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'''Sleep dysfunction''' is universal in [[ME/CFS]] patients, although it can take a very wide range of forms. These include [[dysania]], [[hypersomnia]], [[hypnagogia]], [[insomnia]], [[light sleep]], [[myoclonus]], [[nightmares]], [[night sweats]], [[phase shifting]], [[somnolence]], and [[unrefreshing sleep]].
[[File:Insomnia_sleep_remedies.jpg|alt="Sleep easy" tea bags containing valerian, lemon balm capsules and a bottle of melatonin.|thumb]]
'''Sleep dysfunction''' is very common in [[ME/CFS]] patients and can take a very wide range of forms, with [[unrefreshing sleep]] being particularly common.<ref name="CDC-symptoms">{{Cite web|url = https://www.cdc.gov/me-cfs/symptoms-diagnosis/symptoms.html | title = Symptoms {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|website=[[Centers for Disease Control and Prevention]] | date = Jan 27, 2021|access-date = 2021-02-25}}</ref> The prevalence of sleep disorders in ME/CFS is estimated at 56%.<ref>{{Cite journal | date = 2018-07-01 | title = Chronic fatigue syndrome and sleep disorders: Clinical associations and diagnostic difficulties|url=https://www.sciencedirect.com/science/article/pii/S2173580818300038|journal=Neurología (English Edition)|language=en|volume=33|issue=6|pages=385–394|doi=10.1016/j.nrleng.2015.11.020|issn=2173-5808}}</ref><ref name="ICC2011primer" /><ref name="canadianconsensus-CCC" /><ref name="CDC-symptoms" />
 
[[Fibromyalgia]] patients also suffer from sleep disorders.<ref name="ACR2010">{{Cite journal|url=https://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf | title = American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia | last = Wolfe | first = Frederick | date = May 2010|volume =62 | issue = 5 | pages = 600–610| doi = 10.1002/acr.20140|type=PDF|archive-url=|archive-date=|access-date= | author-link =| last2 = Clauw | first2 = Daniel | authorlink2 = |journal=Arthritis Care & Research | last3 = Fitzcharles | first3=Mary-Ann | first4 = Don| last5 = Katz | last4 = Goldenberg | first5 = Robert | last6 = Mease | first6 = Philip | last7 = Russel | first7 = Anthony | last8 = Russel | first8 = I. Jon | first9 = John | last9 = Winfield | first10 = Muhammad | last10 = Yunus|quote=}}</ref>
 
== Types of sleep dysfunction ==
Some of these sleep dysfunctions or disorders include:
*[[dysania]]<ref>{{Cite web|url=https://ammes.org/symptoms-of-mecfs/ | title = Symptoms of ME/CFS – American ME and CFS Society|website=[[American ME and CFS Society]]|language=en-US|access-date=2018-08-29}}</ref> (a state of finding it hard to get out of bed in the morning; in [[ME/CFS]] it can an extended period lasting several hours after awakening)
*[[hypersomnia]] (excessive sleeping, inability to stay awake)
*[[agogia]] (transitional state from wakefulness to sleep during which lucid thought, lucid dreaming, hallucinations and, sleep paralysis can occur)
*[[insomnia]]<ref>{{Cite journal | date = 2015-05-01 | title = The role of insomnia in the treatment of chronic fatigue|url=https://www.sciencedirect.com/science/article/pii/S002239991400422X|journal=Journal of Psychosomatic Research|language=en|volume=78|issue=5 | pages = 427–432|doi=10.1016/j.jpsychores.2014.11.022|issn=0022-3999}}</ref> (difficulty falling asleep, staying asleep, and/or waking up too early in the morning)
*[[light sleep]] (a non-REM stage and the easiest sleep stage to awaken from)
*[[Periodic limb movement disorder]]/nocturnal myoclonus - involuntary jerking or leg movements when sleeping or when falling asleep<ref name="UScoal-2020">{{Cite web | title =  Diagnosing and Treating Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | last=U.S. ME/CFS Clinician Coalition
|edition=2 | date = July 2020 | url= https://bridgesandpathways.org.au/wp-content/uploads/2021/02/DiagnosingAndTreatingMECFSV2_USCoalition_2020.pdf
| pages = 4}}</ref>
*[[nightmare]]s (a frightening or unpleasant dream)
*[[night sweat]]s (excessive sweating while you sleep)
*[[Restless legs syndrome]]<ref>{{Cite journal | last = Viola-Saltzman | first = Mari | last2 = Watson | first2 = Nathaniel F. | last3 = Bogart | first3=Andy | last4 = Goldberg | first4 = Jack| last5 = Buchwald | first5 = Dedra | date = 2010-10-15 | title = High prevalence of restless legs syndrome among patients with fibromyalgia: a controlled cross-sectional study|url=https://www.ncbi.nlm.nih.gov/pubmed/20957840|journal=Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine|volume=6|issue=5 | pages = 423–427|issn=1550-9389|pmid=20957840|via=}}</ref> (a strong urge to move one's legs)
*[[Sleep apnea]] (pauses in breathing or periods of shallow breathing)
*[[Reversed or chaotic diurnal sleep rhythms|sleep phase shifting]] or [[sleep reversal]]<ref name="Cambras2018">{{Cite journal | last = Cambras | first=Trinitat | last2 = Castro-Marrero | first2 = Jesús | last3 = Zaragoza | first3=Maria Cleofé | last4 = Díez-Noguera | first4 = Antoni| last5 = Alegre | first5 = José | date = 2018-06-06 | title = Circadian rhythm abnormalities and autonomic dysfunction in patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis|url=https://doi.org/10.1371/journal.pone.0198106|journal=PLOS ONE|language=en|volume=13|issue=6| pages = e0198106|doi=10.1371/journal.pone.0198106|issn=1932-6203|pmid=29874259|via=}}</ref> ([[reversed or chaotic diurnal sleep rhythms]]) (circadian abnormalities: delayed sleep phase, non-24hr sleep cycle, loss of rhythm)
*[[somnolence]] (sleepiness)
*[[unrefreshing sleep]] (poor-quality sleep that doesn't relieve fatigue)<ref name="ICC2011primer" /><ref name="canadianconsensus-CCC">{{Citation | last1 = Carruthers | first1 = Bruce M. | authorlink1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | authorlink6 = Martin Lerner | last7 = Bested | first7 = Alison C. | authorlink7 = Alison Bested | last8 = Flor-Henry | first8 = Pierre | authorlink8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip| authorlink9 = Pradip Joshi | last10  = Powles | first10 = AC Peter | authorlink10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | authorlink11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I.  | authorlink12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols| journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 |  pmid    =
| doi = 10.1300/J092v11n01_02| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf}}</ref>


