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.

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.

See ME/CFS.

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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