Treating Chronic Fatigue Syndrome (ME/CFS) and
Fibromyalgia: Sleep Hygiene
"The ‘First and Central Aspect of Treating Sleep Disorders is Good Sleep
Hygiene"
Dr. David Bell
Good sleep hygiene may be the most important aspect of treating
sleep disorders but according to Dr. Bateman, not very many ME/CFS have it.
In fact she says that "Eighty percent of my patients make their sleep
worse."
Sleep hygiene consists of doing things to make it as easy as
possible to for your body to enter into a deep a state of sleep. Dr.
Friedman states that being fully rested and relaxed as you fall asleep will
help make your sleep deeper. The sleep hygiene section includes
everything from what you do before you go to bed to making your sleep
environment as ‘sleep friendly’ as you can. It's broken up into two parts; The Bedroom and Good Sleep
Behavior.
THE BEDROOM
Sleep
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Keep the light levels in the bedroom low. The main agent (melatonin)
that triggers the brain to go to sleep is activated by darkness. Therefore,
if you have trouble getting to sleep, cover your windows with blinds or curtains or blackout shades/liners and/or
sleep with a mask (if you can tolerate it). Use low wattage (75 watt) lights
in a lamp in the bedroom or small reading lights that can clip onto a book.
"Eighty percent of my patients make their sleep worse."
Dr. Lucinda Bateman
Make the bedroom a sleep only room. One of the goals of sleep
hygiene is to get your body/mind to enter into ‘sleep mode’ when you enter your
bedroom. You can do this by removing objects it associates with activity
such as the television and computer from the room.
Take a Warm Bath - approximately three hours before bed. A recent study
showed people with insomniac were able to get to sleep easier if they bathed
three hours before bed. The slow cooling after the bath was believed to
modulate the chemical signals that induce sleep.
Invest in a comfortable mattress. Mary Skeller and Helen Walker
encourage you to ‘invest in the best mattress you can afford." If you can
tolerate rubber they note that mattress or foam rubber pads such as they use
in hospitals are comfortable cheap alternatives. Mary Shomon reports that
the "Cuddle Ewe" sleep pad helps to distributes the body weight more evenly. Sleep
aids such as the "Cuddle Ewe" can be particularly helpful for Fibromyalgia
patients whose tender points make it difficult for them to attain deep
sleep. Good soft cotton bedding with lots of pillows is also recommended as
well as keeping the room somewhat cool and well ventilated.
Continuous background noises generated by a fan or radio with sound
generators (rainstorms, waves, wildlife) that drown out irritating sounds
and sudden noises can also be helpful.
GOOD SLEEP BEHAVIOR
No napping after dinner. Take a nap during the day and don’t do it in
your bedroom – save that room specifically for your nighttime sleep.
Keep to a regular sleep schedule. Train your body/mind to feel there
is a specific time when it should go to sleep.
Exercise to the extent you can. It turns out that
lying in bed is a recipe for poor sleep. Exercise, the other hand, is
a sleep inducer. Try to get in as much exercise as you can without
exacerbating your symptoms (see below).
Don’t overdue it during the day. While some exertion is good too much
exertion can throw ME/CFS patients into the ‘tired but wired’ state that
makes it difficult to get
to sleep and to attain meaningful sleep.
Don’t engage in stimulating activity such as TV and computer games up
to two hours prior to bedtime. Stay away from caffeine in the later part of
the day.
Don't drink a lot of liquids shortly before going to bed
- If you do wake up with the urge to urinate Dr. Teitelbaum
recommends that you tell your bladder "Nighttime is for sleeping. We will go
to the bathroom in the morning when it is time to wake up" and then try to
go to sleep. If that doesn't work then go to the bathroom and try again next
time. (He swears it works!)
If a racing mind is interfering with going to sleep write down your
problems on a piece of paper and set them aside.
Do relaxation exercises for 30 minutes prior to going to sleep - Dr.
Friedman reports that when you fall asleep restfully you sleep more deeply
and for longer periods. He's found that 30 minutes or more of relaxation
exercises often helps chronic fatigue syndrome (ME/CFS) patients sleep
better and have more energy the next day. He suggests focused breathing,
progressive muscle relaxation, guided imagery, etc. .
A warm bath (with I cup of Epsom salts and lavender soap or gel)
before bed can help to get the body relaxed and in the mood
for sleep.
Get out of bed at the same time every morning even if you've had a poor
sleep the night before.
The Dreaded Middle of the Night Wake-ups
Its dark, you're awake and you know that unless you can get to sleep your
next day is shot. What to do? Dr. Friedberg recommends that you do
relaxation exercises such as focused breathing, progressive muscle
relaxation, guided imagery or listening to a relaxation audiotape to ease
you back into the sleep state. If that doesn't work within 30 minutes then
get out of bed and into a comfortable chair and try again. When
you start to feel sleepy get back in bed. If you don't go to sleep then
start the process over again.
Getting up and down may seem to be more arousing than relaxing but
Dr. Friedberg reports that numerous studies have shown this to be
effective if it's done consistently. It may take a couple of days for
it to start working.
(This and all sections of the Phoenix Rising website are
compiled by a layman. They are not a substitute for a physician and are for
informational uses only. Please discuss any treatments in these pages with
your physician.)
____________________________________________
Alison Bested. MD and Allan Logan, ND. 2006. Hope and Help For Chronic
Fatigue Syndrome and Fibromyalgia. Cumberland
Press.
David Bell, M.D. – Lyndonville News, Jan 1st, 2005.
Fred Friedberg, M.D. 2006. Fibromyalgia and Chronic Fatigue Syndrome
- Seven Proven Steps to Less pain and More Energy. Harbinger Press.
Roger Murphee, MD., 2003, Treating and Beating Fibromyalgia and
Chronic Fatigue Syndrome, Hamptom and Hamptom.
Mary Skelly and Helen Walker – Alternative Treatments for Fibromyaglia
and Chronic Fatigue Syndrome.