MS and Breathing Problems

 

When you’re living with multiple sclerosis (MS), there’s a chance you might have trouble breathing. It’s not as common as other MS symptoms, like numbness, tingling, blurry vision, and trouble walking. But it can still happen.

If you start to have trouble breathing, your doctor and other specialists have lots of ways to help. Once they find out the exact cause of your breathing problem, they can recommend treatments that allow you to breathe better and improve your quality of life.

MS can impact the muscles that affect your breathing. So breathing problems with MS usually happen when those muscles lose strength and endurance. There can be other causes, though, and some of them need treatment right away.

If you suddenly have trouble getting air, or if you’re having problems breathing right now, call your doctor or 911 immediately.

What Are Some Symptoms of MS Breathing Problems?

You may have shortness of breath or feel like you can’t take a deep breath.

You might have trouble talking, too. Breathing problems can make it harder and more tiring for you to hold a conversation or speak loudly enough for others to hear you.

Other possible clues of breathing problems with MS are:

• Sleep apnea
• Coughing or hiccupping a lot
• Sighing

What Can Cause Breathing Problems With MS?

The most common cause is weakness in muscles of the chest and belly that help you breathe.

Muscle weakness is common with MS. It can happen in any part of your body, including the muscles involved in breathing. It can also start early in the course of MS and gradually get worse over time.

If the muscles involved in breathing become weak, you’ll need to work harder to breathe in and out. And the more effort it takes, the more it could tire you out, especially if you already have MS fatigue (a symptom that may affect up to 80% of people with multiple sclerosis).

Other things can cause MS-related breathing problems, too. Certain prescription drugs that some people take to ease their symptoms -- like tranquilizers, muscle relaxants, or opioid painkillers -- can cause you to breathe slower and less effectively. Your doctor may want to watch you closely if you’ve had trouble breathing or swallowing and you take any of these meds.

Another cause of MS-related breathing problems is a dangerous condition called aspiration pneumonia. It can happen if you’re not able to clear things like mucus from your nose and throat, or if you accidentally inhale food, liquids, or other particles into your lungs.

A common multiple sclerosis symptom known as the MS hug (which feels like a tight band is wrapped around your torso) can also bring on breathing trouble by causing pain and tightness in your chest.

One much less-common cause of trouble breathing is a problem with the autonomic nervous system. That’s the part of your nervous system that automatically controls things like your breathing and heartbeat. MS doesn’t usually affect your autonomic nervous system.

What Treatments Can Help Breathing Problems?

Talk to your doctor right away. They may send you to a specialist who’s trained to treat breathing problems. Depending on your needs, your treatment plan, and the exact cause of your breathing troubles, your doctors might prescribe a breathing aid like:

• A nebulizer: A small machine that turns liquid medicine into a mist, which you inhale deep into your lungs through a mouthpiece or mask
• An inhaler: A handheld device that lets you breathe medication into your lungs in the form of a mist or spray
• CPAP: A machine that treats sleep apnea by helping you breathe through a mask or nosepiece while you sleep

Build up your breath. Ask your doctor to refer you to a respiratory therapist. They’re a certified medical professional who can come up with a plan to help your lungs work better.

Your plan may include breathing exercises that strengthen the muscles involved in breathing. Along with helping you breathe better, some of these techniques may lower your stress, too. A few examples are:

• Square breathing: Inhale for 2 counts through your nose. Hold it for 2 counts. Then exhale through your mouth for 2 counts. Do it a few times to relax and lower your heart rate.
• 4-7-8: Breathe in through your nose for 4 counts. Hold it for 7 counts. Then slowly breathe out for 8 counts. Closing your eyes while you do this may help you relax.
• Inhale-release, exhale-engage: Place your hands on your stomach. Inhale into your belly and feel it expand. As you exhale, tighten your stomach and engage your abs.

Treat any swallowing issues. If your breathing problems come from trouble swallowing, ask your doctor to refer you to a speech-language pathologist. This communication expert can also help you if your breathing issues affect your ability to talk.

A speech-language pathologist can teach your exercises and do other forms of therapy that help you swallow or speak more easily, which may improve your breathing. They might also recommend changes in your diet, as well as changes in your posture, to help you swallow better while you eat. If you’ve had aspiration pneumonia, they may suggest you use an assistive device called a feeding tube to lower your chances of getting that condition again.

Quit smoking. If you light up, ask your doctor to help you quit. Smoking makes you more likely to get breathing problems -- and it can cause your MS to get worse more quickly. Kicking the habit is one of the best things you can do for your overall health.

Multiple Sclerosis (MS) Tremors

 

What Is a Tremor?

A tremor is when a body part moves or shakes and you can’t control it. Many people with multiple sclerosis (MS) have some form of tremor they can’t control, in different parts of their bodies, like their head, arms, or legs.

What Are the Types of Tremors?

• Intention tremor. There’s no shaking when you’re at rest. It starts when you try to reach or grasp something or move your hand or foot to a precise spot. This is the most common form of MS tremor, and it usually causes the most problems in day-to-day life.
• Postural tremors. You shake when you sit or stand, but not when you lie down.
• Resting tremor. You move more when you’re sitting still and less when you move. This is more common with Parkinson’s disease than MS.
• Nystagmus. This type causes jumpy eye movements.

Why Does MS Cause Tremors?

This disease damages the protective sheath (myelin) that covers the nerves in your brain and spinal cord. Tremors result from damage to a part of your brain called the cerebellum. It controls your balance and coordination and smooths out the actions that you make when you move your limbs and eyes or speak.