==Prevalence==
==Prevalence==
*Depending on the criteria used for diagnosis, prevalence can vary greatly.
*In a 2001 Belgian study, 91.9% of patients meeting the [[Fukuda criteria]] and 94.8% of patients meeting the [[Holmes criteria]], in a cohort of 2073 [[chronic fatigue syndrome|CFS]] patients, reported sleep disturbances.<ref>{{Cite journal | last = De Becker | first=Pascale | authorlink = Pascale De Becker | last2 = McGregor | first2 = Neil | authorlink2 = Neil McGregor | last3 = De Meirleir | first3=Kenny | author-link3 = Kenny De Meirleir | date = December 2001 | title = A definition‐based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome|url=https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2796.2001.00890.x?sid=nlm%3Apubmed|journal=Journal of Internal Medicine|volume=250|issue=3|pages=234–240|doi=10.1046/j.1365-2796.2001.00890.x|quote=|via=}}</ref>
*A 2017 study by Davidson, et al, found up to 96.8% of people with CFS report [[unrefreshing sleep]] and many describe changes in sleep over the course of their illness.<ref name="Davidson, 2017" />
According to the published evidence, the mean prevalence of sleep disorders in patients with CFS is '''estimated at 56%.'''<ref>{{Cite journal | date = 2018-07-01 | title = Chronic fatigue syndrome and sleep disorders: Clinical associations and diagnostic difficulties|url=https://www.sciencedirect.com/science/article/pii/S2173580818300038|journal=Neurología (English Edition)|language=en|volume=33|issue=6|pages=385–394|doi=10.1016/j.nrleng.2015.11.020|issn=2173-5808}}</ref>
{| class="wikitable"
!
!Year
!N
!Prevalence
!Sleep disorders included
|-
|Krupp et al.<ref>{{Cite journal | last = Krupp | first = Lauren B. | last2 = Jandorf | first2 = L. | last3 = Coyle | first3 = P.K. | last4 = Mendelson | first4 = W.B. | date = 1993-05-01 | title = Sleep disturbance in chronic fatigue syndrome|url=http://www.sciencedirect.com/science/article/pii/0022399993901342|journal=Journal of Psychosomatic Research|language=en|volume=37|issue=4|pages=325–331|doi=10.1016/0022-3999(93)90134-2|issn=0022-3999}}</ref>
|1993
|16
|62%
|OSAHS, PLMD, narcolepsy, hypersomnia
|-
|Morriss et al.<ref>{{Cite journal | last = Morriss | first = R. | last2 = Sharpe | first2 = M. | last3 = Sharpley | first3 = A.L. |  last4 = Cowen | first4 = P.J. | last5 = Hawton | first5 = K. | last6 = Morris | first6 = J. | date = 1993-05-01 | title = Abnormalities of sleep in patients with the chronic fatigue syndrome.|url=https://www.bmj.com/content/306/6886/1161|journal=British Medical Journal|language=en|volume=306|issue=6886|pages=1161–1164|doi=10.1136/bmj.306.6886.1161|issn=0959-8138|pmid=8499816}}</ref>
|1993
|12
|58%
|Maintenance insomnia
|-
|Buchwald et al.<ref>{{Cite journal | last = Buchwald | first=Dedra | last2 = Pascualy | first2 = Ralph | last3 = Bombardier | first3=Charles | last4 = Kith | first4 = Phalla | date = 1994-01-01 | title = Sleep Disorders in Patients with Chronic Fatigue|url=https://doi.org/10.1093/clinids/18.Supplement_1.S68|journal=Clinical Infectious Diseases|volume=18|issue=Supplement_1|pages=S68–S72|doi=10.1093/clinids/18.supplement_1.s68|issn=1537-6591}}</ref>
|1994
|59
|81%
|OSAHS, hypersomnia
|-
|Le Bon et al.<ref>{{Cite journal | last = Le Bon | first = O. | last2 = Fischler | first2 = B. | last3 = Hoffmann | first3=G. | last4 = Murphy | first4 = J.R. | last5 = De Meirleir | first5 = K. | last6 = Cluydts | first6 = R. | last7 = Pelc | first7 = I. | date = 2000 | title=How significant are primary sleep disorders and sleepiness in the chronic fatigue syndrome?|url=https://pubmed.ncbi.nlm.nih.gov/11382899/|journal=Sleep research online: SRO|volume=3|issue=2 | pages = 43–48|issn=1096-214X|pmid=11382899}}</ref>
|2000
|53
|46%
|OSAHS
|-
|Fossey et al.<ref>{{Cite journal | last = Fossey | first = Myrtis | last2 = Libman | first2 = Eva | last3 = Bailes | first3=Sally | last4 = Baltzan | first4 = Marc| last5 = Schondorf | first5 = Ronald | last6 = Amsel | first6 = Rhonda | last7 = Fichten | first7 = Catherine S. | date = 2004-12-01 | title = Sleep Quality and Psychological Adjustment in Chronic Fatigue Syndrome|url=https://doi.org/10.1007/s10865-004-0004-y|journal=Journal of Behavioral Medicine|language=en|volume=27|issue=6|pages=581–605|doi=10.1007/s10865-004-0004-y|issn=1573-3521}}</ref>
|2004
|37
|58%
|OSAHS, narcolepsy
|-
|Reeves et al.<ref>{{Cite journal | last = Reeves | first=William C. | last2 = Heim | first2 = Christine | last3 = Maloney | first3 = Elizabeth M. | last4 = Youngblood | first4 = Laura Solomon| last5 = Unger | first5 = Elizabeth R. | last6 = Decker | first6 = Michael J. | last7 = Jones | first7 = James F. | last8 = Rye | first8 = David B. | date = 2006-11-16 | title = Sleep characteristics of persons with chronic fatigue syndrome and non-fatigued controls: results from a population-based study|url=https://doi.org/10.1186/1471-2377-6-41|journal=BMC Neurology|language=en|volume=6|issue=1 | pages = 41|doi=10.1186/1471-2377-6-41|issn=1471-2377|pmc =  1660569|pmid=17109739}}</ref>
|2006
|43
|25%
|OSAHS, PLMD
|-
|Majer et al.<ref>{{Cite journal | last = Majer | first = Matthias | last2 = Jones | first2 = James F. | last3 = Unger | first3=Elizabeth R. | last4 = Youngblood | first4 = Laura Solomon| last5 = Decker | first5 = Michael J. | last6 = Gurbaxani | first6 = Brian | last7 = Heim | first7 = Christine | last8 = Reeves | first8 = William C. | date = 2007-12-05 | title = Perception versus polysomnographic assessment of sleep in CFS and non-fatigued control subjects: results from a population-based study|url=https://doi.org/10.1186/1471-2377-7-40|journal=BMC Neurology|language=en|volume=7|issue=1 | pages = 40|doi=10.1186/1471-2377-7-40|issn=1471-2377|pmc =  2231384|pmid=18053240}}</ref>
|2007
|35
|30%
|OSAHS, PLMD, ISS
|-
|Libman et al.<ref>{{Cite journal | last = Libman | first = Eva | last2 = Creti | first2 = Laura | last3 = Baltzan | first3=Marcel | last4 = Rizzo | first4 = Dorrie| last5 = Fichten | first5 = Catherine S. | last6 = Bailes | first6 = Sally | date = 2009-10-26 | title = Sleep Apnea and Psychological Functioning in Chronic Fatigue Syndrome|url=https://journals.sagepub.com/doi/10.1177/1359105309344895|journal=Journal of Health Psychology|language=en|doi=10.1177/1359105309344895}}</ref>
|2009
|66
|68%
|OSAHS
|-
|Creti et al.<ref>{{Cite journal | last = Creti | first = Laura | last2 = Libman | first2 = Eva | last3 = Baltzan | first3=Marcel | last4 = Rizzo | first4 = Dorrie| last5 = Bailes | first5 = Sally | last6 = Fichten | first6 = Catherine S. | date = 2010-05-11 | title = Impaired Sleep in Chronic Fatigue Syndrome: How Is It Best Measured?|url=https://journals.sagepub.com/doi/10.1177/1359105309355336|journal=Journal of Health Psychology|language=en|doi=10.1177/1359105309355336}}</ref>
|2010
|49
|69%
|OSAHS, PLMD
|-
|
|
|
|65%
|Chronic insomnia
|-
|''Mean''
|
|
|''56.2%''
|
|}


