Postprandial somnolence in people with multiple sclerosis, 2022, Christmas et al

Postprandial somnolence in people with multiple sclerosis

Tatiana Christmas, Neena Singh, Saul Reyes, Kimberley Allen-Philbey, Gavin Giovannoni

Objectives
To identify whether people with MS (pwMS) suffer from postprandial somnolence (PPS) more than people without MS (controls), to examine whether the severity of MS is correlated to the severity of PPS and to describe strategies pwMS are using to reduce their symptoms of PPS.

Background
pwMS might be more sensitive to PPS, but no studies confirming this association have been published.

Methods
A cross-sectional study was conducted among pwMS at The Royal London Hospital, London. Patients and controls completed an online survey including demographics, comorbidities and Stanford Sleepiness Score (SSS) one hour after lunch.

Results
Survey responses of 77 pwMS (mean age 45.3 ± 11.5 years; 62.3% female) and 37 controls (mean age 47.02 ± 13.9 years; 63.8% female) were obtained. The mean SSS for pwMS was 3.46 ± 1.67, whilst the mean SSS for controls was 2.52 ± 1.18 (p=0.001). No linear correlation was observed between EDSS and SSS (R2=0.011). 63% of pwMS reported making self-administered changes to their diet to help their symptoms.

Conclusions
PwMS were affected by PPS more than controls. EDSS was not predictive of PPS severity in pwMS. pwMS are adopting self-management strategies to reduce their symptoms of PPS.

Link (Journal of Neurology, Neurosurgery & Psychiatry) [Poster Presentation - Abstract Only]

 

I'm looking into post-meal fatigue. I get so so tired after a big meal. Barely able to move or think. I usually end up taking a nap. Starts immediately and lasts about 2-3 hours then slowly tapers off.

I know post meal fatigue or sleepiness happens in lots of healthy people, so I'm not sure if it's just that I'm starting at a lower baseline that's the reason the severity is so much worse than healthy people after a meal, or if there's actually some biochemical process relevant to ME/CFS (and maybe MS as well according to the above study) making it more severe than normal.

I think immediate symptom exacerbation after eating is commonly reported in ME/CFS. Might be something to look at.

 

With the MS study, they only surveyed for sleepiness after the meal. Are they sleepier before the meal too? I don't think this is very useful, actually.

 

Is this a rapid fatiguability issue, down to the body diverting resources to digestion, or is it an exacerbation of ME symptoms? Also large meals are usually associated with social settings so it is not always clear what is the result of the meal size and what the demands of the setting?

I had even preME felt sleepy and/or fatigued after a large meal, but this has been much more marked since the onset of ME. I am getting better at only eating small meals, yesterday I only ate half of what I might previously done on Christmas Day, however we ate at 4.30pm and I was in bed and falling asleep by 6.30pm. Though I did wake up enough later to phone my godson in Germany it did require a lot of cognitive effort to remain focused.

I definitely find large meals fatiguing, but sleeping after Sunday lunch or Christmas dinner is a stereotype even in healthy people. Further large meals and/or their social context may contribute to subsequent PEM, however I have not thought whether such meals also trigger an immediate worsening of ME symptoms more generally, suggesting we have an abnormal response rather than an exaggeration of the response normal to healthy people.

Perhaps we could identify a researcher to regularly bring us extra large and tasty meals to investigate further.

(Having said that, my goddaughter did organise my local pub to bring me meals during the first lock down, and they were extra large portions. After the first one left me shattered I did think to divide them into two, keeping half for reheating the next day.)

 

While I suspect many mechanisms are going on, eating a meal diverts blood to the gut. If we have insufficient blood to the brain, like in POTS, NMH etc., then this would automatically be a problem.

I can be fine after a meal, or need a long nap. I am unable to discern a pattern in the food I am eating, at least so far. Its not obviously quantity either.

 

My father used to be able to predict when I was going to have a post-meal crash. He would see the colour suddenly drain from my face and seconds later I would feel rotten and have to go and sit in an armchair.

 

I only really have three symptoms, fatigue, cognitive dysfunction, and anxiety, and they all get worse after eating, but only for a few hours, so not PEM.

It happens to me almost every day, and I eat alone, so I'm sure it's the food. It's not as bad when it's a very small meal, but seems to still make me worse. Maybe it is just what everyone experiences, but starting at a lower set point.

I haven't read too much on this, but it seems to be contested that it's about blood redistribution.

Debunking a myth: neurohormonal and vagal modulation of sleep centers, not redistribution of blood flow, may account for postprandial somnolence