The Reason For Asking My 3 Questions

[Steven Y Park, MD]

I asked everyone on this forum the following 3 questions:

1. do you prefer to sleep on your back, side or stomach?
2. did you or do you have cold hands or feet?
3. did or do either of your parents snore and do they have any medical problems?

Overwhelmingly, the answers were: mainly side and stomach only, the vast majority have cold hands or feet, and almost everyone has one or two parents that snore heavily with various degrees of heart disease. Many of you also complain of intense fatigue.

This sounds amazingly like what I see in patients with upper airway resistance syndrome. UARS is a mild variation or precursor to sleep apnea, but it's different in that it's typically seen in young thin women (and men) who don't snore, can't sleep on their backs, have cold hands or feet, have normal or low BP with lightheadedness or dizziness, chronic fatigue and unrefreshing sleep no matter how long one sleeps, various unexplained gastrointestinal problems, hypothyroidism, depression, and many others. Later on, as they gain weight many of these symptoms improve (especially the cold hand and dizziness), but begin to develop high blood pressure, diabetes, heart disease, heart attack or stroke.

Anatomically, they all have relatively narrowed jaws with very narrowed breathing passageways when on their backs. Due to gravity, the tongue (which takes up too much space within a smaller jaw cavity) falls, back partially, and then when in deep sleep, can obstruct completely due to muscle relaxation. If you stop breathing and wake up after 10 seconds, then that's called an apnea. If you stop breathing and wake up anywhere from 1-9 seconds, then you'll wake up to light sleep or be awake, but it won't get counted as an apnea. The minimum number of apneas you need every hour on average to receive a diagnosis of sleep apnea is 5. But if you stop breathing 25 times every hour and wake up after 2-9 seconds, then you're told you don't have any sleep apnea.

There is a significant group of people who stay in UARS, and with the chronic extra stress response due to the inefficient sleep with repeated arousals, their nervous systems and immune systems are heightened. Having a hypersensitive nervous system or immune system can have certain consequences. UARS patients have normal or heightened nervous systems, whereas OSA patients have diminished nervous systems.

Your anatomy is hereditary, so you got your smaller jaws from one or both of your parents. As people with UARS get older and gain more weight, they'll have the classic signs and symptoms of obstructive sleep apnea: severe snoring, breathing pauses, and medical complications such as heart disease, depression, heart attack or stroke.

I can't say if one definitely causes the other but I can say that there's a definitely link between MS and sleep-breathing problems. Some of you already have sleep apnea. I know it's impractical, but it would be interesting if everyone could get formal sleep studies to see how many people with MS have OSA or UARS. One is not exclusive of the other, so if you have a family history of snoring and heart disease, it's important to get checked for sleep apnea.

Snoring is a sign of major breathing problems at night, and is nothing to be laughed at. A heavy snorer should definitely be checked for sleep apnea, since untreated, it raises your heart attack and stroke rate by 3 and 5 times, respectively. Not to mention high blood pressure, obesity, depression, anxiety, heart disease, and Alzheimers (this one's controversial, but there's plenty of convincing evidence). Also, you don't have to snore to have significant sleep-breathing problems.

[alagirl]

do you happen to have antiphospholipid syndrome, or have you been tested for it?

[Hope75]

Interesting posts.  I c/o cold hands and feet all the time.  But, my feet burn, so I leave socks off, blankets off, even though I can feel that they are too cold.  My doc thinks my anxiety shunts all the blood to the major organs and hence, away from my extremities.  A lack of oxygenated blood in those extremities is leading to neuropathy - per my doc.  What do you think?  After 2.5 years of relapsing/remitting pain, I am at a loss.  Johns Hopkins did a small fiber biopsy that showed excessively segmented nerves.  Their verdict was that there was some insult to the nerves at one time, but are healing.  They don't feel like they are healing this month, but getting worse again.  Thanks for any input!

[Steven Y Park, MD]

Scientists still haven't worked out all the details, but narcolepsy has been shown to be possibly due to a genetic mutation where a person doesn't make enough hypocretin. Interestingly this area of the brain is also involved in other various neurotransmitters that directly or indirectly also can be involved with MS. One possible explanation is that since MS is an autoimmune condition, and since it can affect any part of the brain, perhaps MS can also affect the area of the brain that makes hypocretin.

It also sounds like you may have a strong history of obstructive sleep apnea in your family.

[mom9335]

My adult son has MS.  My husband has always been a heavy snorer and has very high blood pressure.  AND, here is the big question...his mother had Narcolepsy.  I have been reading that the gene(s) for MS and Narcolepsy may be the same.  Your comment?

[young at heart]

Dr.Park,

Thank You for your interest and the comparison of sleep disorders that can effect MS patients.

I sleep on my back---2 back surgeries left me chronic bilateral adheasive arachnoiditis
I have raynaulds
My parents both snore--my mom has high blood pressure,my dad well he's an alcoholic and I don't remember when he was a Drs. last.

I have had an EEG,it was abnormal,but not positive for seizures.
It was the one where you have to be awake for 24 hours.Thats hard for one with MS.I can fall a sleep at the dinner table.Provigil does help some.

T-lynn

[meg321]

thats very interesting, my new Dr is driving me crazy about my sleep problem causing my fatigue and she has set me up for a sleep study. Not sure when but soon.  I have had a sleep problem my whole adult life.

Will let you know when i have it....

hugs, meg