Sleep dysfunction

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

Sleep dysfunction is very common in ME/CFS and can take a very wide range of forms, with unrefreshing sleep being particularly common.[1] Sleep disorders affect around one in two people with ME/CFS, a similar rate is found in long covid.[2][3][4][1][5] Fibromyalgia patients also suffer from sleep disorders.[6]

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.[12]
  • 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.[13]

According to the published evidence, the mean prevalence of sleep disorders in patients with CFS is estimated at 56%.[14]

Year N Prevalence Sleep disorders included
Krupp et al.[15] 1993 16 62% OSAHS, PLMD, narcolepsy, hypersomnia
Morriss et al.[16] 1993 12 58% Maintenance insomnia
Buchwald et al.[17] 1994 59 81% OSAHS, hypersomnia
Le Bon et al.[18] 2000 53 46% OSAHS
Fossey et al.[19] 2004 37 58% OSAHS, narcolepsy
Reeves et al.[20] 2006 43 25% OSAHS, PLMD
Majer et al.[21] 2007 35 30% OSAHS, PLMD, ISS
Libman et al.[22] 2009 66 68% OSAHS
Creti et al.[23] 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,[24] the 2007 Nightingale definition,[25] and the 2015 Institute of Medicine report.[26]

Sleep dysfunction is an optional symptom in the 1988 Holmes criteria,[27] the 1991 Oxford criteria,[28] the 1994 Fukuda criteria,[29] the 2005 Reeves criteria,[30] the 2007 NICE guidelines,[31] the 2012 International Consensus Criteria.[32], and the 2014 London criteria.[33]

Sleep dysfunction is not a criteria listed for diagnosis with the 1986 Ramsay definition.[34]

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[35] - (Abstract)
  • 2012, Sleep Abnormalities in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Review[36] - (Full Text)
  • 2017, Sleep Quality in Adolescents With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)[37] - (Full text)
  • 2018, Circadian rhythm abnormalities and autonomic dysfunction in patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis[38] - (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[39] - (Abstract)
  • 2018, Association of sleep disorders, chronic pain, and fatigue with survival in patients with chronic kidney disease: A meta-analysis of clinical trials[40] - (Abstract)
  • 2021, Systematic Review of Sleep Characteristics in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome[41] (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. ↑ Chinvararak, Chotiman; Chalder, Trudie (December 2023). "Prevalence of sleep disturbances in patients with long COVID assessed by standardised questionnaires and diagnostic criteria: A systematic review and meta-analysis". Journal of Psychosomatic Research. 175: 111535. doi:10.1016/j.jpsychores.2023.111535. ISSN 1879-1360. PMID 37898059.
  6. ↑ 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.
  7. ↑ "Symptoms of ME/CFS – American ME and CFS Society". American ME and CFS Society. Retrieved August 29, 2018.
  8. ↑ "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.
  9. ↑ U.S. ME/CFS Clinician Coalition (July 2020). "Diagnosing and Treating Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)" (PDF) (2 ed.). p. 4.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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
  14. ↑ "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.
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ 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.
  18. ↑ 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.
  19. ↑ 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.
  20. ↑ 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.
  21. ↑ 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.
  22. ↑ 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.
  23. ↑ 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.
  24. ↑ 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.
  25. ↑ "The Nightingale, Myalgic Encephalomyelitis (M.E.) Definition" (PDF). investinme.org. January 2007.
  26. ↑ "Proposed Diagnostic Criteria for ME/CFS". nationalacademies.org. 2015.
  27. ↑ 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.
  28. ↑ 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.
  29. ↑ 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.
  30. ↑ 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.
  31. ↑ "Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management | Guidance and guidelines | NICE". nice.org.uk. August 2007. Retrieved August 29, 2018.
  32. ↑ 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.
  33. ↑ "ME/CFS Medical Update (Layman's version) Winter 2001". axfordsabode.org.uk. Retrieved August 29, 2018.
  34. ↑ "Ramsay's Definition of M.E., 1986". cfids-me.org. Retrieved August 29, 2018.
  35. ↑ 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.
  36. ↑ 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
  37. ↑ 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.
  38. ↑ 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
  39. ↑ 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
  40. ↑ 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.
  41. ↑ 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.
  42. ↑ 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.
  43. ↑ 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.
  44. ↑ "Survey results - insomnia". ME/CFS South Australia Inc. Retrieved February 11, 2021.
  45. ↑ "Melatonin for Sleep: Does It Work?". hopkinsmedicine.org. Retrieved February 11, 2021.
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