Insomnia

Insomnia, also known as sleeplessness, is a sleep disorder where people have trouble falling asleep or staying asleep as long as desired. It can occur independently or as a result of another problem. It is a common symptom of ME/CFS.

Presentation
Insomnia is present when a patient finds it unusually difficult to fall asleep, maintain sleep, or wakes up early in the morning with an inability to return to sleep.

Insomnia can cause many secondary symptoms and problems, including fatigue, daytime sleepiness, feeling unrefreshed after sleep, irritability, anxiety, low energy, and depressed mood. Long-term insomnia can result in muscle weariness, hallucinations, mental fatigue and double vision.

Symptom recognition

 * In the Holmes criteria, sleep disturbance (hypersomnia or insomnia) is an optional criteria for diagnosis, under the section Minor Symptom Criteria.

Notable studies

 * 2012, Sleep Abnormalities in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Review - (Full text)
 * 2015, Sleep quality and the treatment of intestinal microbiota imbalance in Chronic Fatigue Syndrome: A pilot study - (Full Text)
 * 2017, Sleep Quality in Adolescents With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) - (Full text)

Possible causes

 * High levels of stress
 * Changes in levels of cytokines
 * As a sleep dysfunction symptom of ME/CFS or another illness

Potential treatments
Behavioral changes, including: Supplements and natural remedies, including:  category = Hypnotics category = Supplements ordermethod=sortkey order=ascending mode=inline-list  Medications, including: Off-label drugs, e.g.:
 * Sleep hygiene advice
 * Cognitive behavioral therapy for insomnia
 * Benzodiazepines, e.g. temezapam
 * Non-benzodiazepine hypnotics, commonly known as z-drugs, e.g. zopiclone
 * Sedating antidepressants, particularly amitriptyline
 * Sedating anti-histamines including diphenhydramine
 * Melatonin, either on prescription or as a supplement 
 * low dose quetiapine but should this not be used in overweight people with CFS

Learn more

 * Medications for insomnia - drugs.com
 * Solutions for Sleep by Bruce Campbell for ME/CFS & Fibromyalgia Self Help