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Importance of Solid Sleep in Chronic Fatigue Syndrome
and Fibromyalgia Sufferers
by Jacob Teitelbaum, M.D.
ImmuneSupport.com
06-21-2000
The most effective way to eliminate pain in CFS/FM is to get
seven to eight hours of solid, deep sleep each night on a
regular basis. Disordered sleep is, in my opinion, the
underlying process that drives CFS/FM.
Hypothalmic
dysfunction (a major player in CFS/FM) affects sleep, as
well as blood pressure, hormonal systems, and temperature
regulation.In animal studies done at the University of
Tennessee by Carol Everson, Ph.D., sleep deprivation
resulted in immune suppression, resulting in multiple
infections (including yeast overgrowth in the gut). Many
other abnormalities also occurred based on the sleep
disorder. These same processes seem to occur in people with
CFS/FM.
Canadian
researcher, Dr. Harvey Moldofsky, was the first to note that
the quality of deep sleep in FM patients was poor. This was
described as “alpha wave intrusion into delta sleep,” which
means that restorative deep sleep is disrupted.
To put this
into English, sleep has its own architecture of which REM
sleep is the best known part ; it is a light sleep period
where we have our dreams. Stages 1 and 2 of sleep are also
fairly light stages, while stages 3 and 4 (Delta Wave) sleep
are the deeper stages of sleep. My experience, and that of
many other clinicians, suggests that what is inadequate in
FM and CFS are these latter two deep stages (stages 3 and 4)
of sleep.
Dr. Robert
Bennett’s research at The University of Oregon Health
Services Center supports this theory. Dr. Bennett is one of
the world’s foremost researchers in FM. Hefound that growth
hormone deficiency occurs in FM and that treating this
deficiency resulted in improvement of symptoms after four to
five months. He felt uncomfortable recommending routine
growth hormone treatment for FM because of its cost
(approximately $15,000 per year).
What is
interesting, though, is that growth hormone is released
during stages 3 and 4 sleep. In addition, the loss of these
deep stages of sleep may be what accounts for the growth
hormone deficiency that has been observed. My own suspicion
is that not only does hypothalamic dysfunction cause
disordered sleep, but by some unknown mechanism, the poor
sleep then causes further hypothalamic suppression.
Therefore, breaking the cycle of poor sleep and maintaining
quality sleep for six to nine months is critical to breaking
the cycle of FM, CFS, and severe fatigue.
It is
important to note that growth hormone is responsible for
many of the repair processes that go on in our muscles and
in the rest of our body. It is theorized that this loss of
repair function that normally occurs during deep sleep
contributes to the pain of FM. Several studies have now
shown that if you wake up people whenever they go into deep
sleep, or even lightly shake them so they go from deep sleep
into light sleep, they will develop classic FM-like pain
within one to two weeks and often within one night.
What Should
You Do?
It is critical that you get seven to eight hours of solid
sleep each night without waking or hangover. Sound sleep is
the goal and, hard as this may be to believe, it is very
attainable using natural and prescription remedies. This
article focuses on the natural remedies that I use.
Natural Sleep
Remedies
Most of these sleep remedies are not sedating, yet they help
you fall asleep and stay in deep sleep.
Magnesium
Take at least 1 to 2 tables (75 to 150 mg) at night.
Magnesium can help relieve pain associated with FM.
Valerian and
Lemon Balm
A double-blind research study showed that a combination of
valerian (180 to 360 mg) plus lemon balm extract (80 to 160
mg) at night improved deep stage sleep without
over-sedation. In nearly 10% of people, valerian is
energizing and may keep them up. Use valerian during the day
instead of at night if this happens. Valerian is so nontoxic
that it would be hard to overdose.
Passion
Flower
Take 100 to 200 mg at night to help you sleep. It’s also
helpful during the day for anxiety.
5-HTP
Take 100 to 400 mg at night. When used for six weeks, the
300 to 400 mg has been shown to decrease FM pain. One
caution I would note is that if you’re taking high doses of
a number of treatments that increase serotonin (these
includes anti-depressants like Prozac. St. John’s Wort,
Ultram, Desyrel, etc.), one can develop a life-threatening
reaction caused by a too high level of serotonin. These
reactions are very rare. I have never seen a reaction, or
have I talked to anyone who treats CFS/FM who noted that
they have ever seen one. A reaction would feel like “the
panic attack from hell.” If you are taking any of the
serotonin-raising treatments, limit the 5-HTP to 200 mg at
night.
Kava Kava
I would use one that is a 30% extract, and take anywhere
from 200 to 750 mg at night. With prolonged use, a rash will
uncommonly occur. If this happens, take 50mg of a B-complex
vitamin. If the rash continues, stop taking the Kava Kava.
Melatonin
Melatonin is a hormone made by the pineal gland. Although it
is natural and over-the-counter, this does not mean that it
is without risk. All it takes to restore melatonin to normal
levels in most people is 0.3 mg. The usual dose that you
find in the store is 3 mg – ten times the level I recommend.
At high levels, melatonin may raise another hormone called
prolactin (which is often high in
CFS/FM
patients), aggravating the risk of depression or
infertility.
gravating the
risk of depression or infertility. |