27 January 2010

Sleep dysfunction in ME/CFS

Sleep is the regular cycle of unconciousness where an individual can be aroused by stimulation. It is characterized by the depression of cortical activity (Marieb, 2000), where our voluntary muscle activity is diminished (Macmillian Dictionary for Students). The functions of the brain stem, however, (resperation, temperature) continue during sleep (Marieb, 2000). The normal sleep cycle for humans is related to the 24 hour, day/night cycle, or circadian cycle.
Many of us associate sleep with dreaming, and an opportunity to rest our bodies after daily activity, but whilst we are unconscious, trekking in the land of Nod, the brain is rotating through four different stages of NREM (Non-Rapid Eye Movement) sleep, and the dream state of REM (Rapid Eye Movement) sleep. This sleep cycle cumulates in brainwave activity that uses more Oxygen than when we are awake (Marieb, 2000).

The NREM sleep is divided into four stages, vital signs gradualy decline as the individual passes through each stage, until stage four is met, where all muscles are relaxed and arousal is difficult. About 90 minutes after the first stage of sleep is met, the individual enters into REM sleep, where most dreaming occurs. REM sleep is characterised by the increase of vital signs, and though this is the most difficult satge of sleep to arouse from, waking during this stage of sleep is what allows individuals to, on occasion, remember their dreams. A typical nights sleep is the alternation between NREM and REM sleep (Marieb, 2000).
Sleep is important for a number of reasons, both proven and hypothesised. Sleep is a process which allows for growth and rejuvenation, rest and repair of individual cells, as well as whole systems, including the nervous system, the musculoskeletal system and the immune system. There appears to be a correlation between sleep and the white blood cell count (Zager et al. 2007).

Sleep is essential for maintaining health and wellbeing, for everybody, and especially so for individuals with ME/CFS, however, many individuals with ME/CFS appear to have a lot of difficulty with dysfunctional sleep and/or sleeping patterns.

The Canadian Consensus Document refers to research (Fischer, B. et al. 1997) that suggests individuals with ME/CFS have dysfuntional circadian rhythm (sleep associated with the day/night cycle), difficulty getting to sleep, frequent arousal, inability to reach the deeper stages of sleep.

Some of these sleep dysfunctions include the commone ones, such as insomnia, which is the difficulty of getting sleep despite overwhelming fatigue, being 'too tired to sleep'. Insomnia appears to increase during times of relapse. Hypersomnia may also occur, which is the excess of daytime sleepiness, which is not the result of lack of sleep, and may also cause prolonged periods of sleep and/or difficulty arousing from sleep. The Canadian Consensus Document also lists sleep dysfunctions including difficulty with sleep onset, fragmented sleep patterns, non-restoritive sleep, morning exhaustion, and vivid dreaming.

Maintaining healthy sleep patterns, therefore, is an important part of managing ME/CFS. There are a number of different treatments available for individuals to use to assist with healthy sleep, including pharmacutical or natural medicines. Pharmacutical and/or natural medicines will not be discussed in this blog, as these options must be addressed with advice from appropriate medical professionals. Alongside pharmacuticals, it is important for individuals with ME/CFS to learn and implement sleep hygiene.

Sleep hygiene can be defined as controlling "all behavioural and environmental factors that precede sleep and may interfere with sleep." (Van der Heijden, Kristiaan B. et al, 2006). In other words, sleep hygiene includes tasks that individuals can participate in to help improve sleep quality. These include:

  • Stay out of bed unless you are sleepy and intend to sleep. If your not ready to sleep, choose a quiet/relaxing activity such as listening to quiet music or browsing through a book.

  • Spend time out of bed as often as you are able during the day, try resting in the living room, or outside in the sun.

  • Get dressed when you get up, if you are able. Try to keep pyjamas for use in bed. Even getting changed into loose comfortable clothing similar to pyjamas helps to make a differetiation between being up and being in bed.

  • Make a regular time for geting up and going to bed.

  • Create an environment in the bedroom which is associated with sleep, keeping it quiet, dark, and a little bit cool. Avoid activities such as reading and watching tv in bed, if you are able to do these in another room.

  • Try to avoid worrying about getting to sleep, try to engage in relaxation techniques, and allow your body to relax.

Sweet dreams!


Dr Bell article: http://www.davidsbell.com/PrintLynNewsV2N1.htm

American Academy of Sleep Medicine. 2009. http://www.sleepeducation.com/Hygiene.aspx. Retrieved 28 January 2010

Macmillan Dictionary for Students Macmillan, Pan Ltd. (1981), page 936

Zager, A., Andersen, M.L., Ruiz, F.S., Antunes, I.B., & Tufik, S. (2007). Effects of acute and chronic sleep loss on immune modulation of rats [Electronic version]. Regulatory, Integrative and Comparative Physiology, 293, R504-R509.

Marieb, E., (2001). Anatomy and physiology (5th ed.). pp 549 - 551. USA: Benjamin-Cummings pub co.

Van der Heijden, Kristiaan B. et al.: Sleep hygiene and actigraphically evaluated sleep characteristics in children with ADHD and chronic sleep onset insomnia. J. Sleep Res. (2006) 15, 55-62.



  1. Great summary! Very nicely done. My older son and I had great success treating our sleep dysfunction. I often refer people to Dr. Bell's article that you referenced, plus another excellent one by Dr. Lapp. I covered this in a recent blog post:


    Getting good sleep makes a HUGE difference!


  2. Hi Sue

    Thank you for Dr Lapp's article - I will pop a reference to it on the home page also. Is there a link to your blog on this site? If not, may I have permission to add a link? the bigger the network, the better, I beleive.