Medicines That Treat MS Tremors

These problems are one of the hardest MS symptoms to treat. There aren’t any drugs made just to treat MS tremors. Your doctors may prescribe drugs for another condition that could help, like:

• Acetazolamide (Diamox), which treats a type of glaucoma and altitude sickness
• Buspirone (Buspar) and clonazepam (Klonopin), which are anti-anxiety drugs
• Hydroxyzine (Atarax, Vistaril), an antihistamine
• Isoniazid (INH), a drug for tuberculosis
• Primidone (Mysoline), a seizure medicine
• Propranolol (Inderal), which treats heart problems, high blood pressure, and migraines

 Nonmedicinal Tremor Treatments

• Braces: These can hold your joint still and stop extra movement. A brace on your ankle or foot can make it easier to walk. They can help control your arm, hand, or neck, too.
• Deep brain stimulation: This experimental approach is mostly used for people who have tremors from Parkinson’s disease. A doctor implants electrodes into your brain. Wires connect them to a gadget in your chest. You use it to send your brain signals that stop the tremors.
• Medical cannabis: There’s little evidence that cannabis can help with tremors, but study results are mixed and usually only include small numbers of people.
• Physical therapy: It can show you exercises that increase your range of motion, improve your posture and balance, and make your body more stable
• Speech therapy: If you have tremors in your lips, tongue, or jaw, a health professional can work with you to slow your speech, make it clearer, and control the volume.
• Occupational therapist: This person will set you up with special tools called adaptive or assistive devices. They can help you grab things from up high or off the floor, pull up a zipper, or hold a fork more easily.
• Weights: Adding extra weight to a body part can help keep it still. You can also add weights to commonly used items like forks, pencils, pens, eating utensils, canes, and walkers.

Tremors and Depression

Tremors can be tough to handle in social situations. You may feel like you want to be alone, but that can make you feel lonely and depressed. A psychologist or counselor can help you find ways to feel more comfortable in public and keep the tremors from changing how you live your life.

What Is the MS Hug?

Written by Tracy Brown

Medically Reviewed by Christopher Melinosky, MD on April 14, 2022

If you have multiple sclerosis, an autoimmune disease that affects the brain and spinal cord, you might have felt a band of pain around your torso. It’s often called the “MS hug.”

What It Feels Like

Like most MS symptoms, it’s different for each person. You might feel it right under your rib cage, in your chest, or anywhere between your neck and waistline. It can be:

Burning

Dull and achy pain

Hard to breathe

Pain on one side of your body

Pressure

Sharp pain

Tickling

Tightness

Tingling or pins and needles

Vibration

It can last a few seconds to a few hours, and in rare cases, a few days. People often say it’s like wearing a girdle around the middle of your body. For that reason, you may also hear it called by a number of names, like:

Banding

Girdle-band

Girdling

MS girdle

You might feel it in your head, hands, or feet instead. People with this type of sensation feel like they’re wearing tight gloves or boots. Read more about muscle spasms and tightness with MS.

What Causes It?

MS affects the way nerves send messages. The tightness, pain, or whatever you’re feeling results from spasms in small muscles between your ribs. The doctor will call these intercostal muscles. They hold your rib cage together and help it expand when you move, bend, or breathe. If these muscles have spasms, you feel painful, tightening pressure.

The hug is a type of nerve pain. You might hear a doctor call it dysesthesia, which means a sensation that isn't normal.

If other symptoms come on quickly at the same time, the hug can also be a sign that your MS is relapsing. Call your doctor if this happens. Get more information on what dyesthesia pain feels like with MS.

What Should You Do?

If you think you’re having an MS hug, talk to your neurologist or main doctor right away. The symptoms can seem like those of a heart attack, so it’s important to make sure that’s not the case and to rule out any other causes of the pressure.

Your doctor will most likely give you an MRI to look for other things, like gallbladder problems or lung disease. MS hug can also happen to people with other rib and spinal cord conditions.

Can You Prevent It?

Yes. The hug responds to the same triggers as other MS symptoms. Keep notes and learn what sets yours off. It might show up, or get worse if you’re:

Fighting a cold, flu, or bladder infection

Fatigued

Stressed out

Too hot

Medications for MS Hug

You may not need treatment. But if you do, what your doctor gives you will depend on the cause.

If they think your symptoms signal a relapse, you might get steroids to help prevent it:

Corticotropin (Acthar, HP Acthar)

Methylprednisone

Prednisone

Your doctor may suggest over-the-counter treatments like:

Acetaminophen or ibuprofen

Pain relief cream

Or they could prescribe other medications, including:

Drugs for depression that also fight nerve pain, such as amitriptyline (Elavil) and duloxetine  (Cymbalta)

Drugs that stop convulsions and also halt nerve pain, like gabapentin (Neurontin) and          pregabalin (Lyrica)

Muscle relaxers like baclofen (Lioresal, Gablofen)

Your health care team will work with you to choose the best mix of treatments for you.

How to Manage the MS Hug

You can try these things at home:

Apply a warm compress. (Be careful: Heat might make your pain worse.)

Drink plenty of water.

Eat healthy food.

Get a massage.

Stay rested. Get at least 8 hours of sleep each night.

Use deep breathing techniques, yoga, and meditation.

Some people get relief from wearing tight clothing but may prefer loose clothing.

View a slideshow to learn more about other unusual symptoms of MS.