Multiple Sclerosis Centers of Excellence » Veterans » Living with MS Selecting the Appropriate Mattress for People with MS Richard Buhrer, ARNP, MSCN Why do people with MS need special mattresses? What are the various types of mattresses? What are mattress covers? Will the VA cover special mattresses? Why do people with MS need special mattresses? Because of the problems with sensation and movement that are often a component of multiple sclerosis, people with the disease often require special mattresses to keep them safe from developing bed sores and other skin problems. Another problem that people with MS suffer from is heat intolerance. In the presence of a high ambient temperature (temperature of the inside or outside environment), the nerves damaged by MS cease to function. So that when people with MS become overheated, their ability to move and sense the environment is diminished. Choosing a mattress that will protect the individual from becoming overheated and that will provide skin protection is very important for the health of the person with MS.
What are the various types of mattresses? When choosing a mattress, it is important to consider the effects of that mattress on skin protection and heat intolerance. Mattresses may be either static or dynamic. In general, a static mattress refers to a mattress that doesn’t move when a person lies on it. A dynamic mattress is powered by electricity to change the surface under a person to allow for a variety of medical needs. Dynamic mattresses involve at least one of the following technologies: fluidized air, alternating pressure or side-to-side turning. Fluidized air therapy involves blowing warmed air through a bed of tiny silicone beads creating a surface that is like a “waterbed” but with warm air blowing up through it continuously. This type of surface is used mostly in health care institutions for patients either with very severe pressure ulcers (bedsores) or after surgery to close these wounds. Alternating pressure: Air is pumped into cylinders that are placed parallel to each other inside a mattress.
As one set of cylinders inflates, the other set deflates. This way the pressure under any part of the body is relieved on a regular basis. This type of mattress can reduce the number of times a person needs to be turned while in bed. Side-to-side turning: One side of the mattress deflates and the other side inflates, alternating over time, turning the person in the bed gently from side to side. This is normally used for patients with lung problems, but can be used for people with MS as another way to reduce the number of times an attendant must turn a person while in bed. Of these mattresses, only fluidized air is heated. The heat can be adjusted so that people with MS can use these surfaces, but they carry some risk of overheating. Alternating pressure and side-to-side turning are not heated. Therefore, heat intolerance is not as much of an issue with these mattresses. Viscoelastic or memory foam: One kind of static mattress that gets a lot of attention on TV is made of viscoelastic or memory foam (the Tempur-pedic ™).
People with disabilities often find these mattresses difficult to use because they get "stuck" in a hole in the mattress and cannot move themselves out of it. Some medical mattresses are made of this substance but they do not really work out very well for people with MS. Low air loss: This involves an air sack where a small amount of air leaks through the cover on a continuous basis. It helps to control moisture (like sweating). It provides some pressure reduction but the surface doesn't change over time and people need to be turned more frequently on this kind of surface. The air in a low air loss mattress may be heated and so this could pose problems with heat intolerance for people with MS. Air covered by foam: Another kind of static mattress is filled with air covered by foam. The air is in interwoven but not interconnected air cells that have certain stretchiness (distensibility). That way when a person lies on the bed, the air cells move and adjust to small changes in position.
This kind of mattress is a good basic surface for a person who does not have a high-risk of developing bedsores. What are mattress covers? All of these mattresses (except fluidized air) have Gortex ™ covers. This is a slippery fabric that is often used to make rain gear for hiking. It allows moisture to travel in one direction (which is to say, not into the mattress) so that the mattress is protected from moisture, and bowel and bladder accidents. It is customary to cover these mattresses with only one sheet. The goal is to minimize the number of layers between the skin and the surface of the mattress. Too many layers will increase the risk of bedsores and negate the advantages of the mattress. Gortex™ fabric reduces the friction and shear from the mattress that could also injure the skin when a person is repositioned (especially pulled up in the bed). Lying on these mattresses may feel "sweaty" and warm to the person in the bed and this can be a problem for a person with MS.
The only real alternative is to control the temperature in the room where the person is sleeping by using air conditioning or fans. Will the VA cover special mattresses? The VA will only purchase single-bed sized mattresses. Most of them work best on a hospital-type bed frame. If Veterans prefer to sleep with their spouse or partner, then a good quality, soft, commercial mattress is probably the best choice. Air filled adjustable mattresses (for example, the Sleep Number Bed ™) are also available and might be a good choice for people with MS. It is recommended that you review all your mattress choices with your healthcare provider. They will be able to help you select the appropriate mattress surface for your particular medical need. Note: While name brands of mattresses were discussed in this document, they were used for purposes of name clarification and are not to be construed as promoting any particular brand of mattress. Last Updated: October 2009Symptoms of multiple sclerosis — from spasticity and restless leg syndrome to heat sensitivity — are prime examples of why living with MS often gets in the way of a good night’s sleep.
