Among the many possible complications of multiple sclerosis (MS) is a reduction in your ability to exhale fully and to cough effectively enough to clear secretions or food from your airway, says Anthony Reder, MD, a multiple sclerosis specialist and professor of neurology at the University of Chicago. A serious consequence of these changes is a higher risk of respiratory infections like pneumonia. Changes in breathing function can also cause fatigue, as you work harder to breathe and supply your body with the oxygen it needs

Multiple sclerosis can negatively affect multiple processes that control or modulate breathing. Here’s what you can do to improve your respiratory function.

How MS Can Affect Your Breathing

There are a number of ways that MS can lead to breathing problems, including the following:

Lesions in the Brain 

As multiple sclerosis progresses, lesions in your brain and spine can affect almost every aspect of your physical functioning. It’s possible that brain lesions could change your respiratory function, says Zulma Hernandez-Peraza, MD, a neurologist at the University of Illinois Hospital and Health Sciences System in Chicago.

Lesions that disrupt the signals from the brain to the lungs can result in a condition known as central sleep apnea, in which breathing stops and restarts repeatedly during sleep, notes Dr. Reder. Symptoms of central sleep apnea include waking up abruptly with shortness of breath, having shortness of breath that improves with sitting up, insomnia, daytime sleepiness, and chest pain at night.

A more common form of sleep apnea, where the upper airway becomes intermittently obstructed, can also occur in people with MS if the muscles that normally keep the airway open become slack due to lesions in the brain, adds Reder. Obstructive sleep apnea is associated with snoring and obesity.

Spinal Lesions 

These can cause weakness of the breathing muscles and also restrict your ability to get air in and out of the lungs, says neurologist Staley Brod, MD, professor of neurology at the Medical College of Wisconsin in Milwaukee. “Weakness can affect breathing,” says Dr. Brod. Spasticity in the muscles that help with inhaling and exhaling could also contribute to the problem.

“A lesion in the cervical spine creates the ‘MS hug’ sensation, which can cause the feeling of shortness of breath,” adds Dr. Hernandez-Peraza. “This is usually just an unpleasant perception. When tested, the oxygen levels in your blood should be normal.”

Medication 

One of the side effects of the MS disease-modifying drug Gilenya (fingolimod) is a reduction in some measures of breathing function, says Reder. Some types of medication, such as tranquilizers, muscle relaxants, and opioids, can also slow or reduce breathing.

In 2019, the U.S. Food and Drug Administration (FDA) issued a warning that serious breathing difficulties may occur in people who have respiratory risk factors who are taking gabapentin (Neurontin, Gralise, Horizant) or pregabalin (Lyrica, Lyrica CR). According to the National Multiple Sclerosis Society, these pain medications (known as gabapentinoids) are sometimes prescribed for people who have multiple sclerosis. Talk to your doctor if you have respiratory risk factors including (but not limited to) chronic obstructive pulmonary disease (COPD) or older age and you have been prescribed these medications, especially at high doses, notes Reder.

Why Multiple Sclerosis Can Affect Your Breathing | Everyday Health