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CFS - Sleep

Discussed below are some non-drug options for dealing with insomnia. It is essential that people with CFS work towards 8-9 hours sleep per day. People with major sleep problems almost always require a combination of treatments to create optimal sleep.

Sleep disorders.

Sleep apnea can present clinically as difficulty falling asleep and waking up in the night with breathing pauses being unknown to the patient. If you have a significant number of the following symptoms/signs consider that you may have sleep apnea.

Do you snore moderately or severely? Do you sometimes wake up in the night with a snort, gasp or choking/breathless feeling? Has your partner heard you making gasping/choking/snorting noises or breathing pauses during the night? Fall asleep very easily during day (e.g. sitting reading or watching TV)? Regularly wake up in night with a headache or have a headache upon awakening in the morning? Obesity (BMI over 30) or large neck circumference (greater than 40 cm’s)? Do you have a close family history of sleep apnea?

Do you snore moderately or severely?
Do you sometimes wake up in the night with a snort, gasp or choking/breathless feeling?
Has your partner heard you making gasping/choking/snorting noises or breathing pauses during the night?
Fall asleep very easily during day (e.g. sitting reading or watching TV)?
Regularly wake up in night with a headache or have a headache upon awakening in the morning?
Obesity (BMI over 30) or large neck circumference (greater than 40 cm’s)?
Do you have a close family history of sleep apnea?

Another common but less well known sleep disorder is called delayed sleep phase syndrome (DSPS). DSPS is a disorder in which a persons sleep-wake cycle (circadian rhythm) is delayed. In other words your body-closk is out of sync. People often describe themselves as night owls. Symptoms/signs include the following.

Often feel more awake when lying in bed at night than during much of the day? Sleep much better and feel much better in the day if you go to bed late (after 12 PM) and get up late? Find it easy to sleep in morning hours (e.g. 5-7 AM) but difficult during 10-12 PM? Difficulty waking up in morning plus feel much better in the evening or night / ‘night owl’?

Often feel more awake when lying in bed at night than during much of the day?
Sleep much better and feel much better in the day if you go to bed late (after 12 PM) and get up late?
Find it easy to sleep in morning hours (e.g. 5-7 AM) but difficult during 10-12 PM?
Difficulty waking up in morning plus feel much better in the evening or night / ‘night owl’?

Delayed sleep phase syndrome can be treated with a combination of bright light therapy, melatonin, earthing technology (described below), dietary changes (described below) and consistent sleeping times.

1. Yoga breathing.

Our breathing rate is a key cue to the autonomic nervous systems need for sympathetic nervous system ('fight or flight' / stress response) activation. While a typical person might have 15-20 breath cycles per minute, slowing our breathing down to five breaths per minute puts our autonomic nervous system (ANS) into a state of coherence, toning down stress-response associated sympathetic activity and increasing the relaxation/rejuvenation associated parasympathetic response. Five breath cycles per minute = one breath cycle per 12 seconds, or inhaling for six seconds and exhaling for 6 seconds. Read the fascinating article ‘The Science of Coherent Breathing’ by Stephen Elliott for a more in depth discussion of this topic. While laying in bed a person can listen to an audio track which has a sound cue every six seconds. You simply inhale or exhale at each interval using the track like a metronome. You can order a CD called Respire I or download the audio tracks as MP3s. I enjoy Respire 1, track 2 which has Tibetan bells as the breath cue. For an even more potent effect combine with Ujjayi breathing as described HERE.

2. Guided imagery/hypnosis audio tracks.

Audio tracks are available for insomnia which include elements of guided imagery, hypnosis, meditative practices, relaxing sounds/music, and beats/rhythms which entrain brainwave patterns. The CD’s and mp3’s available vary enormously in quality and the methods they use, so don’t assume they are all the same. A person listens to them while lying in bed at night with their eyes closed. Some of the best quality products available are listed below. The first two items are also available for mp3 download.

'Easing Into Sleep' by Dr. Emmett Miller.
'Natural, Restful Sleep' by Dr. Martin Rossman.
'Beat Insomnia' by Rick Collingwood.

3. Earthing.

A fascinating technology called earthing is available as an option for various health issues. I have recently made earthing as a standard part of my CFS treatment protocol. See What is Earthing? for background and explanation of this technology. I have learnt both from people who have used these products and the research performed that sleep is the most consistent area of improvement from earthing and that the vast majority of people report improved sleep. The cheapest place to buy earthing products is directly from Earthfx (760.778.1200 / info@earthfx.net).

4. Nervous system inhibition by small, slow, gentle movements.

The Sounder Sleep System was created by Michael Krugman. It is based on the principal that small, slow, gentle movements lead to nervous system inhibition, whereas large, fast, powerful movements lead to nervous system excitation. These principles are exploited to create sleep-inducing effects. Mp3 downloads, CDs, DVDs and books are available to teach us these techniques.

5. RelaxMate II photostimulation glasses.

The RelaxMate II photostimulation glasses were designed by Dr. Norman Shealy (Neurosurgeon). Dr. Shealy’s glasses produce pulses of coloured light at specific frequencies. The person lays down with their eyes closed and light enters their eyes, affecting the brain in a number of ways.

