The Complex yet Unsurprising Connection Between Sleep Disorders and Neurological Autoimmune Conditions

Sleep disorders have long been recognized as a common complication of various neurological conditions. However, recent research has unveiled a fascinating and complex relationship between autoimmune neurological disorders and sleep disturbances. At the Texas Center for Lifestyle Medicine, we believe it's crucial to understand these connections to provide comprehensive care for our patients.

Autoimmune Neurological Disorders and Sleep: An Overview

Autoimmune neurological syndromes occur when the body's immune system mistakenly attacks the nervous system. These disorders can affect various parts of the nervous system, leading to a wide range of symptoms. Recent studies have shown that sleep disturbances are not just a side effect of these conditions but can be a central feature of the disease process itself (Dubey et al.).

Common Sleep Disturbances in Autoimmune Neurological Disorders

Research has identified several sleep disorders associated with autoimmune neurological disorders:

1. Insomnia: Difficulty falling asleep or staying asleep is common in many autoimmune conditions.
2. Hypersomnia: Excessive daytime sleepiness can occur, particularly in conditions like narcolepsy associated with certain autoimmune disorders.
3. Parasomnias: Abnormal behaviors during sleep, such as REM sleep behavior disorder (RBD), have been observed in several autoimmune conditions.
4. Sleep-disordered breathing: Conditions like sleep apnea are more prevalent in some autoimmune disorders.
5. Circadian rhythm disorders: Disruptions to the body's natural sleep-wake cycle can occur in autoimmune neurological disorders.

Specific Autoimmune Conditions and Their Sleep Manifestations

1. IgLON5 Syndrome: This rare disorder is characterized by complex sleep symptoms, including sleep-disordered breathing, abnormal sleep behaviors, and insomnia. Polysomnography often shows abnormal sleep architecture and atypical movements during sleep (Dubey et al.).
2. LGI1 and CASPR2 Autoimmunity: These conditions can present with insomnia, REM sleep behavior disorder, and Morvan syndrome, which includes severe insomnia and sleep-related movements (Dubey et al.).
3. NMDA Receptor Encephalitis: Patients often experience insomnia in the acute phase, followed by hypersomnia during recovery. Sleep-disordered breathing and hypoventilation can also occur (Dubey et al.).
4. Aquaporin-4 Antibody-Associated Neuromyelitis Optica Spectrum Disorder: Some patients develop hypersomnia and secondary narcolepsy, often associated with hypothalamic lesions (Dubey et al.).

Diagnosis and Treatment

Diagnosing sleep disorders in patients with autoimmune neurological conditions requires a comprehensive approach. At the Texas Center for Lifestyle Medicine, we employ various diagnostic tools, via extensive collaborative experts. This includes collaborating with airway dentists and orthodontics, and sleep neurologists who perform the following: 

• Detailed sleep history and symptom screening (At home sleep assessment)
• Polysomnography (sleep study)
• Multiple Sleep Latency Test (MSLT)

Once we receive the results, we will create an individualized, detailed journey toward healing with the patient that will help them achieve their goals. 

Treatment and lifestyle tools typically involves a combination of approaches:

1. Lifestyle tools: Addressing the underlying autoimmune condition can often improve sleep symptoms. This includes dietary interventions, stress management, supplements/micronutrient support, and more.
2. Symptom management: Using supplements, mind-body tools, and behavioral interventions to manage specific sleep issues and sleep aversion. 
3. Sleep Disorder Treatment: This may include one or multiple of the following: CPAP/APAP therapy, orthodontic treatment to expand the sinuses and open the airway, myofunctional therapy to retrain the muscles of the tongue and mouth to assist structural changes, sleep medications if needed, etc. 
4. Lifestyle modifications: Implementing good sleep hygiene practices and addressing other lifestyle factors that may impact sleep.
5. Continuous monitoring: Regular follow-ups to assess treatment efficacy and make necessary adjustments.

The relationship between autoimmune neurological disorders and sleep is complex and multifaceted. At the Texas Center for Lifestyle Medicine, we recognize the importance of addressing sleep disturbances as an integral part of managing autoimmune neurological conditions. By taking a comprehensive approach to diagnosis and treatment, we aim to improve both sleep quality and overall quality of life for our patients.

If you're experiencing sleep issues and have been diagnosed with or suspect an autoimmune disorder, we encourage you to reach out to our team for a comprehensive evaluation.

Resources: 

Devine, Michelle F, and Erik K St Louis. “Sleep Disturbances Associated with Neurological Autoimmunity.” Neurotherapeutics : The Journal of the American Society for Experimental NeuroTherapeutics, U.S. National Library of Medicine, Jan. 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC8116412/.

Mazurek-Mochol, Małgorzata, et al. “The Role of Interleukin 6 in Periodontitis and Its Complications.” International Journal of Molecular Sciences, U.S. National Library of Medicine, 10 Feb. 2024, www.ncbi.nlm.nih.gov/pmc/articles/PMC10889213/.