Email this pageAging Well with Muscular Dystrophy and Sleep Problems
By researchers at the University of Washington's Rehabilitation Research and Training Center
Physical and other factors that affect sleep
Getting a better night’s sleep may not always happen overnight, but if your sleep problems are due to medical causes or issues, there are ways you can manage them. Many medical problems can disrupt sleep in people with muscular dystrophy, such as breathing problems (sleep apnea, for example), muscle spasms or stiffness, and pain. A brief overview of common physical reasons for sleep problems is below.
Sleep apnea
Sleep apnea is when there is reduced airflow or breathing during sleep. Symptoms can be mild or dangerous. On the dangerous side, people can often stop breathing for short time during sleep. Sleep apnea occurs for different reasons.
Problems can develop because air passage ways are blocked or narrowed (called obstructive sleep apnea). Obstructive sleep apnea is often caused by weak lung and throat muscles, from being overweight, or because bones in your head, neck, and chest interfere with breathing. Another type of apnea is “central” and means that there are problems with how your brain and nerves sends signals to the muscles responsible for breathing. There is often a mix of complications involving both muscles and the brain in sleep apnea.
Because there are the different treatments for each type of sleep apnea, a doctor will need to diagnose the type. Examples of treatments include lifestyle changes (losing weight and exercising), surgeries to “clear-up” obstructions in the mouth and throat, and breathing devices like continuous positive airway pressure (CPAP) machines. Please consult your primary care doctor or muscular dystrophy specialist to discuss these options. Your doctors will often recommend seeing specialized sleep doctors or therapists.
More information about sleep apnea and its causes and treatments can also be obtained from The National Heart, Lung, and Blood Institute (NHLBI) by calling 301 592 8573 or at: http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_WhatIs.html
Muscle problems
In addition to problems with the muscles that affect breathing, people with sleep problems often report muscles that are tight, itchy, jerky, or painful. One common problem is called Restless Legs Syndrome (RLS).
RLS occurs when people have a strong urge to move their legs when they lie down or sit. Symptoms are described as creeping, crawling, tingling or burning. When people move their legs, they often feel better, but the relief does not last long.
People also can have sudden muscles movements or spasms in their leg and arm muscles. Symptoms can include mild muscle stiffness to severe and painful muscle spasms.
Some of the symptoms associated with restless leg syndrome and movements in the legs can be improved by mild exercise, relaxation techniques, and stretches. Medications are also available to help. Your sleep doctor or muscular dystrophy specialist can help you develop ways to treat your symptoms.
Pain
Another large and complex part of sleep problems is pain. And, because sleep problems caused by pain are a large topic, we will discuss how to deal with the effects of pain on sleep as a separate issue in a future column.
Other factors that can disrupt sleep include medication issues, which we discuss briefly below and will discuss more in depth in a future column. Anyone with sleep problems should look closely at the following factors that can disrupt sleep:
Stimulants
Caffeine
Caffeine often plays a role in sleep problems. Caffeine is a stimulant that affects the central nervous system. It temporarily increases alertness and wards off drowsiness, but can also contribute to poor sleep. People who drink caffeine are less likely to sleep well than those who do not, and so caffeine may be contributing to your sleep problems. If you have sleep difficulties, it is a good idea to avoid caffeine or limit it only to the morning. Caffeine is present not only in coffee and black tea, but also in many sodas, so check labels. Decaffeinated coffee and tea are good substitutes if you like the flavor of these drinks, but need to avoid caffeine.
Nicotine
Nicotine, whether smoked or chewed, is a stimulant like caffeine. It causes temporary alertness or “jitteriness” and speeds up the metabolism. These physical changes can in turn keep you from falling asleep or disturb your sleep once you’ve fallen asleep. For these reasons and more, it can contribute to sleep problems. (Just another reason to quit!)
Sedatives
Alcohol
Alcohol is a sedative. Although it may seem like alcohol helps with sleep problems, it can actually cause them. For example, alcohol can help you to “fall asleep,” but it also disrupts the sleep cycle and the quality of sleep. The sleep you get after drinking alcohol is not restful. It is a good idea to avoid alcohol altogether if you have sleep problems; at a minimum, you should limit drinking to earlier in the evening rather than right before going to bed.
Sleeping pills
Even though they are often prescribed to help people fall asleep, sleeping pills can actually cause more sleep problems over time. Many sleeping medications can help you fall asleep however most disrupt the sleeping cycle so you do not actually get restful sleep. Almost all sedatives are recommended only for a very short time (about two weeks at most) to help someone sleep during a stressful time or while in the hospital. Many sleep medications are also addictive and your body builds up a tolerance to them, especially benzodiazapines such as Valium. If you are taking a strong sedative for sleep, you should talk to your doctor about tapering it. Getting off these drugs must be done gradually and with medical supervision. Stopping abruptly can be very dangerous.
Ideas to improve sleep
The list above is only a small picture of the problems that can affect sleep. But these and other lists are important to help you and your doctors understand why your sleep problems may occur. By understanding the cause of the problem, your doctor will be able to treat your symptoms better. Examples of things to help you sleep better are:
Exercise
Getting regular exercise and being aerobically fit can contribute to good sleep. Fitness helps the body naturally create healthy sleep cycles. However, people with sleep problems may want to limit exercise to the morning, since vigorous exercise late in the day may make it difficult for your body to start winding down for sleep. If you have sleeping problems and are not exercising, starting an exercise program with advice from your doctor or physical therapist may help.
There are many important factors to discuss with your doctor and therapist before starting an exercise program. Symptoms of muscular dystrophy vary from person to person and amongst family members. Important screening tools used by your doctors to develop an exercise plan may include measurements of your heart health, breathing ability, strength of your joints and other factors. Finding the correct exercise program and tailoring this to help your sleep is often a very good way to stay healthy and get a good night’s rest!
Medications
Unlike sedatives, medications generally prescribed for depression can improve sleep and help you get back into a more normal sleep cycle. Although stimulants can cause more problems for individuals with having trouble sleeping, stimulants can be effective for individuals with excessive daytime sleepiness. These medications may have side effects so it is important to discuss all treatments with your doctor and pharmacist.
We will describe other sleep-related issues, such as pain and ways to manage its symptoms, and medication issues in future columns. We welcome your feedback on the information presented in this column and ways to improve our understanding of sleep problems in older adults and people with muscular dystrophy. Thank you and hope you have a good night’s rest!
Previous highlights from the University of Washington
Please click on the link below for more information about the Rehabilitation Research and Training Center (RRTC) from the research team at the University of Washington.
Sleep problems (June 2009)
Overview of the RRTC and aging well with muscular dystrophy (March 2009)
The contents of this column were developed under a grant from the Department of Education, NIDRR grant number H133B080024. However, those contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government.
Last Reviewed and Updated 10/08/2009
