Charcot-Marie-Tooth disease (CMT) is the name given to a group of inherited progressive disorders that affect the peripheral nerves. The peripheral nerves are involved in transmitting signals between the brain and the rest of the body to control movement and relay sensory information. Damage caused by CMT commonly results in muscle weakness but can also cause a range of other symptoms, including issues with sleep.
CMT and sleep
CMT has been associated with several sleep disorders, which can either reduce the quality of sleep or make it difficult to achieve sleep. There are different types of sleep disorders that a CMT patient might experience. Among them:
Obstructive sleep apnea
Obstructive sleep apnea is a breathing condition that occurs during sleep. It is when the throat closes during the night and breathing stops for a short period. The patient may not wake up during this episode, but it can severely affect the quality of sleep and cause fatigue throughout the day.
The prevalence of sleep apnea can be much higher in CMT patients compared to other people. A study in 61 patients with CMT type 1, published in the Journal of Neurology, Neurosurgery & Psychiatry found that 37.7 percent of patients had sleep apnea, compared with only 4.9 percent of the control group.
The association between CMT and sleep apnea has been observed in another case study, published in The Lancet. A study of 14 family members revealed that sleep apnea was present in all 11 patients with CMT type 1 but not in the three CMT-free family members.
Restless legs syndrome
Restless legs syndrome is associated with an unpleasant sensation in the legs accompanied by an irresistible urge to move. This is often worse at night when trying to sleep, making it difficult to fall asleep or return to sleep.
A study in 61 CMT type 1 patients published in the Journal of Neurology, Neurosurgery, and Psychiatry showed that 40.9 percent of patients experienced restless legs syndrome and had significantly diminished sleep quality, compared with 16.4 percent of the control group.
Periodic limb movements in sleep
Periodic limb movements in sleep (PLMS) can be more common in patients with restless legs syndrome. The condition is associated with involuntary and repetitive flexing or twitching of the limbs. The condition can occur frequently in CMT patients, but may not always disrupt sleep.
A case study in 16 related CMT type 2 patients, published in the Journal of Clinical Sleep Medicine, suggested that the disease may be associated with general poor sleep quality irrespective of other sleep disorders. The study found that patients tended to experience fragmented sleep, leading to a decrease in REM sleep.
Managing sleep problems in CMT
It can be difficult to manage sleep problems in CMT and there is no one right answer for what is best for the individual patient.
Provigil (modafinil) is a therapy approved to treat sleep apnea, and while not specifically tested in CMT patients, it may improve their sleep quality. This is supported by a case series, published in the American Journal of Hospice and Palliative Care, that reported Provigil significantly reduced symptoms of fatigue in four CMT type 1A patients.
There are also devices that can ease sleep apnea. They include a continuous positive airway pressure (CPAP) device, which is a mask that is placed over the nose or mouth while sleeping. This is connected to a device that provides a constant air pressure to keep the airways open. Mild sleep apnea may also be eased with a mouthpiece or a mandibular repositioning device that can help keep the throat open.
Treatment for restless legs syndrome would normally begin with iron supplements. Several types of other medication such as anti-seizure medications, dopaminergic agents, opioids, or benzodiazepines may be prescribed if this is unsuccessful. However, as these may cause fatigue or trigger sleep apnea, they are generally only used if the condition is severe.
There are several lifestyle changes that may help patients get more sleep. For example, maintaining a regular sleep pattern can help, along with a hot bath before bed. Trying to sleep on the back may also help with sleep apnea, and leg massages may improve restless legs syndrome.
Diet can also have an impact on sleep. For example, reducing caffeine and alcohol intake may make it easier to go to sleep, as well as improve sleep quality. A good diet and exercise program can help people lose weight, which may make sleep easier.
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