Sleep dysfunction is nearly universal in ME/CFS patients, although it can take a very wide range of forms. 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.
Types of Sleep dysfunction[edit | edit source]
Some of these sleep dysfunctions include:
- dysania (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 (sleeping too much)
- hypnagogia (transitional state from wakefulness to sleep during which lucid thought, lucid dreaming, hallucinations and, sleep paralysis can occur)
- insomnia (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)
- myoclonus (an involuntary twitch which occurs when a person is beginning to fall asleep, causing them to jump and awaken)
- nightmares (a frightening or unpleasant dream)
- night sweats (excessive sweating while you sleep)
- restless legs syndrome (a strong urge to move one's legs)
- sleep apnea (pauses in breathing or periods of shallow breathing)
- sleep phase shifting (reversed or chaotic diurnal sleep rhythms) (circadian abnormalities: delayed sleep phase, non 24, loss of rhythm)
- somnolence (sleepiness)
- unrefreshing sleep (poor-quality sleep that doesn't relieve fatigue)
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.
- 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.
Symptom recognition[edit | edit source]
Sleep dysfunction is a core requirement to meet the diagnostic criteria for ME/CFS according to the 2003 Canadian Consensus Criteria, the 2007 Nightingale definition, and the 2015 Institute of Medicine report.
Sleep dysfunction is an optional symptom in the 1988 Holmes criteria, the 1991 Oxford criteria, the 1994 Fukuda criteria, the 2005 Reeves criteria, the 2007 NICE guidelines, the 2012 International Consensus Criteria., and the 2014 London criteria.
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 - (Abstract)
- 2012, Sleep Abnormalities in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Review - (Full Text)
- 2017, Sleep Quality in Adolescents With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) - (Full text)
- 2018, Circadian rhythm abnormalities and autonomic dysfunction in patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis - (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 - (Abstract)
- 2018, Association of sleep disorders, chronic pain, and fatigue with survival in patients with chronic kidney disease: A meta-analysis of clinical trials - (Abstract)
Treatment[edit | edit source]
Treatment can include non-benzodiazepine hypnotics, or benzodiazepine hypnotics, other sedatives, sedating antidepressants, cannabidiol (CBD), melatonin, vitamin B12, meditation and good sleep hygiene practices.
Amitriptyline, a sedating antidepressant, may be helpful for improving quality of sleep in individuals with CFS. While originally considered an antidepressant, it is also prescribed at low doses to specifically manage pain and sleep for a number of conditions.
See also[edit | edit source]
- 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).
References[edit | edit source]
- Davidson, Sean L.; Gotts, Zoe M.; Ellis, Jason G.; Newton, Julia L. (Mar 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
- "Fibromyalgia Sufferers Have Difficulty Maintaining Continuous Sleep, Study Says". National Pain Report. Mar 25, 2016. Retrieved Aug 20, 2018.
- "Symptoms of ME/CFS – American ME and CFS Society". ammes.org. Retrieved Aug 29, 2018.
- "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.
- Viola-Saltzman, Mari; Watson, Nathaniel F.; Bogart, Andy; Goldberg, Jack; Buchwald, Dedra (Oct 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.
- Cambras, Trinitat; Castro-Marrero, Jesús; Zaragoza, Maria Cleofé; Díez-Noguera, Antoni; Alegre, José (Jun 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.
- 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.
- 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.
- "The Nightingale, Myalgic Encephalomyelitis (M.E.) Definition" (PDF). investinme.org. Jan 2007.
- "Proposed Diagnostic Criteria for ME/CFS". nationalacademies.org. 2015.
- 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.
- 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.
- Fukuda, K.; Straus, S. E.; Hickie, I.; Sharpe, M. C.; Dobbins, J. G.; Komaroff, A. (Dec 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.
- Reeves, William C.; Wagner, Dieter; Nisenbaum, Rosane; Jones, James F.; Gurbaxani, Brian; Solomon, Laura; Papanicolaou, Dimitris A.; Unger, Elizabeth R.; Vernon, Suzanne D. (Dec 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.
- "Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management | Guidance and guidelines | NICE". www.nice.org.uk. Aug 2007. Retrieved Aug 29, 2018.
- 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. (Oct 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.
- "ME/CFS Medical Update (Layman's version) Winter 2001". www.axfordsabode.org.uk. Retrieved Aug 29, 2018.
- "Ramsay's Definition of M.E., 1986". www.cfids-me.org. Retrieved Aug 29, 2018.
- 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.
- 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
- Josev, Elisha K.; Jackson, Melinda L.; Bei, Bei; Trinder, John; Harvey, Adrienne; Clarke, Cathriona; Snodgrass, Kelli; Scheinberg, Adam; Knight, Sarah J. (Sep 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 . PMID 28760189.
- 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
- 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
- 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.
- "ME/CFS Guidelines - Management Guidelines for General Practitioners" (PDF). sacfs.asn.au.
- "Treatment - Chronic fatigue syndrome (CFS/ME)". nhs.uk. Retrieved Aug 29, 2018.
chronic fatigue syndrome (CFS) - A fatigue-based illness. The term CFS was invented invented by the U.S. Centers for Disease Control as an replacement for myalgic encephalomyelitis (ME). Some view CFS as a neurological disease, others use the term for any unexplained long-term fatigue. Sometimes used as a the term as a synonym of myalgic encephalomyelitis, despite the different diagnostic criteria.
myalgic encephalomyelitis (ME) - 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.
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. Although "Somatic Symptom Disorder" is the term used by DSM-5, the term "Bodily Distress Disorder" has been proposed for ICD-11. (Learn more: www.psychologytoday.com)