Fatigue and Sleep

Fatigue is one of the three most frequently disabling symptoms of MS (129) and may be considered abnormal in as many as 78% of patients (130,131). A particular feeling of enervation, severe enough to prevent a patient from carrying out duties and responsibilities or to interfere with work, family, or social life, occurs (132). This specific, but poorly understood, type of fatigue in MS must be distinguished from symptoms of depression, medication side effects, consequences of other medical conditions such as anemia, hypothyroidism, or simple physical tiredness. No definitive explanation for fatigue in MS has been established. One type of fatigue, so-called handicap fatigue, is characterized by the requirement for an increased effort to perform routine tasks. This may be a consequence of the fact that nerve conduction in demyelinated fibers is susceptible to exhaustion, rate-dependent block, and conduction block with increased temperature.

Alternatively, patients with MS may experience the so-called systemic fatigue, which they describe as chronic lack of energy, tiredness, or malaise that are often sufficiently severe to prevent activities at home or work. Similar chronic lassitude is a common feature of a number of inflammatory diseases, suggesting that it may be due to the effects of soluble immune mediators on the CNS. Objective studies have provided little support for an alternative suggestion of an autonomic basis for fatigue. The MRI abnormalities typically seen in MS do not correlate with fatigue, but some recent studies suggest that a relationship may exist between cortical function and fatigue.

The prevalence of sleep complaints was three times greater in a group of MS patients than in controls. Sleep complaints were associated with greater levels of depression. In addition, several lesion sites subserving supplementary motor areas were related to the sleep complaints. The authors speculated that such lesions might be related to the production of sleep-disturbing nocturnal spasms (133).

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