ALS and Sleep

There are several links between amyotrophic lateral sclerosis (ALS) and sleep disturbances. Lack of quality sleep can affect symptoms of ALS during the day. Conversely, sleep disorders can affect disease progression and survival time.

About 70% of people with ALS report having a sleep disorder. But the effects of sleep disorders can look a lot like symptoms of ALS, so they may go unrecognized.

This article discusses the connections between ALS and sleep and treatment options.

The Connections Between ALS and Sleep

ALS and sleep are connected in multiple ways, with one affecting the other. It can become a cycle of sleep problems aggravating ALS symptoms, leading to more sleep problems.

Does ALS Affect Your Sleep?

ALS is an irreversible neurodegenerative condition. It affects the brain and spinal cord and causes progressive muscle atrophy. Symptoms such as breathing problems, muscle pain, and immobility can make it hard to fall asleep or stay asleep.  

Does Sleep Have Any Effect on ALS?

Good sleep is crucial to overall health. Sleep helps repair the nervous system and promote nerve regeneration. Lack of quality sleep can exacerbate symptoms and the progression of ALS. Not getting enough sleep can even shorten the median survival time of people with ALS.

Types of Sleep Issues Likely Caused by ALS

All motor symptoms of ALS can affect sleep quality. Sleep issues related to ALS include:

• Sleep apnea: Frequent pauses in your breathing while you sleep are common among people with ALS. This may have to do with atrophy of the tongue and how that affects the upper airway.
• Sleep-related hypoventilation: Too slow or shallow breathing causes less oxygen in the blood and higher carbon dioxide levels. In ALS, this may be related to diaphragm weakness.
• Leg twitches and cramps: Most people with ALS experience nighttime leg muscle twitches and cramps; a disruption in signals between the nerves and muscles causes them.
• Restless legs syndrome (RLS): This overwhelming urge to move your legs or unpleasant leg sensations is common among people with ALS. These symptoms are similar to those of ALS.
• Lack of movement: When you have ALS, it becomes difficult to change sleep positions on your own, making it challenging to fall into a deep sleep or get into a comfortable position.
• Pain: ALS can lead to nighttime pain due to muscle cramps, spasticity, and pressure on bones and joints due to muscle atrophy and lack of movement.

Each of these problems can lead to insomnia, the inability to get enough quality sleep to feel refreshed during the day. Other things, such as depression, fear, and grief, can also contribute to insomnia.

Treatments for ALS-Introduced Sleep Issues

There are measures you can take that might help you sleep better. Your healthcare provider can establish whether symptoms are due to ALS, a sleep disorder, or both, which will help determine the appropriate treatment.

Home Remedies

Make sure you create the most comfortable sleep environment possible, starting with your bed. Consider getting a hospital bed or one made for people with mobility problems.

An adjustable bed with sections that can be raised or lowered for head and neck support, electric hand controls, and a mattress overlay that provides alternating pressure to prevent bedsores are good features to look for.

Your health insurance may cover some of these items, so it's worth checking in advance. Other things you can try:

• Choose comfortable sleepwear that won't get tangled or bunch up under you.
• Try satin sheets, which reduce friction and make moving easier.
• Use a variety of pillows, such as wedge pillows, body pillows, and U-shaped pillows that support the neck.
  

Medications

Medicines that may help ease muscle spasticity and twitches include muscle relaxants such as:

• Lyvispah, Ozobax (baclofen)
• Zanaflex (tizanidine)
• Valium (diazepam)

Medicines that may help with painful muscle cramps are:

• Qualaquin (quinine)
• Keppra, Elepsia (levetiracetam)
• Mexiletine

Some medications may help ease symptoms of RLS, but they don't work for everyone. Some of these are:

• Dopamine-related medications
• Opiates
• Benzodiazepines receptor agonists
• Alpha-2 delta medications
• Iron supplementation

Other medicines may include pain relievers, antidepressants, and sleep aids. You'll want to work closely with your healthcare team to prevent drug interactions and serious side effects.

Other Therapies

Active stretching may help decrease muscle twitching and cramping, but this can be difficult when there's significant limb weakness. A physical therapist can work with you on daily range of motion and stretching exercises to help prevent spasticity.

If you're having breathing problems at night, it may be time to look into noninvasive ventilation breathing support to help you sleep. This involves wearing a mask over your nose and mouth while you sleep. It may also improve quality of life and prolong survival.

When breathing becomes more difficult, you may need a respirator (mechanical ventilation). The breathing tube can be inserted through the mouth or the windpipe (tracheostomy).

Non-drug treatments that may relieve RLS symptoms include taking a hot bath, rubbing and massaging the legs, and applying hot or cold packs.

Lifestyle Changes for Sleep Issues

Ensure you get proper nutrition and fluids through diet or a feeding tube. Dehydration and low levels of electrolytes can cause muscle cramps.

Basic sleep hygiene can help with sleep problems. Here are some tips for improving sleep:

• Keep the bedroom dark and quiet. Set the thermostat to a comfortable temperature.
• Try to sleep at the same time every night and wake up at the same time every morning.
• Move electronics. Glowing devices such as smartphones, laptops, and TVs can interfere with sleep. If possible, remove them from the room or turn them off.
• Be sure to avoid drinks containing caffeine or alcohol in the hours before bedtime.
  

When to See Your Healthcare Provider

Call your healthcare provider if you're having trouble sleeping and home remedies aren't helping. The sooner you identify the cause, the sooner you can start treatment. Here are some signs that it's time to make that call:

• You wake up often during the night or too early in the morning.
• You feel like you haven't slept much or are excessively sleepy during the day.
• You've started to snore, or snoring is getting worse.
• Muscle pain or twitching makes it impossible to sleep.
• You can't stop moving your legs at night.
• You can't get comfortable or change position when you're uncomfortable.
• You feel anxious or depressed.

Summary

It's common for people with ALS to have sleep problems such as sleep apnea, sleep-related hypoventilation, and insomnia. The connection between ALS and sleep goes both ways. Lack of sleep can aggravate symptoms of ALS. It can also affect disease progression and survival time. You can take a few steps to improve sleep hygiene and promote a better night's sleep. However, your healthcare provider may be able to treat specific sleep disorder symptoms.

A Word From Verywell

With all the serious symptoms associated with ALS, you might think that poor sleep isn't important. But it significantly impacts how you feel during the day and can worsen ALS symptoms. You don't have to ride it out alone. If you have ALS-related insomnia, let your healthcare provider know that sleep is a problem. While there's no cure for ALS, your healthcare team can help you feel more comfortable so you can get the rest you need.