, researchers conducted the BETASLEEP study (NCT01766063), sponsored by Bayer. The prospective trial was conducted in Germany and assessed sleep quality, fatigue, quality of life, and coexisting conditions over two years in MS patients taking Betaferon — known as Betaseron in the U.S. and marketed by Bayer — in a real-world setting.

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The study enrolled 139 adults with RRMS or CIS from December 2012 to January 2015. CIS is a neurological episode lasting at least 24 hours, characterized by inflammation and loss of myelin (the protective layer of nerve fibers), often preceding the development of MS.

Participants were evaluated at the study’s start, or baseline, and at six, 12, 18, and 24 months. Treatment with Betaferon did not last more than six months.

A total of 128 patients, at a mean age of 41.5 years, of whom 71.1% were women, were available for full analysis; 89.1% had RRMS, and 10.9% had CIS. They had a median Expanded Disability Status Scale (EDSS) score of two, meaning minimal disability in one of the body’s eight functional systems.

Of the patients who quit the study, 35.3% were lost to follow-up, 23.5% withdrew consent to participate, 13.7% switched to another therapy, and 27.5% discontinued for other reasons.

The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality in 106 patients. Of these patients, 62 of 93 RRMS patients and nine of 13 CIS patients were poor sleepers at the study’s start.

The proportion of poor sleepers, indicated by a PSQI score of five or higher, decreased by the end of the study to 37.7% versus 55.47% at the beginning. The team attributed this to the decreasing number of patients with an evaluable sleep score throughout the study, although stable disease course achieved with Betaferon could also be a contributor.

Fatigue — measured by the Modified Fatigue Impact Scale (MFIS) — was higher in poor sleepers than in good sleepers at all study visits. Poor sleepers also showed worse scores on physical and mental components of a health assessment (Short Form-36), depression and anxiety (Hospital anxiety and depression scale), and daytime sleepiness (Epworth Sleepiness Scale) throughout the study.

All six patients diagnosed with restless legs syndrome at the study’s start (four at final visit) were poor sleepers. The proportion of patients with this condition was much lower than in previous research. The team noted that restless legs syndrome may be under-reported, but short disease duration could explain this low prevalence.

Of note, the prevalence of depression (15.4-22.7%) and anxiety (25-34.9%) was lower than in prior studies, a finding possibly explained by lower (better) disability scores, the researchers hypothesized.

The data further showed that poor sleepers had lower MS Functional Composite — measuring leg and hand function, as well as cognition — and a higher, or worse, EDSS disability score at most visits.

PSQI and MFIS scores showed a strong positive correlation, meaning the greater the sleep impairment, the higher the fatigue. A similar strong to moderate link was found with low health status, indicating a lower quality of life.

Links between sleep quality and anxiety, depression, and daytime sleepiness were weaker, but still statistically significant.

Daytime sleepiness and poor sleep quality at the beginning of the study were possible predictors for sleep quality at one year of follow-up. However, there was no variable that predicted sleep quality at the two-year follow-up.

“Taken together, our study confirms the high prevalence of poor sleep quality among patients with MS,” the team wrote. “The results highlight the importance of interventions targeted at improving sleep quality in patients with MS.”

Of note, the lack of a control group prevented an evaluation of the Betaferon effect. However, the medication was used to provide stable treatment conditions, not to analyze its effects on sleep and fatigue, the scientists said.

Six of the seven study authors are former or current employees at Bayer.

José is a science news writer with a PhD in Neuroscience from Universidade of Porto, in Portugal. He has studied Biochemistry also at Universidade do Porto and was a postdoctoral associate at Weill Cornell Medicine, in New York, and at The University of Western Ontario, in London, Ontario. His work ranged from the association of central cardiovascular and pain control to the neurobiological basis of hypertension, and the molecular pathways driving Alzheimer’s disease.
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José is a science news writer with a PhD in Neuroscience from Universidade of Porto, in Portugal. He has studied Biochemistry also at Universidade do Porto and was a postdoctoral associate at Weill Cornell Medicine, in New York, and at The University of Western Ontario, in London, Ontario. His work ranged from the association of central cardiovascular and pain control to the neurobiological basis of hypertension, and the molecular pathways driving Alzheimer’s disease.
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  1. Gardenlady says:

    I find this article absolutely silly. It is well known that people with MS have pain, bladder issues, and anxiety which can keep them up at night. It’s a vicious cycle. Then of course you’re fatigued due to lack of sleep.
    Why do we keep repeating studies on things we already know?