==Symptom recognition==
==Symptom recognition==
*In the [[Holmes criteria]], '''sleep disturbance''' is an optional criteria for diagnosis, under the section ''Minor Symptom Criteria''.<ref>[http://www.cfids-me.org/holmes1988.html The 1988 Holmes Definition for CFS]</ref>
Sleep dysfunction is a core diagnostic symptom required in the 2003 [[Canadian Consensus Criteria]] diagnostic criteria for [[ME/CFS]],<ref name="CCC">{{Cite journal | last = Carruthers | first=Bruce M. | last2 = Jain | first2 = Anil Kumar | last3 = De Meirleir | first3=Kenny L. | last4 = Peterson | first4 = Daniel L. | last5 = Klimas | first5 = Nancy G. | last6 = Lerner | first6 = A. Martin | last7 = Bested | first7 = Alison C. | last8 = Flor-Henry | first8 = Pierre | last9 = Joshi | first9 = Pradip | date = 2003 | title=Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://doi.org/10.1300%2Fj092v11n01_02 |journal=Journal of Chronic Fatigue Syndrome|language=en|volume=11|issue=1 | pages = 7–115|doi=10.1300/j092v11n01_02|issn=1057-3321|via=}}</ref> the 2007 [[Nightingale definition]],<ref>{{Cite web|url=http://www.investinme.org/Documents/PDFdocuments/Byron%20Hyde%20Definition%20Booklet.pdf | title = The Nightingale, Myalgic Encephalomyelitis (M.E.) Definition | last = | first =  | date = Jan 2007 | website = investinme.org|archive-url=|archive-date=|url-status=|access-date=}}</ref> and the 2015 [[Systemic Exertion Intolerance Disease|Institute of Medicine report]].<ref>{{Cite web|url=http://iom.nationalacademies.org/~/media/Files/Report%20Files/2015/MECFS/MECFS_ProposedDiagnosticCriteria?_ga=1.14761526.1865741811.1437002921 | title = Proposed Diagnostic Criteria for ME/CFS | last = | first =  | date = 2015 | website = nationalacademies.org|archive-url=|archive-date=|url-status=|access-date=}}</ref>
*With the [[Systemic Exertion Intolerance Disease]] criteria, [[unrefreshing sleep]] is a core requirement for diagnosis.<ref>http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2015/MECFS/MECFScliniciansguide.pdf</ref>
 
Sleep dysfunction is an optional symptom in the 1988 [[Holmes criteria]],<ref>{{Cite journal | last = Holmes | first=G. P. | last2 = Kaplan | first2 = J.E. | last3 = Gantz | first3 = N.M. | last4 = Komaroff | first4 = A.L. |  last5 = Schonberger | first5 = L.B. |last6 = Straus | first6 = S.E. | last7 = Jones | first7 = J.F. |last8 = Dubois | first8 = R.E. | last9 = Cunningham-Rundles | first9 = C. | date = 1988 | title = Chronic fatigue syndrome: a working case definition|url=https://www.ncbi.nlm.nih.gov/pubmed/2829679|journal=Annals of Internal Medicine|volume=108|issue=3|pages=387–389|issn=0003-4819|pmid=2829679|via=}}</ref> the 1991 [[Oxford criteria]],<ref>{{Cite journal | last = Sharpe | first = M. C. | last2 = Archard | first2 = L.C. | last3 = Banatvala | first3 = J.E. | last4 = Borysiewicz | first4 = L.K. | last5 = Clare | first5 = A.W. | last6 = David | first6 = A. | last7 = Edwards | first7 = R.H. | last8 = Hawton | first8 = K.E. | last9 = Lambert | first9 = H.P. | date = 1991 | title = A report--chronic fatigue syndrome: guidelines for research|url=https://www.ncbi.nlm.nih.gov/pubmed/1999813|journal=Journal of the Royal Society of Medicine|volume=84|issue=2|pages=118–121|issn=0141-0768|pmid=1999813|via=}}</ref> the 1994 [[Fukuda criteria]],<ref>{{Cite journal | last = Fukuda | first = K. | last2 = Straus | first2 = S.E. | last3 = Hickie | first3 = I. | last4 = Sharpe | first4 = M.C. | last5 = Dobbins | first5 = J.G. |last6 = Komaroff | first6 = A. | date = 1994-12-15 | title = The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group | url = https://www.ncbi.nlm.nih.gov/pubmed/7978722|journal=Annals of Internal Medicine|volume=121|issue=12 | pages = 953–959|issn=0003-4819|pmid=7978722}}</ref> the 2005 [[Reeves criteria]],<ref>{{Cite journal | last = Reeves | first=William C. | last2 = Wagner | first2 = Dieter | last3 = Nisenbaum | first3 = Rosane | last4 = Jones | first4 = James F. | last5 = Gurbaxani | first5 = Brian | last6 = Solomon | first6 = Laura | last7 = Papanicolaou | first7 = Dimitris A. | last8 = Unger | first8 = Elizabeth R. | last9 = Vernon | first9 = Suzanne D. | date = 2005-12-15 | title = Chronic fatigue syndrome--a clinically empirical approach to its definition and study|url=https://www.ncbi.nlm.nih.gov/pubmed/16356178|journal=BMC medicine|volume=3|pages=19|doi=10.1186/1741-7015-3-19|issn=1741-7015|pmid=16356178|via=}}</ref> the 2007 [[NICE guidelines]],<ref>{{Cite web|url=https://www.nice.org.uk/guidance/CG53/chapter/1-Guidance#diagnosis | title = Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management {{!}} Guidance and guidelines {{!}} NICE | last = | first =  | date = Aug 2007 | website = nice.org.uk|language=en-GB|archive-url=|archive-date=|url-status=|access-date=2018-08-29}}</ref> the 2012 [[International Consensus Criteria]].<ref>{{Cite journal | last = Carruthers | first=B. M. | last2 = Sande | first2 = M. I. van de | last3 = Meirleir | first3=K. L. De | last4 = Klimas | first4 = N.G. | last5 = Broderick | first5 = G. | last6 = Mitchell | first6 = T. | last7 = Staines | first7 =  D. | last8 = Powles | first8 = A.C.P. | last9 = Speight | first9 = N. | date = 2011-10-01 | title = Myalgic encephalomyelitis: International Consensus Criteria|url=http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02428.x/full|journal=Journal of Internal Medicine|language=en|volume=270|issue=4|doi=10.1111/j.1365-2796.2011.02428.x/full|issn=1365-2796}}</ref>, and the 2014 [[London criteria]].<ref>{{Cite web|url=http://www.axfordsabode.org.uk/me/mecrit2014.htm | title = ME/CFS Medical Update (Layman's version) Winter 2001 | website = axfordsabode.org.uk|access-date=2018-08-29}}</ref>
 
