MG Patients Need to Sleep Right and Sleep Tight
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Sleep Right, Sleep Tight.

Sleep Right, Sleep Tight.

By Kinjal Madhav, MD, MBA

Sleep is vital to biological functioning as it has an impact on physical and mental health. The essential quantity of sleep varies by age. It is recommended that a healthy adult aim for 7-9 hours of sleep a night. Although, the total sleep time a person may allocate on day-to-day basis may vary based on familial and work life commitments or be behaviorally induced. As you get older the quantity of sleep you need does not change, but the quality can. Overall, poor sleep can increase your risk of cardiovascular and cerebrovascular disorders- such as a heart attack, irregular heart rhythms, heart failure, high blood pressure and stroke. It is important to understand the effect comorbid medical conditions may have on your sleep as well.


When you sleep, your body cycles through two primary stages of sleep- non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. NREM sleep is further subdivided into stage N1 and N2 (light), and N3 (deep) sleep. These stages are specific in their functions. During NREM sleep your body repairs and regenerates tissues, strengthens the immune system and builds bone and muscle. In other words- the body restores itself. REM sleep is where you dream. Here your body works on consolidating memories and improving mood. This is where the mind restores itself.


As you get older, sleep architecture changes. The amount of deep sleep and dream sleep decreases which makes you a lighter sleeper and increasing the risk of sleep fragmentation. In addition, poor sleep habits, certain medications and underlying sleep disorders can affect the quantity and quality of each sleep stage, influencing your physical and emotional wellbeing.


There is limited research on the direct impact of myasthenia gravis (MG) on sleep. But there is an overlap of some MG symptoms with common symptoms of disturbed sleep- such as daytime fatigue, sleepiness, leg movements during sleep, and pain. The most commonly reported sleep complaints are trouble falling and/or staying sleep, waking up unrefreshed, and daytime sleepiness. Medical conditions that can cause or contribute to these symptoms include- insomnia, sleep apnea, restless legs syndrome, narcolepsy, pain, depression, anxiety and medication effect to name a few.


Due to lack of literature, many times these symptoms are attributed to a neurological process rather than neuromuscular disease. Regardless, evaluating for underlying sleep disorders and treating them will improve overall functioning.


Our sleep-wake cycle is influenced by chemical signals from neurotransmitters in our brain. A shift in this balance can make us more awake or drowsy.  External factors can affect this balance as well- alcohol, caffeine, smoking and medications to name a few. Steroids, such as Prednisone are commonly prescribed in patients with MG. They can affect mood- making you more irritable, depressed or anxious. Steroids can also make you feel wired, making it difficult to fall asleep.


Once asleep, you may experience more wakeful episodes as well. This is why it is recommended to take the dose as further away from bedtime as possible. Benzodiazepines are frequently prescribed as an adjunct to treat anxiety. They can help you fall asleep quicker and longer, but decrease the amount of deep sleep you get. You may also experience daytime sleepiness despite allowing adequate hours of sleep at night. A restful night’s sleep would be achieving a balance of both good quality and adequate quantity of sleep, instead of focusing on just one.


Good sleep hygiene allows you to get enough quality total sleep time. Ensure a regular bedtime and wake up time on all days of the week, allocating between 7-9 hours. Envision your bedroom as a space of Zen and relaxation. Declutter and make sure your bed and pillows are comfortable. Have a pre-bedtime relaxation routine- may it be brushing your teeth and taking a warm bath or sinking into a book and listening to soft music. This allows your body to unwind and prepare for sleep.


Your bedroom environment is also important. A cooler temperature is conducive to sleep. Light is one of the regulators of our sleep-wake cycle. Black out shades allow your body’s melatonin production to rise and increases your drive to sleep. What you eat can also have an impact on sleep. Avoid consumption of alcohol close to bedtime or a heavy meal within 2-3 hours of bedtime. Despite these measures- if sleep continues to be dysregulated and symptoms are daytime fatigue and sleepiness persist, seeking medical help is suggested.


Rest and sleep is critical for patients with MG. Ensuring good sleep can allow the body to perform its vital function of repair and restoration. Improving mood, lowering pain threshold, reducing daytime fatigue improves daytime functioning and overall quality of life in a patient with MG. I urge you to discuss your sleep habits and sleep related concerns with your doctor. Further evaluation with a detailed history, physical, review of medications and sleep study may be warranted.

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