Sleep Abnormalities

Most patients with CFS were found to have sleep disorders which are likely to contribute to the daytime fatigue and may also be important in the etiology of the syndrome.

  • S. Yamamoto, Y. Ouchi, H. Onoe, E. Yoshikawa, H. Tsukada, H. Takahashi, et al., "Reduction of Serotonin Transporters of Patients with Chronic Fatigue Syndrome," Brain Imaging, Vol. 15, No. 17, 2004, pp. 2571-2574. (Subgroup of CFS).
  • A. R. Spitzer and M. Broadman, "Treatment of the Narcoleptiform Sleep Disorder in Chronic Fatigue Syndrome and Fibromyalgia with Sodium Oxybate," Pain Practice, Vol. 10, No. 1, 2010, pp. 54-59.
    Spitzer and Broadman believe that many patients with ME/CFS and FM have a lesion in the ventral-lateral preoptic nucleus of hypothalamus, which is critical to initiating and maintaining sleep. This explains the sleep abnormalities in these illnesses.
  • Van Hoof E, De Becker P, Lapp C, Cluydts R, De Meirleir K. Defining the occurrence and influence of alpha-delta sleep in chronic fatigue syndrome. Am J Med Sci 2007;333(2):78–84.
  • A. Kishi, B. H. Natelson, F. Togo, Z. R. Struzik, D. M. Rapoport and Y. Yamamoto, "Sleep Stage Transitions in Chronic Fatigue Syndrome Patients With or Without Fibromyalgia," Proceedings of the International Conference of the IEEE Engineering in Medicine and Biology Society, Vol. 1, 2010, pp. 5391-5394.
  • Kishi A, Struzik ZR, Natelson BH, Togo F, Yamamoto Y. Dynamics of sleep stage transitions in healthy humans and patients with chronic fatigue syndrome. Am J Physiol Regul Integr Comp Physiol ( 2008 ) 294 : R198 0 - R1987. doi: 10.1152/ajpregu.00925.2007.
  • Kishi A, Natelson BH, Togo F, Struzik ZR, Rapoport DM, Yamamoto Y. Sleep - stage dynamics in patients with chronic fatigue syndrome with or without fibromyalgia. Sleep ( 2011 ) 34 : 1551 - 1560. doi: 10.5665/sleep.1396.
  • Neu D, Mairesse O, Verbanck P, Le Bon O. Slow wave sleep in the chronically fatigued: power spectra distribution patterns in chronic fatigue syndrome and primary insomnia. Clin Neurophysiol 2015;126(10):1926–33.
  • Decker MJ, Tabassum H, Lin JM, Reeves WC. Electroencephalographic correlates of chronic fatigue syndrome. Behav Brain Funct ( 2009 ) 5 : 43. doi: 10.1186/1744 - 9081 - 5 - 43.
  • Neu D, Mairesse O, Verbanck P, Linkowski P, Le Bon O. Non-REM sleep EEG power distribution in fatigue and sleepiness. J Psychosom Res 2014;76(4):286–91
  • Jackson ML, Bruck D. Sleep abnormalities in chronic fatigue syndrome/myalgic encephalomyelitis: a review. J Clin Sleep Med 2012;8(6):719–28.
  • A. N. Vgontzas, V. M. Zoumakis D. A. Papanicolaou, E. O. Bixler, P. Prolo, H. M. Lin, A. Vela-Bueno, A. Kales and G. P. Chrousos, "Chronic Insomnia is Associated with a Shift of Interleukin-6 and Tumor Necrosis Factor Secretion from Nighttime to Daytime," Metabolism, Vol. 51, 2002, pp. 887-892.
  • Togo F, Natelson BH, Cherniack NS, FitzGibbons J, Garcon C, et al. Sleep structure and sleepiness in chronic fatigue syndrome with or without coexisting fibromyalgia. Arthritis Res Ther. 2008;10(3):R56.
  • Sleep quality and psychological adjustment in chronic fatigue syndrome. Fossey M, Libman E, Bailes S, Baltzan M, Schondorf R, Amsel R, Fichten CS. J Behav Med. 2004 Dec;27(6):581-605.
  • Sleep apnea in male patients with the fibromyalgia syndrome.
    May KP, West SG, Baker MR, Everett DW. Am J Med. 1993 May;94(5):505-8.
  • Morriss R et al. BMJ 1993; 306: 1161
  • McClusky DR. Ciba Found Symp 1993; 173: 280