Sleep dysfunction is not a criteria listed for diagnosis with the 1986 [[Ramsay definition]].<ref>{{Cite web|url=http://www.cfids-me.org/ramsay86.html | title = Ramsay's Definition of M.E., 1986 | website = cfids-me.org|access-date=2018-08-29}}</ref>


==Notable studies==
==Notable studies==
*2017, Sleep Quality in Adolescents With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)[https://www.ncbi.nlm.nih.gov/pubmed/28760189 (ABSTRACT)]<ref>Josev EK, Jackson ML, Bei B, Trinder J, Harvey A, Clarke C, Snodgrass K, Scheinberg A, Knight SJ. (2017) Sleep Quality in Adolescents With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). ''J Clin Sleep Med''. 2017 Jul 28. pii: jc-17-00047</ref>
*2007, Paradoxical NREMS Distribution in “Pure” Chronic Fatigue Patients: A Comparison with Sleep Apnea-Hypopnea Patients and Healthy Control Subjects<ref>{{Cite journal | last = Bon | first = Olivier Le | last2 = Neu | first2 = Daniel | last3 = Valente | first3 = Filomena | last4 = Linkowski | first4 = Paul | date = 2007 | title=Paradoxical NREMS Distribution in “Pure” Chronic Fatigue Patients|url=https://www.tandfonline.com/doi/abs/10.1300/J092v14n02_05|journal=Journal of Chronic Fatigue Syndrome|language=en|volume=14|issue=2 | pages = 45–59|doi=10.1300/j092v14n02_05|issn=1057-3321|via=}}</ref> - [https://www.tandfonline.com/doi/abs/10.1300/J092v14n02_05 (Abstract)]
*2007, Paradoxical NREMS Distribution in “Pure” Chronic Fatigue Patients: A Comparison with Sleep Apnea-Hypopnea Patients and Healthy Control Subjects<blockquote>"Abstract - Objective: The chronic fatigue syndrome (CFS) is a debated clinical entity, not presently associated with specific sleep abnormalities. However, higher levels of deep sleep and/or lower levels of light sleep have been reported in several all-night polysomnography studies in CFS patients. This distribution of Non-Rapid Eye Movement Sleep (NREMS) contrasts with what would be expected if sleep was interrupted by microawakenings, such as in sleep apneas or periodic limb movements, where more light sleep and less deep sleep are commonly observed. This “paradoxical” distribution of NREMS could represent a characteristic feature of chronic fatigue and deserved to be investigated. Methods: A retrospective comparison of the NREMS distribution was performed between 28 “pure” Chronic Fatigue Syndrome patients (without primary sleep or psychiatric disorders), 27 Apneic-Hypopneic patients and 27 Healthy Controls. Results: Data showed CFS patients to have a higher stage 4/stage 2 or stage 4/light sleep ratios than the other two conditions. Conclusion: This sleep pattern is closer to what is observed in cases of infections than to what is seen after sleep fragmentation by primary sleep or in psychiatric disorders. Such a particular sleep pattern could provide insights into the pathophysiology of fatigue.''<ref>Olivier Le Bon, Daniel Neu, Filomena Valente & Paul Linkowski. (2007). Health-Related Quality of Life in Chronic Fatigue Syndrome versus Rheumatoid Arthritis as Control Group. ''Journal of Chronic Fatigue Syndrome'', Vol. 14, Iss. 2, pp. 45-59. http://dx.doi.org/10.1300/J092v14n02_05</ref></blockquote>
*2012, Sleep Abnormalities in [[ME/CFS|Chronic Fatigue Syndrome/Myalgic Encephalomyelitis]]: A Review<ref name="Jackson, 2012" /> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3501671/ (Full Text)]
*2017, Sleep Quality in Adolescents With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)<ref>{{Cite journal | last= Josev | first = Elisha K. | author-link = Elisha Josev | last2 = Jackson | first2 = Melinda L. | authorlink2 = Melinda Jackson | last3 = Bei | first3 = Bei | author-link3 = | last4 = Trinder | first4 = John | author-link4 = | last5 = Harvey | first5 = Adrienne | authorlink5 = | last6 = Clarke | first6 = Cathriona | last7 = Snodgrass | first7 = Kelli | last8 = Scheinberg | first8 = Adam | authorlink8 = | last9 = Knight | first9 = Sarah J. | authorlink9 = Sarah Knight | date = 2017-09-15 | title = Sleep Quality in Adolescents With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)|url=http://jcsm.aasm.org/ViewAbstract.aspx?pid=31079|journal=Journal of Clinical Sleep Medicine|language=en|volume=13|issue=09|pages=1057–1066|doi=10.5664/jcsm.6722|issn=1550-9389|pmc=5566461|pmid=28760189|quote=|via=}}</ref> - [[pubmed:28760189|(Full text)]]
*2018, Circadian rhythm abnormalities and [[autonomic dysfunction]] in patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis<ref name="Cambras, 2018" /> - [http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198106 (Full Text)]
*2018, The putative role of oxidative stress and inflammation in the pathophysiology of sleep dysfunction across neuropsychiatric disorders: Focus on chronic fatigue syndrome, bipolar disorder and [[multiple sclerosis]]<ref name="Morris, 2018" /> - [https://www.ncbi.nlm.nih.gov/pubmed/29759891 (Abstract)]
*2018, Association of sleep disorders, chronic pain, and fatigue with survival in patients with chronic kidney disease: A meta-analysis of clinical trials<ref>{{Cite journal | last = Yang | first = Xiu Hong | last2 = Zhang | first2 = Bao Long | last3 = Gu | first3 = Yan Hong | last4 = Zhan | first4 = Xiao Li| last5 = Guo | first5 = Li Li | last6 = Jin | first6 = Hui Min | date = 2018 | title=Association of sleep disorders, chronic pain, and fatigue with survival in patients with chronic kidney disease: a meta-analysis of clinical trials|url=https://www.sleep-journal.com/article/S1389-9457(18)30397-6/abstract|journal=Sleep Medicine|language=English|volume=51|pages=59–65|doi=10.1016/j.sleep.2018.06.020|issn=1389-9457|via=}}</ref> - ([https://www.sleep-journal.com/article/S1389-9457(18)30397-6/abstract Abstract])
*2021, Systematic Review of Sleep Characteristics in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Maksoud2021">{{Cite journal | last = Maksoud | first = Rebekah | authorlink = | last2 = Eaton-Fitch | first2 = Natalie | authorlink2 = Natalie Eaton-Fitch | last3 = Matula | first3=Michael | authorlink3 = | last4 = Cabanas | first4 = Hélène | authorlink4 = Hélène Cabanas| last5 = Staines | first5 = Donald | authorlink5 = Donald Staines | last6 = Marshall-Gradisnik | first6 = Sonya | author-link6 = Sonya Marshall-Gradisnik | date = May 2021 | title = Systematic Review of Sleep Characteristics in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.mdpi.com/2227-9032/9/5/568|journal=Healthcare|language=en|volume=9|issue=5|pages=568|doi=10.3390/healthcare9050568|pmc=|pmid=|access-date=|quote=|via=}}</ref> [https://www.mdpi.com/2227-9032/9/5/568 (Full text)]