  2. GARY SHAMBLEN says:

    I’ve experienced the restless leg, except it went all over me. Fentanyl patches for pain helped for a while. I can see how anyone with RL could get into drug abuse. Regarding sleep, it’s still hard for to shut down at night. I don’t take naps. I used to sleep about an hour and wake up wide awake after going to bed. Due to extreme pain I received a pain pump. Afterward the RL ceased. I imagine that Cannabinoids would produce similar results although I’ve tried them.

    • Lynda Strecker says:

      AMEN to that, Laurie HYNTER! And, they keep saying how now they can predict who will probably be diagnosed with MS. WHO CARES? Find a CURE!

  3. Ruth says:

    I agree with Gardenlady. I don’t take any type of MS Prescriptions dealing with injections. I was diagnosed in 2002. My physician told me to do my research which I did and found Low Dose Naltrexone. My symptoms in 2002 was I slept all night but was very fatigued during the day. My physician contacted Dr. Bahri at Mayo Clinic who was treating his MS pts with this compounded medicine. I tried it starting at 3mg hcl and worked up to 4.5mg within 3 months. I became a new person. Years went by and spasms started to effect me so I am on baclofen which I feel don’t help at all. I started to use Salonpas patches and heating pad with relaxation. I am 65 and last year and a half I wake up couple times during the night. Sometimes for a bathroom run which healthy aging people do and other times I just wake up and I am wide awake for some reason. I just lay back down and try to use self hypnosis and other methods I have researched to put myself back to sleep. It usually works. If not I take naps during the day instead of fighting the tiredness which for me gives me a second wind at a time I don’t need it which is bedtime. So if I am having the same problem as patients taking injections where is the scientific facts for my case which I suffer with same symptoms. Now I will say this. My sons Veterans doctor at hospital suggested to get a sleep study done. The VA did a study as to why so many of their pts have diabetes. The study found out majority of pts had sleep apnea, my son being one of them. He was put on CPAP machine and his numbers came down dramatically. He was told by putting on weight as he did and a lot of people do this can effect their sleep. He is now sleeping thru the night, taken off one script and is working on totally reversing his diabetes. VA claims many people can be living with a sleep disorder that can effect daily life and health problems. It would be great to see the MS researchers do a study on sleep apnea and MS.

    • Bryan says:

      I found this information to be just what I experience in my fight for a good night’s sleep. I have restless leg syndrome and insomnia. I rest in the afternoon for two hours to help me feel rested for the evenings.I came up with my own solution to help me get some sleep. I use Marijuana just before bed, some would say, “not very conventional” but it works for me for the past 20 years and both of my doctors have no objections but they don’t endorse the practice. You have to do what works for you, conventional or not.

      • Bryan, Since I live in NY, I am able to get med. marijuana which does help w/sleep and spasticity. My neurologist agreed that med marijuana would be effective. That was when I was using a bong, before it was legalized. Good luck and keep pushing for legal med mar.

  4. TH says:

    I also agree with Gardenlady. I’ve had MS for over 30 years, have bladder/bowel issues for sure, minor walking difficulties, but more concerning for me are cognitive issues and work. I’m 54 and feeling increasing worried about my work life. I’d much rather see more studies on cognitive functioning in MS, and how this impacts overall quality of life, especially work life. We already know how MS can cause depression, anxiety, fatigue and that these can effect sleep.

  5. Trish says:

    I have RRMS BUT was also diagnosed with RLS years ago from a sleep test my neurologist gave me because I was always exhausted & extremely fatigued. Lyrica works very well (75 mg am / 150 mg pm) but I recently went off it because wanted to lose the extra 12 lbs it caused me to gain and I was not happy being constipated. Doc was thrilled but I’m now suffering with horrible leg (& torso) twitches, keeping me awake, etc.
    He prescribed a muscle relaxer (Tizanadine) which I take maybe once or twice a week when I can’t bear it anymore. Nothing works better than Lyrica… but I don’t want to be fat & constipated. I already take a couple handfuls of pills a day, for all the other stuff.

  6. KT says:

    Honestly, the best thing I’ve done for my MS is to use Cannabis edibles for sleep. It used to be impossible for me to get even 5 hours of deep sleep – and that got much worse with my worsening MS symptoms. Fast forward to now, almost 2 years later, and I consistently get 8-9 hours of deep restorative sleep every night. Waking up pain free every day starts each day right. Of course, MS pain creeps in throughout the day, but to start pain free has been such an improvement in my quality of life. I hope medicinal Cannabis will be accessible to everyone very soon.

    • Lee Hudelson says:

      Thanks KT. Can you describe the type of cannibus that is effective for you? CBD to thc %. I currently use a liquid 50-50 medical grade cannibus but tend to wake up too early.


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