  • Ultra-Slow delta power in chronic fatigue syndrome. Le Bon et al. Psychiatry Research. Volume 200, Issue 2 , Pages 742-747, 30 December 2012
  • "A survey of over 1000 patients with Fibromyalgia Syndrome (FMS) and Chronic Fatigue Syndrome (CFS) showed that prior to their illness fewer than 1% had disturbed sleep, whereas during their illness this rose to over 90%."
    Fibromyalgia Network Newsletters : October ‘90 through January ‘92 Compendium #2, January 1993, May 1993 Compendium, January 1994, July 1994. (the Newsleter is highly recommended for information on FMS) Available from Fibromyalgia Network PO Box 31750, Tucson Arizona 85751-1750 USA
  • Consequences of GABA depletion
    • T. Doi, Y. Ueda, K. Nagatomo and L. J. Willmore, "Role of Glutamate and GABA Transporters in Development of Pentylenetetrazol-Kindling," Neurochemistry Research, Vol. 34, 2009, pp. 1324-1331.
    • J. W. Winkelman, O. M. Buxton, J. E. Jensen, K. L. Benson, S. P. O'Connor, W. Wang and P. F. Renshaw, "Reduced Brain GABA in Primary Insomnia: Preliminary Data from 4T Proton Magnetic Resonance Spectroscopy (1H-MRS)," Sleep, Vol. 31, No. 11,2008, pp. 1499-1506.
    • M. M. Halassa, C. Florian, T. Fellin, J. R. Munoz, S. Y. Lee, T. Abel, P. Haydon and M. G. Frank, "Astrocytic Modulation of Sleep Homeostasis and Cognitive Consequences of Sleep Loss," Neuron, Vol. 61, No. 2, 2009, pp. 213-219. doi:10.1016/j.neuron.2008.11.024
    • Z. Y. Hong, Z. L. Huang, W. M. Qu, N. Eguchi, Y. Urade and O. Hayaishi, "An Adenosine A Receptor Agonist Induces Sleep by Increasing GABA Release in the Tuberomammillary Nucleus to Inhibit Histaminergic Systems in Rats," Journal of Neurochemistry, Vol. 92, 2005, pp. 1542-1549.
    • J. Krueger, "The Brain that Never Fully Sleeps," Fibromyalgia Network, Vol. 85, 2009, pp. 12-15.
  • "Consultant psychiatrist Dr Peter White, of London’s St Bartholomews’s Hospital, states ' We know that two thirds of CFS patients have sleep disorders ' ".
    Quoted in the Ann Macintyre Interview in ‘INTERACTION’ (Journal of ‘Action for ME’) No.16 Summer 1994 p20-24(highly recommended for information onME) Available from PO Box 1302, Wells BA5 2WE, United Kingdom
  • "Serotonin has been found to be deficient in people with CFS(ME) and FMS, which has a profound influence on sleep patterns and alterations in pain sensitivity."
    Leon Chaitow, N.D., D.O., MRO, Senior Lecturer, University of Westminster
    Chronic Fatigue Syndrome & Fibromyalgia: The Brain/Sleep Connection

  • "Dr Vesselinova has been measuring blood and salivary melatonin levels through the night and found them to be depressed in CFS patients. This is to be expected since we know that hormone output from the hypothalamus/pituitary/adrenal axis is abnormal, so the pineal, a similar gland, is likely to be affected."
    Dr. Sarah Myhill, Wales, UK.  Dr Vesselinova is a doctor at Lister Hospital in London, England.

  • Fragmented sleep (periods of wakefulness throughout the sleep period) and lack of deep-stage sleep are very common in CFS patients. True insomnia (inability to fall asleep) is uncommon, although patients may have delayed sleep onset because of a disrupted circadian rhythm.
    Nancy Klimas, MD, University of Miami,  CFS Basic Science Panel meeting, March 16-18 in Reno, Nevada, USA. Eighteen CFS researchers and clinicians participated on two panels to examine rehabilitation strategies and basic science findings and make recommendations about what and how knowledge about CFS could be applied by clinicians to help patients.

  • Hyde, Byron Marshall, Editor; The Clinical and Scientific Basis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome; Nightingale Research Foundation, Ottawa, Ontario, Canada, 1992.

    Dr Richard Morris, Senior Lecturer in Psychiatry, University of Manchester
    Fatigue 2000: International Conference,  23-24 April 1999

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