==Treatment==
==Treatment==
Treatment can include:
*perscription drugs
*[[Cannabinoid|cannabiniods]] (CBD)
*alternative natural remedies including [[chamomile]], [[kava]], [[hops]], [[lavender]], [[lemon balm]], and [[passiflora]] (passion flower), and [[valerian]]; kava and valerian have the most evidence
*over-the-counter [[melatonin]] or sedating anti-histamines like [[diphenhydramine]]
*[[vitamin B12]]
*relaxation techniques e.g., [[meditation]]
*good [[sleep hygiene]] practices.<ref name="Gyllenhaal2000">{{Cite journal|title=Efficacy and safety of herbal stimulants and sedatives in sleep disorders|date=2000-06-01|url=https://www.sciencedirect.com/science/article/pii/S108707929990093X|journal=Sleep Medicine Reviews|volume=4|issue=3|pages=229–251|last=Gyllenhaal|first=Charlotte|last2=Merritt|first2=Sharon L.|last3=Peterson|first3=Sara Davia|last4=Block|first4=Keith I.|last5=Gochenour|first5=Tom|doi=10.1053/smrv.1999.0093|issn=1087-0792}}</ref><ref name="Chaudhury2019">{{Cite journal|title=Chronic Insomnia: A Review|date=May 2019|url=https://journals.lww.com/mjdy/Fulltext/2019/12030/Chronic_Insomnia__A_Review.3.aspx|journal=Medical Journal of Dr. D.Y. Patil University|volume=12|issue=3|pages=193|last=Chaudhury|first=Suprakash|last2=Singh|first2=Rakesh Kumar|last3=Kumari|first3=Dolly|last4=Diwan|first4=Chetan|last5=Mujawar|first5=Swaleha|last6=Saldanha|first6=Daniel|language=en-US|doi=10.4103/mjdrdypu.mjdrdypu_76_19|issn=2589-8302}}</ref>


Amitriptyline may be helpful for improving quality of sleep in individuals with CFS. <ref>http://sacfs.asn.au/download/guidelines.pdf</ref><ref>http://www.nhs.uk/Conditions/Chronic-fatigue-syndrome/Pages/Treatment.aspx</ref> While originally considered an antidepressant, it is also prescribed at low doses to specifically manage pain and sleep for a number of conditions.
Medications, including:
*[[:Category:Benzodiazepines|Benzodiazepines]] (benzos), e.g. [[temazepam]], [[Valium]] (diazepam)<ref name="SACFS-survey">{{Cite web|url=https://www.sacfs.asn.au/news/2014/02/02_28_survey_results_insomnia.htm | website = ME/CFS South Australia Inc | title = Survey results - insomnia |access-date=2021-02-11}}</ref>
*[[:Category:Non-benzodiazepine hypnotics|Non-benzodiazepine hypnotics]], commonly known as z-drugs, e.g. [[zopiclone]], [[Ambien]] (zolpidem)
*Sedating [[antidepressant]]s, particularly [[amitriptyline]]
*Sedating [[:Category:Antihistamines|anti-histamines]], e.g., [[diphenhydramine]] (Benadryl)
*[[Melatonin]], either on prescription or as a supplement<ref>{{Cite web|url=https://www.hopkinsmedicine.org/health/wellness-and-prevention/melatonin-for-sleep-does-it-work | title = Melatonin for Sleep: Does It Work?|website=hopkinsmedicine.org|language=en|access-date=2021-02-11}}</ref>
*Anticonvulsants, such as gabapentin and valproic acid
*Other medications, when used off-label<ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | authorlink7 = Donald Staines | last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 =  L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 =  N | authorlink13 = Nicoletta Carlo-Stella | last14 = Chia | first14 =  J | authorlink14 = John Chia | last15 = Darragh | first15 =  A | authorlink15 = Austin Darragh | last16 = Gerken | first16 = A | authorlink16 = Anne Gerken | last17 = Jo | first17 =  D | authorlink17 = Daehyun Jo | last18 = Lewis | first18 =  DP | authorlink18 = Donald Lewis | last19 = Light | first19 = AR | authorlink19 = Alan Light | last20 = Light | first20 =  KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 =  S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 =  J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 =  I | authorlink23 =  Ismael Mena | last24 = Miwa | first24 =  K | authorlink24 =  Kunihisa Miwa | last25 = Murovska | first25 =  M | authorlink25= Modra Murovska | last26 = Stevens | first26 =  SR | authorlink26 =  Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners  | date = 2012| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf }}</ref>
 
Supplements and natural remedies include:<dynamicpagelist>
category = Sleep aids and hypnotics
category = Supplements
ordermethod=sortkey
order=ascending
mode=inline-list
</dynamicpagelist>
 
== See also ==
* [[Buspirone challenge test]] (the degree of prolactin released by buspirone in ME/CFS patients correlates to the degree of shift in their sleep/wake cycle).
* [[Hypersomnia]]
* [[Insomnia]]
* [[Unrefreshing sleep]]
 
==Learn more==
*[https://www.drugs.com/condition/insomnia.html Medications for insomnia] - drugs.com


