Although we have traditionally managed fatigue with a variety of medications, recent research suggests that it is possible that we may be doing to a disfavor some of these patients. Although many MS patients are disabled by their fatigue and need to aggressively treat it with medications, the sense of “tiredness” noted by some patients may be related to the progressive establishment of new brain traces “plasticity” occurring in a condition which produces ongoing neural degeneration. Clinicians often note a disconnection between the marked brain atrophy present in an individual patient (implying significant loss of pre-formed neural pathways) and the ability of such a patient to function. To function as well as they do, extensive plasticity — confirmed by imaging studies — has occurred in these patients.
What is required for plasticity to occur most efficiently? Studies in rodents demonstrate that new learning requires fairly immediate slow-wave deep sleep to encode newly learned information. Additionally, studies in volunteers confirm this in humans. It appears that the consolidation of new brain traces for efficient learning requires a fairly immediate period of slow-wave sleep to allow for the “offline” processing required for new synaptic plasticity. Consequently, the question arises as to whether it would be better for MS patients to have more periods of deep sleep rather than take drugs to stay awake. Are tiredness and fatigue trying send to the message “Give this brain sleep?”
If anyone wants me, I'll be taking a nap. And possibly removing all caffeinated beverages from the house.