It has been known for many decades that our brainwave pattern ‘follows’ the rhythm of repetitive sound and light frequencies. When exposed to a constant rhythm of light entering our eyes, our brainwave pattern ‘follows’ the emitted frequency enabling us to induce a state of deeper brain activity. Our normal waking brainwave pattern may be around 14 Hz (14 cycles per second), which is a beta wave. If the light stimulation is set to 1-2 cycles/second, our brainwave pattern starts to slow down to match that frequency. Brainwave entrainment has been used to enter meditative and hypnotic states, which are basically lower patterns of brainwave activity. Many people have trouble entering those deeper states of consciousness that some people enter through meditation and hypnosis. Traditionally many cultures have used rhythmic noises (e.g. the beating of drums) to enable them to enter deeper states of consciousness. The benefit of this is achieving deep states of relaxation on cue.

Research has also documented that the RelaxMate II increases levels of endorphins, serotonin and oxytocin. Endorphin levels increased between 10-50% (average 14%) and serotonin increased 14% in one study. (Shealy. 1996) Oxytocin has been described as the nurturing and relaxation hormone. Feeling nurtured increases oxytocin levels.

In use with thousands of patients Dr. Shealy has reported around 90% of people can induce deep states of relaxation, usually within 10 minutes. In one study by Schmadel:

16/16 participants reported quick relaxation (most above 75%).
16/16 reported improved sleep and 12/12 with sleep problems reported “substantial” to “incredible” results.
12/12 reported reduced anxiety.
9/10 reported reduced depression.
4/5 reported reduced pain.

RelaxMate II can be purchased from selfhealthsystems.com or from amazon.com

6. Supplements.

There are several nutritional and herbal options for insomnia available. Everyone responds differently so some experimentation is often required and people often need to combine a few different treatments to optimal sleep. Often people will need to combine more than one option.

1. Valerian/hops. Before you say 'I’ve already tried that and it didn't work' you should know that herbal medicine companies vary enormously in terms of quality and potency. The concentration of the active ingredient in herbal products should be both known by the company and the product created to include the optimal dose. Strangely many companies don’t do this. ReDormin by Flordis is the highest quality and potency of valerian/hops formula available and frequently works when others don’t. Try 2/night for several nights and then try 3/night if needed.
2. Melatonin. Melatonin works extremely well for many people. Melatonin is the hormone produced in our pineal gland which is a key mediator of sleep. Start with 3 mg and see how this goes. If not hugely effective try 6 mg or if too sedating try 1 mg. Melatonin is available by faxing FX-Med in New Zealand or otherwise on prescription via a compounding pharmacy, however the first option is cheaper.
3. GABA. GABA is the neurotransmitter which drugs like valium/xanax/avitan stimulate. It is one of our key relaxing, sedating, calming neurochemicals. Stimulating GABA pathways is often used in the treatment of anxiety, insomnia, pain and epilepsy. Supplements of GABA are available and are best taken in sublingual form. GABA troches are available at compounding pharmacies. Please note the prices quoted by compounding pharmacies vary considerably. L-theanine influences GABA pathways and can also be useful for some.
4. Glycine. Glycine is an amino acid which is an inhibitory neurotransmitter and involved in GABA metabolism. Supplementation of 2-4 grams of glycine powder before bed is very useful for some.
5. Magnesium/Calcium. Magnesium and calcium have mild sedative properties. Deficiencies of either are associated with sleep problems. Taking around 300-400 mg of magnesium (in the form of glycinate or chloride) along with 600 mg of calcium (in the form of citrate) is helpful when taken at night for some with insomnia.

7. Protein in the morning and carbohydrates in the evening.

The timing of our consumption of carbohydrates and protein can have a profound impact on our sleep and various other aspects of our health. The following is a quote from Dr. Sidney Baker regarding dietary modification for insomnia. Dr. Sidney Baker is one of the worlds top integrative medicine experts (40 years experience) and he lists this as the first option for insomnia. Try it for a minimum of two weeks and observe the effects.

