Sleep and CFS

Sleep structure and sleepiness in chronic fatigue syndrome with or
without co-existing fibromyalgia.

Journal: Arthritis Res Ther. 2008 May 12;10(3):R56 [Epub ahead of print]

Authors: Togo F [1,3] Natelson BH [1], Cherniack NS [2], Fitzgibbons
J [1], Garcon C [1], Rapoport DM [4]

Affiliations:
Pain & Fatigue Study Center, Departments of Neurosciences [1] and
Medicine [2],
UMDNJ-New Jersey Medical School, Newark NJ 07103, USA,
Department of Work Stress Control, Japan National Institute of
Occupational Safety and
Health [3], Kawasaki, 214-8585, Japan, and
Department of Medicine, Division of Pulmonary and Critical Care
Medicine [4], NYU School
of Medicine, New York NY 10016, USA

NLM Citation: PMID: 18474105

ABSTRACT:
INTRODUCTION: We evaluated polysomnograms of chronic fatigue syndrome
(CFS) patients with and without fibromyalgia to determine if patients
in either group had elevated rates of sleep disturbed breathing
(obstructive sleep apnea or upper airway resistance syndrome) or
periodic leg movement disorder. We also determined whether feelings
of unrefreshing sleep were associated with differences in sleep
architecture from normal.

METHODS: We compared sleep structures and subjective scores on visual
analog scales for sleepiness and fatigue in CFS patients with or
without co-existing fibromyalgia (n = 12 and 14, respectively) to 26
healthy subjects; none had current major depressive disorder, and all
were studied at the same menstrual phase.

RESULTS: CFS patients had significant differences in polysomnograpic findings from healthy controls and felt sleepier and more fatigued than controls after a night's sleep. CFS patients as a group had less total sleep time, lower sleep efficiency and less REM sleep than controls. A possible explanation for the unrefreshing quality of
sleep in CFS patients was revealed by stratification of patients into
those who reported more or less sleepiness after a night's sleep (AM
sleepier or less sleepy respectively). Those in the sleepier group
reported that sleep did not improve their symptoms and had poorer
sleep efficiencies and shorter runs of sleep than both controls and
patients in the less sleepy group; patients in the less sleepy group
reported reduced fatigue and pain after sleep and had relatively
normal sleep structures. This difference in sleep effects was
primarily due to a decrease in the length of periods of uninterrupted
sleep in the AM sleepier group.

CONCLUSIONS: CFS patients had significant differences in polysomnograpic findings from healthy controls and felt sleepier and more fatigued than controls after a night's sleep. This difference was due to neither diagnosable sleep disorders nor co-existing fibromyalgia, but primarily due to a decrease in the length of periods of uninterrupted sleep in the patients with more sleepiness in the morning than on the night before. This sleep disruption may explain the overwhelming fatigue, report of unrefreshing sleep, and pain in this subgroup of patients.


[Note: This is an Open Access article. The full text in
PDF is available for free at
http://arthritis-research.com/content/pdf/ar2425.pdf  ]

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My first specialist told me the first step in treating CFS should be to improve the QUALITY of sleep, which would often reduce the quantity.  You need deep Stage 4 sleep to heal, and most CFS patients drift in and out of light Stage 1 sleep without ever getting to Stage 4.

Some of the older sleeping pills did nothing but render you unconscious so you wouldn't spend the night stressing over how you were going to function at work the next day on no sleep.  Some of fhe newer sleeping pills will actually help you get that Stage 4 healing sleep -- those are preferable to the mere "knock-out drops".

Some doctors don't recognize the difference between quality and quantity, and therefore think that a sleeping pill is unnecessary because you're already spending a lot of time in bed.  They need to be educated that 20 hours of poor-quality sleep is not as good as 8 hours of good sleep, and therefore, you need the newer pills that will achieve the deep sleep that you aren't getting in that 20 hours.

Only when you are getting the deep sleep can your body start to heal itself.  When I have effective sleeping pills, I sleep a reasonable 8 hours and my health starts to improve.  When I don't have effective sleeping pills, I sleep 2-3 hours and my health goes back downhill.  Getting 6-8 hours of sleep per night reduced a lot of symptoms; what used tobe a daily problem is now an annoyance only a few days a week.