Sleep Dysfunction

Common sleep symptoms

Non-restorative sleep

• Symptoms of ME/CFS are not relieved by sleep.
• Research suggests disruptions to delta wave sleep and alterations in sleep-stage transitions. Intense dreams are common.
• Due to the poor quality of sleep, people awaken unrefreshed, regardless of the duration of sleep.
  

Altered sleep patterns

• day-night reversal and other circadian rhythm abnormalities
• insomnia: difficulty falling asleep and frequent awakenings
• hypersomnia: difficulty staying awake, sleeping many more hours than is normal

Other common issues

• Night-time muscle spasms, including Restless Legs Syndrome, disrupt sleep.
• A sensation of being 'tired but wired', where people feel exhausted, but their central nervous system is in arousal, prevents sleep.
  

Diagnosis of additional sleep disorders

Patients may have additional diagnosable sleep disorders, such as obstructive sleep apnoea or sleep hypoventilation, that require consultation with a sleep disorder specialist.

Management

People with ME/CFS sleep better when they are well-rested. Insomnia often increases when the patient has done too much and exceeded their available energy reserves.

Symptoms interfere with sleep. Careful management of rest and activity, known as pacing, will reduce the risk of exacerbating symptoms. Conversely, poor sleep quality often makes other ME/CFS symptoms worse.

Aspects of basic sleep hygiene may be applicable for some individuals. For example, patients who are well enough may benefit from morning exposure to full spectrum light, e.g. sunlight, to help with circadian rhythms.

Sleep, however, is dysfunctional and care is required when applying common sleep strategies. People with ME/CFS will react differently from a healthy person and may experience worsening symptoms.

Treatment

• Start with a low dose since the usual doses are often poorly tolerated.
• Introduce one change at a time so the effect can be monitored.

Medications

Sedating medications are often prescribed. Due to drug sensitivities in ME/CFS, it may be necessary to try a number of medications before a suitable one is found. For some patients, nutritional supplements may be better tolerated than medications.

There are prescription and over the counter medications that address:

• sleep onset
• sustaining sleep
• muscle relaxation

Long-acting medications that assist people with ME/CFS into deeper stages of sleep may be useful.

Nutritional supplements

People with ME/CFS use a wide variety of supplements for sleep onset, sleep quality and muscle relaxation.

The two most commonly recommended by patients and clinicians are:

• magnesium
  • topical applications: magnesium oil or Epsom Salts
  • oral administration: available in a variety of magnesium forms, for example magnesium citrate, sulfate, glycinate, etc. Each form has different benefits and side effects.

• melatonin
  • available in immediate-release form for sleep onset, and slow-release form for sustaining sleep
  • the most effective dose for ME/CFS patients varies widely

Patients taking both medications and nutritional supplements for sleep must discuss the risks of serotonin syndrome with their doctor before changing dose or regime.