“Recently I have focused on sleep problems in MS. One particular problem is bladder overactivity at night that results in you having to get up several times to pass urine. There is a treatment for this. The drug is called DDAVP or desmopressin; it comes in the form of a nasal spray or tablets. The drug works by acting on the kidney and reduces the amount of urine the kidney produces over the next 6 hours. By reducing the volume of urine produced it allows you to get a good night’s sleep. What is the downside? The main downside is that you can only use this drug once a day; if you use it more than once a day you may develop water retention that can be dangerous. To make sure this is not occurring you need to have your blood electrolytes, in particular your sodium levels, checked after you have been on desmopressin for 4-6 weeks. The other side effect that occurs in about 30% of MSers is mild foot swelling; this is more common in MSers with reduced mobility. I must stress that the foot swelling is mild and is seldom a problem. In the study below desmopressin reduced episodes of night time voiding significantly; it is a pity they didn’t include a sleep metric. In my experience the biggest benefit of nighttime desmopressin is improved sleep quality. MSers who respond to desmopressin feel more refreshed on awakening the morning, have reduced daytime tiredness or hypersomnolence, and occasionally reduced fatigue.”
Zahariou et al. Maximal bladder capacity is a positive predictor of response to desmopressin treatment in patients with MS and nocturia. Int Urol Nephrol. 2008;40(1):65-9.
OBJECTIVE: The aim of the study is to evaluate the efficacy of desmopressin therapy in the symptomatic treatment of nocturia in MSers and neurogenic detrusor overactivity, and to investigate the validity of maximal bladder capacity as a predictor of response to intranasal desmopressin inhalation.
MATERIAL AND METHODS: A set of 20 women MSers and neurogenic detrusor overactivity enrolled in a prospective pilot study and were divided into two groups: Group A, the large bladder capacity group (maximal bladder capacity >250 ml, compliance >20 ml/cm H(2)O, n=10) and Group B, the small bladder capacity group (maximal bladder capacity <250 ml, compliance <20 ml/cm H(2)O, n=10). Maximal bladder capacities were measured by urodynamic evaluation. The dosage selected for the study was based on the established dose of commercially available desmopressin nasal spray (20 micrograms before bedtime) and on clinical trial experience. All MSers were monitored for arterial blood pressure before and after treatment and for weight increase for the first 5 days of treatment. Night time voiding diaries were maintained for the 6 weeks of the trial; similarly, serum electrolyte levels and urine osmolality were measured twice weekly during the trial.
RESULTS: The mean volume of nocturnal incontinence decreased significantly in both groups (P<0.005). The average number of episodes of nocturia per night in Group A decreased from 2.35 to 0.89 and in Group B from 2.31 to 1.65. The maximum hours of sleep uninterrupted by nocturia increased from 2.54 to 4.62 in Group A and from 2.45 to 3.23 in Group B. Side effects were infrequent; only 2 MSers complained of transient headaches. Neither hyponatremia nor serum electrolyte abnormalities occurred.
CONCLUSIONS: Our results suggest that desmopressin is effective in the symptomatic management of nocturia in MSers with neurogenic detrusor overactivity. Maximal bladder capacity is a valuable predictor of response to desmopressin.