Speak with your medical care provider about sleep issues, recommended Nicholas LaRocca, PhD, vice president of health care delivery and policy research at the Multiple Sclerosis Society. Don't rely on over-the-counter medications or figure it's something you just have to live with. "Self-management is important, but asking for help is equally important," he said. A medical evaluation can help determine the best way to resolve your sleep problem.In the meantime, here are things you can do to prepare for a good night's sleep:If you still have problems falling asleep or if you still wake up feeling tired, try to identify the source of your sleep problems and discuss it with your physician. Here are some tips on how to deal with the most common underlying sleep issues.Feeling anxious can make it difficult to fall asleep. Dr. LaRocca recommended examining the root of such feelings. Is there anything you can do to change the problem? For instance, if your mind races at night, thinking of tasks you need to complete in the future, grab a notepad and jot them down, then relax your mind so that your body can follow suit.
If your anxiety is caused by something you can't change, such as the unpredictability of your MS symptoms, you will need to find ways to come to terms with it. Your multiple sclerosis doctor may suggest relaxation techniques, counseling, cognitive behavioral strategies, or a support group as possible tools for helping you gain peace of mind and hopefully get the restful sleep you need.The pain and sporadic movements of multiple sclerosis spasticity can cause multiple interruptions to your sleep cycle, frequently waking you. This type of fragmented sleep can leave you feeling exhausted in the morning. "Sometimes spasticity can be triggered by external stimulants -- something about the bed, pajamas, or linens," explained LaRocca. Identify and avoid possible triggers. Your MS doctor may prescribe medication, rehabilitation exercises, or a combination of both to help get a handle on spasticity so that you can sleep more soundly.Nocturia, or the need to urinate during the night, happens when bladder muscles are spastic, contracting when they aren’t supposed to and giving you the feeling that you have to urinate.
"This is a medical issue that should be evaluated," said LaRocca. "It can get complicated to determine which parts of the voiding apparatus are being affected and how best to treat [the problem]." Your multiple sclerosis doctor may recommend occasional use of catheters or another treatment option. Botox has recently been approved for reducing hyperactive bladder. Also ask your doctor how much fluid you should be drinking and when. Don't limit fluids so much that you become dehydrated, but do create a plan to taper off fluid intake before bedtime.Restless leg syndrome (RLS) is one of the most common sleep disorders for people with multiple sclerosis. The urge to move legs and the unpleasant sensations that accompany this urge typically occur at night or when legs are at rest. You can reduce the risk by avoiding alcohol before bed. Your MS doctor may prescribe medication to help ease symptoms so that you're able to sleep without frequent interruption.People who have RLS frequently also have periodic leg movements in sleep (PLMS), but having PLMS does not automatically mean a diagnosis of RLS.
PLMS is a rhythmic movement of the lower extremities, bending at the hips, knees, or toes during sleep. The constant movement can result in a less-than-ideal sleep cycle. LaRocca suggested working with your doctor to make sure that what you're experiencing is in fact PLMS and not spasticity. PLMS is diagnosed by a full night polysomnogram, testing that monitors your movement while you sleep. If you do have PLMS, there are medications and treatment options that can effectively treat the condition.Sleep apnea should be taken seriously, said LaRocca. Medical treatments such as CPAP (a special breathing device and mask used while sleeping) or surgery may be necessary for moderate to severe cases. For those without sleep apnea who snore, or for those who have very mild sleep apnea, there are a few things you can do on your own to improve the flow of air to lungs while sleeping:Depression is common in people with MS. A study published in the Multiple Sclerosis Journal found that people with MS are more likely to be diagnosed as clinically depressed, the most severe form of depression, than the general population.
Depression is known to disrupt sleep in different ways. "For some people it causes them to not sleep as much," explained LaRocca. "In others, it causes early awakening.” Depression is not a sign of weakness. It is a medical condition that can be treated effectively with therapy, medication, or a combination of the two."Sleep is a fairly complex activity," LaRocca said. "For many people, just addressing an individual problem is not necessarily going to do the trick. There may be other factors involved." Because MS is a neurological condition, it may not be a single symptom preventing you from sleeping soundly-- it could, for instance, be damage to the nervous system that is disrupting your sleep cycle.If nothing else resolves the issue, your doctor may refer you to a sleep specialist to try to determine the root of the problem. During a session in a sleep lab, physicians can monitor your brain waves and breathing and gather other data to get a precise idea of what's happening when you sleep.