==References==
==References==
<references>
<references>
 
<ref name="Cambras, 2018">{{Citation | last1 = Cambras | first1 = T. | authorlink1 = | last2 = Castro-Marrero | first2 = J. | authorlink2 = Jesús Castro-Marrero | last3 = Zaragoza | first3 = MC. | authorlink3 = | last4 = Díez-Noguera | first4 = A. | authorlink4 = | last5 = Alegre | first5 = J. | authorlink5 = José Alegre | title = Circadian rhythm abnormalities and autonomic dysfunction in patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis | journal = PLoS ONE | volume = 13 | issue = 6 | page = e0198106 | date = 2018 | pmid =  | doi = 10.1371/journal.pone.0198106 }}</ref>
<ref name="Davidson, 2017">{{Citation | last1 = Davidson | first1 = Sean L. | authorlink1 = | last2 = Gotts | first2 = Zoe M. | authorlink2 = Zoe Gotts | last3 = Ellis | first3 = Jason G.  | authorlink3 = | last4 = Newton | first4 = Julia L.  | authorlink4 = Julia Newton | title = Two year follow-up of sleep diaries and polysomnography in chronic fatigue syndrome: a cohort study | journal = Fatigue: Biomedicine, Health & Behavior | volume = | issue =  | page =  | date = Mar 2017 | pmid =  | doi = 10.1080/21641846.2017.1297280 }}</ref>
<ref name="Jackson, 2012">{{Citation | last1 = Jackson | first1 = ML  | authorlink1 = Melinda Jackson | last2 = Bruck | first2 = D | authorlink2 = Dorothy Bruck | title = Sleep Abnormalities in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Review, Journal of Clinical Sleep Medicine | journal = Journal of Clinical Sleep Medicine | volume = 8 | issue = 6  | page = 719-28 | date = 2012
| doi = 10.5664/jcsm.2276 }}</ref>
<ref name="Morris, 2018">{{Citation | last1 = Morris | first1 = Gerwyn | authorlink1 = Gerwyn Morris | last2 = Stubbs | first2 = Brendon | authorlink2 = | last3 = Köhler | first3 = Cristiano A. | authorlink3 = | last4 = Walder | first4 = Ken | authorlink4 = | last5 = Slyepchenko | first5 = Anastasiya  | authorlink5 = | last6 = Berk | first6 = Michael| authorlink6 = Michael Berk | last7 = Carvalho | first7 = André F.  | authorlink7 = | title = The putative role of Oxidative Stress and Inflammation in the pathophysiology of sleep dysfunction across neuropsychiatric disorders : Focus on Chronic Fatigue Syndrome, Bipolar Disorder and Multiple Sclerosis | journal = Sleep Med Reviews | volume = | issue =  | page =  | date = 2018  | pmid = 29759891
| doi = 10.1016/j.smrv.2018.03.007 }}</ref>
</references>
</references>


[[Category:Signs and symptoms]]
[[Category:Signs and symptoms]]
[[Category:Sleep signs and symptoms]]
[[Category:Sleep signs and symptoms]]

Latest revision as of 00:06, January 1, 2024

"Sleep easy" tea bags containing valerian, lemon balm capsules and a bottle of melatonin.

Sleep dysfunction is very common in ME/CFS patients and can take a very wide range of forms, with unrefreshing sleep being particularly common.[1] The prevalence of sleep disorders in ME/CFS is estimated at 56%.[2][3][4][1]

Fibromyalgia patients also suffer from sleep disorders.[5]

Types of sleep dysfunction[edit | edit source]

Some of these sleep dysfunctions or disorders include:

Prevalence[edit | edit source]

  • Depending on the criteria used for diagnosis, prevalence can vary greatly.
  • In a 2001 Belgian study, 91.9% of patients meeting the Fukuda criteria and 94.8% of patients meeting the Holmes criteria, in a cohort of 2073 CFS patients, reported sleep disturbances.[11]
  • A 2017 study by Davidson, et al, found up to 96.8% of people with CFS report unrefreshing sleep and many describe changes in sleep over the course of their illness.[12]

According to the published evidence, the mean prevalence of sleep disorders in patients with CFS is estimated at 56%.[13]

Year N Prevalence Sleep disorders included
Krupp et al.[14] 1993 16 62% OSAHS, PLMD, narcolepsy, hypersomnia
Morriss et al.[15] 1993 12 58% Maintenance insomnia
Buchwald et al.[16] 1994 59 81% OSAHS, hypersomnia
Le Bon et al.[17] 2000 53 46% OSAHS
Fossey et al.[18] 2004 37 58% OSAHS, narcolepsy
Reeves et al.[19] 2006 43 25% OSAHS, PLMD
Majer et al.[20] 2007 35 30% OSAHS, PLMD, ISS
Libman et al.[21] 2009 66 68% OSAHS
Creti et al.[22] 2010 49 69% OSAHS, PLMD
65% Chronic insomnia
Mean 56.2%

Symptom recognition[edit | edit source]

Sleep dysfunction is a core diagnostic symptom required in the 2003 Canadian Consensus Criteria diagnostic criteria for ME/CFS,[23] the 2007 Nightingale definition,[24] and the 2015 Institute of Medicine report.[25]

Sleep dysfunction is an optional symptom in the 1988 Holmes criteria,[26] the 1991 Oxford criteria,[27] the 1994 Fukuda criteria,[28] the 2005 Reeves criteria,[29] the 2007 NICE guidelines,[30] the 2012 International Consensus Criteria.[31], and the 2014 London criteria.[32]

Sleep dysfunction is not a criteria listed for diagnosis with the 1986 Ramsay definition.[33]

Notable studies[edit | edit source]

  • 2007, Paradoxical NREMS Distribution in “Pure” Chronic Fatigue Patients: A Comparison with Sleep Apnea-Hypopnea Patients and Healthy Control Subjects[34] - (Abstract)
  • 2012, Sleep Abnormalities in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Review[35] - (Full Text)
  • 2017, Sleep Quality in Adolescents With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)[36] - (Full text)
  • 2018, Circadian rhythm abnormalities and autonomic dysfunction in patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis[37] - (Full Text)
  • 2018, The putative role of oxidative stress and inflammation in the pathophysiology of sleep dysfunction across neuropsychiatric disorders: Focus on chronic fatigue syndrome, bipolar disorder and multiple sclerosis[38] - (Abstract)
  • 2018, Association of sleep disorders, chronic pain, and fatigue with survival in patients with chronic kidney disease: A meta-analysis of clinical trials[39] - (Abstract)
  • 2021, Systematic Review of Sleep Characteristics in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome[40] (Full text)

Treatment[edit | edit source]

Treatment can include:

Medications, including:

Supplements and natural remedies include:


