Why Sleep is Harder When You Have Spinal Muscular Atrophy
Sleep can be more difficult for people living with Spinal Muscular Atrophy, also known as SMA, because the same muscle weakness that affects movement can also affect breathing during the night. Respiratory muscles, particularly the muscles between the ribs, may become weaker and make it harder to take sufficiently deep breaths while sleeping. This becomes especially important during REM sleep, when normal muscle activity decreases even further. Research on sleep and SMA shows that respiratory muscle weakness can contribute to nocturnal hypoventilation, meaning the body does not move enough air during sleep and carbon dioxide can begin to build up. A person may therefore appear to sleep for many hours while still waking up feeling exhausted because the quality of breathing and sleep was disrupted throughout the night.
Breathing is not the only reason sleep can be challenging with Spinal Muscular Atrophy. Scoliosis and other changes in the chest wall can further restrict lung expansion, while limited mobility may make independently changing positions during the night difficult. Some individuals may experience discomfort, pressure, stiffness, temperature problems, or the need for caregiver assistance with repositioning. Signs of nighttime hypoventilation can also be surprisingly subtle and may include restless or disrupted sleep, morning headaches, daytime fatigue, nausea, difficulty concentrating, or feeling unusually tired despite spending enough time in bed. Because breathing difficulties may first become noticeable during sleep before significant daytime respiratory problems appear, sleep studies, respiratory evaluations, oxygen measurements, and carbon-dioxide monitoring can become important parts of SMA respiratory care when clinically appropriate.
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