Why MS Can Affect Your Breathing — and What You Can Do About It

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.

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.

What You Can Do When MS Attacks Your Breathing Function

If you’re unable to cough normally or you're feeling short of breath, dizzy, or even faint, don't just write off these symptoms as an expected part of life with MS. Taking the following steps can help you manage the problem and prevent it from getting worse, says Reder.

See your doctor. Your doctor will ask you about your symptoms and do a physical exam to look for the cause of the problem. They may conduct tests of your lung function or refer you to a pulmonologist for pulmonary function tests. Lung function tests are painless and noninvasive, and they allow your doctor to see how much air is moving in and out of your lungs, how forcefully you can exhale after inhaling, and how quickly you can force air out of your lungs.

Go to pulmonary rehabilitation. Depending on the cause of your breathing problems, your doctor may refer you for pulmonary rehabilitation, where you’ll learn exercises and techniques to improve your breathing. You may be instructed to spend several minutes a day using a handheld device to build your breathing muscles and increase your lung volume. You may also work with a physical therapist or pulmonary rehabilitation specialist on exercises to strengthen your upper body.

A study published in October 2020 in Multiple Sclerosis and Related Disorders found that 12 weeks of inspiratory muscle training with low resistance (like breathing in and out through a wide straw) was more effective than conventional respiratory exercises to improve respiratory strength and labored breathing in people who have MS.

Additionally, a review published in December 2017 in the Cochrane Library found some evidence that inspiratory muscle training with a resistive device is moderately effective at improving respiratory muscle strength in people who have mild to moderate MS.

Aim for a healthy weight. Being overweight and having a thick neck can lead to sleep apnea, says Brod. To maintain a healthy weight, you may have to battle the fatigue that often comes with MS, notes Reder. “Many patients with MS are tired, fatigued, and weak from deconditioning and the MS,” he says, adding that it’s important to “fight” these symptoms and try your best to exercise regularly and eat a healthy diet.

Stop smoking. “It is known that smoking is bad for a person with MS,” points out Brod. It's also bad for your lungs. If you smoke and have multiple sclerosis, you're increasing the burden on your lungs.

Use oxygen if it's prescribed. Supplemental oxygen is rarely needed for MS unless you have another medical condition that affects your lungs, such as COPD. But if oxygen is prescribed, it can help you feel better and function better.