See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 "Symptoms | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". Centers for Disease Control and Prevention. January 27, 2021. Retrieved February 25, 2021.
  2. ↑ "Chronic fatigue syndrome and sleep disorders: Clinical associations and diagnostic difficulties". Neurología (English Edition). 33 (6): 385–394. July 1, 2018. doi:10.1016/j.nrleng.2015.11.020. ISSN 2173-5808.
  3. ↑ 3.0 3.1 3.2 Carruthers, BM; van de Sande, MI; De Meirleir, KL; Klimas, NG; Broderick, G; Mitchell, T; Staines, D; Powles, ACP; Speight, N; Vallings, R; Bateman, L; Bell, DS; Carlo-Stella, N; Chia, J; Darragh, A; Gerken, A; Jo, D; Lewis, DP; Light, AR; Light, KC; Marshall-Gradisnik, S; McLaren-Howard, J; Mena, I; Miwa, K; Murovska, M; Stevens, SR (2012), Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners (PDF), ISBN 978-0-9739335-3-6
  4. ↑ 4.0 4.1 Carruthers, Bruce M.; Jain, Anil Kumar; De Meirleir, Kenny L.; Peterson, Daniel L.; Klimas, Nancy G.; Lerner, A. Martin; Bested, Alison C.; Flor-Henry, Pierre; Joshi, Pradip; Powles, AC Peter; Sherkey, Jeffrey A.; van de Sande, Marjorie I. (2003), "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols" (PDF), Journal of Chronic Fatigue Syndrome, 11 (2): 7–115, doi:10.1300/J092v11n01_02
  5. ↑ Wolfe, Frederick; Clauw, Daniel; Fitzcharles, Mary-Ann; Goldenberg, Don; Katz, Robert; Mease, Philip; Russel, Anthony; Russel, I. Jon; Winfield, John; Yunus, Muhammad (May 2010). "American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia" (PDF). Arthritis Care & Research (PDF). 62 (5): 600–610. doi:10.1002/acr.20140.
  6. ↑ "Symptoms of ME/CFS – American ME and CFS Society". American ME and CFS Society. Retrieved August 29, 2018.
  7. ↑ "The role of insomnia in the treatment of chronic fatigue". Journal of Psychosomatic Research. 78 (5): 427–432. May 1, 2015. doi:10.1016/j.jpsychores.2014.11.022. ISSN 0022-3999.
  8. ↑ U.S. ME/CFS Clinician Coalition (July 2020). "Diagnosing and Treating Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)" (PDF) (2 ed.). p. 4.
  9. ↑ Viola-Saltzman, Mari; Watson, Nathaniel F.; Bogart, Andy; Goldberg, Jack; Buchwald, Dedra (October 15, 2010). "High prevalence of restless legs syndrome among patients with fibromyalgia: a controlled cross-sectional study". Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine. 6 (5): 423–427. ISSN 1550-9389. PMID 20957840.
  10. ↑ Cambras, Trinitat; Castro-Marrero, Jesús; Zaragoza, Maria Cleofé; Díez-Noguera, Antoni; Alegre, José (June 6, 2018). "Circadian rhythm abnormalities and autonomic dysfunction in patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis". PLOS ONE. 13 (6): e0198106. doi:10.1371/journal.pone.0198106. ISSN 1932-6203. PMID 29874259.
  11. ↑ De Becker, Pascale; McGregor, Neil; De Meirleir, Kenny (December 2001). "A definition‐based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome". Journal of Internal Medicine. 250 (3): 234–240. doi:10.1046/j.1365-2796.2001.00890.x.
  12. ↑ Davidson, Sean L.; Gotts, Zoe M.; Ellis, Jason G.; Newton, Julia L. (March 2017), "Two year follow-up of sleep diaries and polysomnography in chronic fatigue syndrome: a cohort study", Fatigue: Biomedicine, Health & Behavior, doi:10.1080/21641846.2017.1297280
  13. ↑ "Chronic fatigue syndrome and sleep disorders: Clinical associations and diagnostic difficulties". Neurología (English Edition). 33 (6): 385–394. July 1, 2018. doi:10.1016/j.nrleng.2015.11.020. ISSN 2173-5808.
  14. ↑ Krupp, Lauren B.; Jandorf, L.; Coyle, P.K.; Mendelson, W.B. (May 1, 1993). "Sleep disturbance in chronic fatigue syndrome". Journal of Psychosomatic Research. 37 (4): 325–331. doi:10.1016/0022-3999(93)90134-2. ISSN 0022-3999.
  15. ↑ Morriss, R.; Sharpe, M.; Sharpley, A.L.; Cowen, P.J.; Hawton, K.; Morris, J. (May 1, 1993). "Abnormalities of sleep in patients with the chronic fatigue syndrome". British Medical Journal. 306 (6886): 1161–1164. doi:10.1136/bmj.306.6886.1161. ISSN 0959-8138. PMID 8499816.
  16. ↑ Buchwald, Dedra; Pascualy, Ralph; Bombardier, Charles; Kith, Phalla (January 1, 1994). "Sleep Disorders in Patients with Chronic Fatigue". Clinical Infectious Diseases. 18 (Supplement_1): S68–S72. doi:10.1093/clinids/18.supplement_1.s68. ISSN 1537-6591.
  17. ↑ Le Bon, O.; Fischler, B.; Hoffmann, G.; Murphy, J.R.; De Meirleir, K.; Cluydts, R.; Pelc, I. (2000). "How significant are primary sleep disorders and sleepiness in the chronic fatigue syndrome?". Sleep research online: SRO. 3 (2): 43–48. ISSN 1096-214X. PMID 11382899.
  18. ↑ Fossey, Myrtis; Libman, Eva; Bailes, Sally; Baltzan, Marc; Schondorf, Ronald; Amsel, Rhonda; Fichten, Catherine S. (December 1, 2004). "Sleep Quality and Psychological Adjustment in Chronic Fatigue Syndrome". Journal of Behavioral Medicine. 27 (6): 581–605. doi:10.1007/s10865-004-0004-y. ISSN 1573-3521.
  19. ↑ Reeves, William C.; Heim, Christine; Maloney, Elizabeth M.; Youngblood, Laura Solomon; Unger, Elizabeth R.; Decker, Michael J.; Jones, James F.; Rye, David B. (November 16, 2006). "Sleep characteristics of persons with chronic fatigue syndrome and non-fatigued controls: results from a population-based study". BMC Neurology. 6 (1): 41. doi:10.1186/1471-2377-6-41. ISSN 1471-2377. PMC 1660569. PMID 17109739.
  20. ↑ Majer, Matthias; Jones, James F.; Unger, Elizabeth R.; Youngblood, Laura Solomon; Decker, Michael J.; Gurbaxani, Brian; Heim, Christine; Reeves, William C. (December 5, 2007). "Perception versus polysomnographic assessment of sleep in CFS and non-fatigued control subjects: results from a population-based study". BMC Neurology. 7 (1): 40. doi:10.1186/1471-2377-7-40. ISSN 1471-2377. PMC 2231384. PMID 18053240.
  21. ↑ Libman, Eva; Creti, Laura; Baltzan, Marcel; Rizzo, Dorrie; Fichten, Catherine S.; Bailes, Sally (October 26, 2009). "Sleep Apnea and Psychological Functioning in Chronic Fatigue Syndrome". Journal of Health Psychology. doi:10.1177/1359105309344895.
  22. ↑ Creti, Laura; Libman, Eva; Baltzan, Marcel; Rizzo, Dorrie; Bailes, Sally; Fichten, Catherine S. (May 11, 2010). "Impaired Sleep in Chronic Fatigue Syndrome: How Is It Best Measured?". Journal of Health Psychology. doi:10.1177/1359105309355336.
  23. ↑ Carruthers, Bruce M.; Jain, Anil Kumar; De Meirleir, Kenny L.; Peterson, Daniel L.; Klimas, Nancy G.; Lerner, A. Martin; Bested, Alison C.; Flor-Henry, Pierre; Joshi, Pradip (2003). "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". Journal of Chronic Fatigue Syndrome. 11 (1): 7–115. doi:10.1300/j092v11n01_02. ISSN 1057-3321.