The remedy has a universal application and is relevant to many aspects of human health. The scientific basis for it is explored in my book “The Circadian Prescription.” The gist is that there is a marked difference between the biochemical sequences of daytime and what goes on in our chemistry at night. It is as different as night is from day. Food that supplies the different phases should be of the right sort, which turns out to be opposite to the habit of many folks: cereal and fruit, or, worse, sweet roll and coffee in the morning, and meat for dinner. I became interested in the subject when I read the studies of Charles Ehret, Ph.D., author of “Overcoming Jet Lag” and noted researcher in the field of circadian (daynight cycle) physiology. I really became hooked when I saw dramatic changes in attention and vitality as well as a host of other functions in people of all ages who took my suggestion of experimenting with the “jet lag diet” delineated by Dr. Ehret. Getting protein into the breakfast of a finicky autistic child could be impossible without the amenity of Rice Protein. This is a bland powder that is essentially 100% protein. As such, it will jack up the protein content of anything to which it is added. Thus, 30 grams (one scoop) of this powder added to any food (say fruit) that contains 30 grams of carbohydrate would give you an end product that is 50% protein, which qualifies as “high protein.” Naturally, if your child has good appetite for chicken, turkey, beef, pork, lamb, fish, beans or eggs, then you will not need recourse to rice protein. Load him or her up with these high protein foods at breakfast and lunch, and save most of the carbohydrates for any time after 4 p.m. My book on circadian rhythms has recipes for various high protein shakes. If your child would take to such an offering, you may want to try such a shake or experiment by making your own based on rice protein and banana. Soy protein is OK occasionally, but I do not think it is a good steady diet for children. Whey protein is good, too, but you may not be able to guarantee freedom from casein. Egg protein is the best, if the child is not allergic to egg. Dr. Sidney Baker

The remedy has a universal application and is relevant to many aspects of human health. The scientific basis for it is explored in my book “The Circadian Prescription.” The gist is that there is a marked difference between the biochemical sequences of daytime and what goes on in our chemistry at night. It is as different as night is from day. Food that supplies the different phases should be of the right sort, which turns out to be opposite to the habit of many folks: cereal and fruit, or, worse, sweet roll and coffee in the morning, and meat for dinner. I became interested in the subject when I read the studies of Charles Ehret, Ph.D., author of “Overcoming Jet Lag” and noted researcher in the field of circadian (daynight cycle) physiology. I really became hooked when I saw dramatic changes in attention and vitality as well as a host of other functions in people of all ages who took my suggestion of experimenting with the “jet lag diet” delineated by Dr. Ehret. Getting protein into the breakfast of a finicky autistic child could be impossible without the amenity of Rice Protein. This is a bland powder that is essentially 100% protein. As such, it will jack up the protein content of anything to which it is added. Thus, 30 grams (one scoop) of this powder added to any food (say fruit) that contains 30 grams of carbohydrate would give you an end product that is 50% protein, which qualifies as “high protein.” Naturally, if your child has good appetite for chicken, turkey, beef, pork, lamb, fish, beans or eggs, then you will not need recourse to rice protein. Load him or her up with these high protein foods at breakfast and lunch, and save most of the carbohydrates for any time after 4 p.m.

My book on circadian rhythms has recipes for various high protein shakes. If your child would take to such an offering, you may want to try such a shake or experiment by making your own based on rice protein and banana. Soy protein is OK occasionally, but I do not think it is a good steady diet for children. Whey protein is good, too, but you may not be able to guarantee freedom from casein. Egg protein is the best, if the child is not allergic to egg. Dr. Sidney Baker

8. Electromagnetic radiation minimization.

Exposure to electromagnetic radiation, form electrical sources, both reduces production of melatonin and disrupts our circadian rhythm. One study measured the levels of electromagnetic fields in the homes of CFS patients and gave instructions on how to minimze exposures. The main change people reported was an improvement of sleep. The following are some of the key symptoms to keep in mind.

Sleep with electric blanket or electric heating pad
Use a heated water bed
Meter box or refrigerator on the other side of the wall from your bed head
Computer, television or washing machine on the opposite side of the wall from your bed head which is often operating while you are in bed
Within two feet of your body while in bed (e.g. by bed or under bed) there is an electric alarm clock, a cordless phone or a power adapter (power adapter rather than regular power plug)
House is within 40 meters horizontally of electrical pylons or the lines which extend between them
Mobile phone within two feet of body while in bed
WiFi base station in bedroom
In floor electrical heating
Regular power lines are less than 5 metres horizontally from sleep area
Close proximity of radio tower or mobile phone towers to home

9. Basic sleep hygiene.

A slight lowering of body temperature which occurs at night plays a very important role in modulating the chemical signals which induce sleep. In one study a group of insomniacs were instructed to have a hot shower approximately 3 hours before bed. Many reported this had a dramatic effect on improving their sleep. While trying to fall asleep in bed always take steps to achieve a comfortable temperature as being too hot or too cold can inhibit sleep. This can be difficult for people with CFS as they typically have major problems in thermoregulation. If you are bothered by cold feet in the night, or wake up in the night feeling cold, wear socks to bed.
Keep your bedroom as dark as possible. Light exposure to your eyes or skin lowers levels of sleep inducing melatonin. Wear a comfortable eye-mask. These are available from travel sections of stores like Myer.
Have a regular sleep cycle, e.g. 10 PM - 7 AM.
If your partner snores have them sleep elsewhere until they sort this out. Sleep apnea is a common cause of snoring.
Only use caffeine in the morning.
Minimize fluids in the period before bed to avoid having to get up in the night to go to urinate.
Do not drink alcohol before bed.
If you are bothered by noise either use a white noise generator or buy some comfortable earplugs.
Establish consistent sleep times (e.g. 10:30 PM – 7:30 AM).
Try not to oversleep. This disrupts our sleep cycle and makes it more difficult to sleep the following night.