  24. ↑ "The Nightingale, Myalgic Encephalomyelitis (M.E.) Definition" (PDF). investinme.org. January 2007.
  25. ↑ "Proposed Diagnostic Criteria for ME/CFS". nationalacademies.org. 2015.
  26. ↑ Holmes, G. P.; Kaplan, J.E.; Gantz, N.M.; Komaroff, A.L.; Schonberger, L.B.; Straus, S.E.; Jones, J.F.; Dubois, R.E.; Cunningham-Rundles, C. (1988). "Chronic fatigue syndrome: a working case definition". Annals of Internal Medicine. 108 (3): 387–389. ISSN 0003-4819. PMID 2829679.
  27. ↑ Sharpe, M. C.; Archard, L.C.; Banatvala, J.E.; Borysiewicz, L.K.; Clare, A.W.; David, A.; Edwards, R.H.; Hawton, K.E.; Lambert, H.P. (1991). "A report--chronic fatigue syndrome: guidelines for research". Journal of the Royal Society of Medicine. 84 (2): 118–121. ISSN 0141-0768. PMID 1999813.
  28. ↑ Fukuda, K.; Straus, S.E.; Hickie, I.; Sharpe, M.C.; Dobbins, J.G.; Komaroff, A. (December 15, 1994). "The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group". Annals of Internal Medicine. 121 (12): 953–959. ISSN 0003-4819. PMID 7978722.
  29. ↑ Reeves, William C.; Wagner, Dieter; Nisenbaum, Rosane; Jones, James F.; Gurbaxani, Brian; Solomon, Laura; Papanicolaou, Dimitris A.; Unger, Elizabeth R.; Vernon, Suzanne D. (December 15, 2005). "Chronic fatigue syndrome--a clinically empirical approach to its definition and study". BMC medicine. 3: 19. doi:10.1186/1741-7015-3-19. ISSN 1741-7015. PMID 16356178.
  30. ↑ "Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management | Guidance and guidelines | NICE". nice.org.uk. August 2007. Retrieved August 29, 2018.
  31. ↑ Carruthers, B. M.; Sande, M. I. van de; Meirleir, K. L. De; Klimas, N.G.; Broderick, G.; Mitchell, T.; Staines, D.; Powles, A.C.P.; Speight, N. (October 1, 2011). "Myalgic encephalomyelitis: International Consensus Criteria". Journal of Internal Medicine. 270 (4). doi:10.1111/j.1365-2796.2011.02428.x/full. ISSN 1365-2796.
  32. ↑ "ME/CFS Medical Update (Layman's version) Winter 2001". axfordsabode.org.uk. Retrieved August 29, 2018.
  33. ↑ "Ramsay's Definition of M.E., 1986". cfids-me.org. Retrieved August 29, 2018.
  34. ↑ Bon, Olivier Le; Neu, Daniel; Valente, Filomena; Linkowski, Paul (2007). "Paradoxical NREMS Distribution in "Pure" Chronic Fatigue Patients". Journal of Chronic Fatigue Syndrome. 14 (2): 45–59. doi:10.1300/j092v14n02_05. ISSN 1057-3321.
  35. ↑ Jackson, ML; Bruck, D (2012), "Sleep Abnormalities in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Review, Journal of Clinical Sleep Medicine", Journal of Clinical Sleep Medicine, 8 (6): 719-28, doi:10.5664/jcsm.2276
  36. ↑ Josev, Elisha K.; Jackson, Melinda L.; Bei, Bei; Trinder, John; Harvey, Adrienne; Clarke, Cathriona; Snodgrass, Kelli; Scheinberg, Adam; Knight, Sarah J. (September 15, 2017). "Sleep Quality in Adolescents With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)". Journal of Clinical Sleep Medicine. 13 (09): 1057–1066. doi:10.5664/jcsm.6722. ISSN 1550-9389. PMC 5566461. PMID 28760189.
  37. ↑ Cambras, T.; Castro-Marrero, J.; Zaragoza, MC.; Díez-Noguera, A.; Alegre, J. (2018), "Circadian rhythm abnormalities and autonomic dysfunction in patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis", PLoS ONE, 13 (6): e0198106, doi:10.1371/journal.pone.0198106
  38. ↑ Morris, Gerwyn; Stubbs, Brendon; Köhler, Cristiano A.; Walder, Ken; Slyepchenko, Anastasiya; Berk, Michael; Carvalho, André F. (2018), "The putative role of Oxidative Stress and Inflammation in the pathophysiology of sleep dysfunction across neuropsychiatric disorders : Focus on Chronic Fatigue Syndrome, Bipolar Disorder and Multiple Sclerosis", Sleep Med Reviews, doi:10.1016/j.smrv.2018.03.007, PMID 29759891
  39. ↑ Yang, Xiu Hong; Zhang, Bao Long; Gu, Yan Hong; Zhan, Xiao Li; Guo, Li Li; Jin, Hui Min (2018). "Association of sleep disorders, chronic pain, and fatigue with survival in patients with chronic kidney disease: a meta-analysis of clinical trials". Sleep Medicine. 51: 59–65. doi:10.1016/j.sleep.2018.06.020. ISSN 1389-9457.
  40. ↑ Maksoud, Rebekah; Eaton-Fitch, Natalie; Matula, Michael; Cabanas, Hélène; Staines, Donald; Marshall-Gradisnik, Sonya (May 2021). "Systematic Review of Sleep Characteristics in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome". Healthcare. 9 (5): 568. doi:10.3390/healthcare9050568.
  41. ↑ Gyllenhaal, Charlotte; Merritt, Sharon L.; Peterson, Sara Davia; Block, Keith I.; Gochenour, Tom (June 1, 2000). "Efficacy and safety of herbal stimulants and sedatives in sleep disorders". Sleep Medicine Reviews. 4 (3): 229–251. doi:10.1053/smrv.1999.0093. ISSN 1087-0792.
  42. ↑ Chaudhury, Suprakash; Singh, Rakesh Kumar; Kumari, Dolly; Diwan, Chetan; Mujawar, Swaleha; Saldanha, Daniel (May 2019). "Chronic Insomnia: A Review". Medical Journal of Dr. D.Y. Patil University. 12 (3): 193. doi:10.4103/mjdrdypu.mjdrdypu_76_19. ISSN 2589-8302.
  43. ↑ "Survey results - insomnia". ME/CFS South Australia Inc. Retrieved February 11, 2021.
  44. ↑ "Melatonin for Sleep: Does It Work?". hopkinsmedicine.org. Retrieved February 11, 2021.

circadian rhythm Physical, mental, and behavioral changes that follow a 24-hour cycle, responding mostly to light and dark. Controlled the brain's hypothalamus. (Learn more: www.nigms.nih.gov)

chronic fatigue (CF) - Persistent and abnormal fatigue is a symptom, not an illness. It may be caused by depression, multiple sclerosis, fibromyalgia, chronic fatigue syndrome or many other illnesses. The term "chronic fatigue" should never be confused with the disease chronic fatigue syndrome.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

circadian rhythm Physical, mental, and behavioral changes that follow a 24-hour cycle, responding mostly to light and dark. Controlled the brain's hypothalamus. (Learn more: www.nigms.nih.gov)

somatic symptom disorder A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience.

BMJ The BMJ (previously the British Medical Journal) is a weekly peer-reviewed medical journal.

stress Stress can by either physical or psychological, or both. Stress is either 1) a state of emotional or psychological strain or 2) the physical stress (pressure or tension) that a physical object such the human body is placed under, e.g., a stress test is a medical test that monitors the cardiovascular system during strenuous exercise.

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