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by Jacob Teitelbaum, M.D.
June 21, 2000
The most effective way to eliminate pain in CFS/FM is to get seven to eight hours of solid, deep sleep each night on a regular basis. Disordered sleep is, in my opinion, the underlying process that drives CFS/FM.
Hypothalmic dysfunction (a major player in CFS/FM) affects sleep, as well as blood pressure, hormonal systems, and temperature regulation.In animal studies done at the University of Tennessee by Carol Everson, Ph.D., sleep deprivation resulted in immune suppression, resulting in multiple infections (including yeast overgrowth in the gut). Many other abnormalities also occurred based on the sleep disorder. These same processes seem to occur in people with CFS/FM.
Canadian researcher, Dr. Harvey Moldofsky, was the first to note that the quality of deep sleep in FM patients was poor. This was described as “alpha wave intrusion into delta sleep,” which means that restorative deep sleep is disrupted.
To put this into English, sleep has its own architecture of which REM sleep is the best known part ; it is a light sleep period where we have our dreams. Stages 1 and 2 of sleep are also fairly light stages, while stages 3 and 4 (Delta Wave) sleep are the deeper stages of sleep. My experience, and that of many other clinicians, suggests that what is inadequate in FM and CFS are these latter two deep stages (stages 3 and 4) of sleep.
Dr. Robert Bennett’s research at The University of Oregon Health Services Center supports this theory. Dr. Bennett is one of the world’s foremost researchers in FM. Hefound that growth hormone deficiency occurs in FM and that treating this deficiency resulted in improvement of symptoms after four to five months. He felt uncomfortable recommending routine growth hormone treatment for FM because of its cost (approximately $15,000 per year).
What is interesting, though, is that growth hormone is released during stages 3 and 4 sleep. In addition, the loss of these deep stages of sleep may be what accounts for the growth hormone deficiency that has been observed. My own suspicion is that not only does hypothalamic dysfunction cause disordered sleep, but by some unknown mechanism, the poor sleep then causes further hypothalamic suppression. Therefore, breaking the cycle of poor sleep and maintaining quality sleep for six to nine months is critical to breaking the cycle of FM, CFS, and severe fatigue.
It is important to note that growth hormone is responsible for many of the repair processes that go on in our muscles and in the rest of our body. It is theorized that this loss of repair function that normally occurs during deep sleep contributes to the pain of FM. Several studies have now shown that if you wake up people whenever they go into deep sleep, or even lightly shake them so they go from deep sleep into light sleep, they will develop classic FM-like pain within one to two weeks and often within one night.
What Should You Do?
It is critical that you get seven to eight hours of solid sleep each night without waking or hangover. Sound sleep is the goal and, hard as this may be to believe, it is very attainable using natural and prescription remedies. This article focuses on the natural remedies that I use.
Natural Sleep Remedies
Most of these sleep remedies are not sedating, yet they help you fall asleep and stay in deep sleep.
Magnesium
Take at least 1 to 2 tables (75 to 150 mg) at night. Magnesium can help relieve pain associated with FM.
Valerian and Lemon Balm
A double-blind research study showed that a combination of valerian (180 to 360 mg) plus lemon balm extract (80 to 160 mg) at night improved deep stage sleep without over-sedation. In nearly 10% of people, valerian is energizing and may keep them up. Use valerian during the day instead of at night if this happens. Valerian is so nontoxic that it would be hard to overdose.
Passion Flower
Take 100 to 200 mg at night to help you sleep. It’s also helpful during the day for anxiety.
5-HTP
Take 100 to 400 mg at night. When used for six weeks, the 300 to 400 mg has been shown to decrease FM pain. One caution I would note is that if you’re taking high doses of a number of treatments that increase serotonin (these includes anti-depressants like Prozac. St. John’s Wort, Ultram, Desyrel, etc.), one can develop a life-threatening reaction caused by a too high level of serotonin. These reactions are very rare. I have never seen a reaction, or have I talked to anyone who treats CFS/FM who noted that they have ever seen one. A reaction would feel like “the panic attack from hell.” If you are taking any of the serotonin-raising treatments, limit the 5-HTP to 200 mg at night.
Kava Kava
I would use one that is a 30% extract, and take anywhere from 200 to 750 mg at night. With prolonged use, a rash will uncommonly occur. If this happens, take 50mg of a B-complex vitamin. If the rash continues, stop taking the Kava Kava.
Melatonin
Melatonin is a hormone made by the pineal gland. Although it is natural and over-the-counter, this does not mean that it is without risk. All it takes to restore melatonin to normal levels in most people is 0.3 mg. The usual dose that you find in the store is 3 mg – ten times the level I recommend. At high levels, melatonin may raise another hormone called prolactin (which is often high in CFS/FM patients), aggravating the risk of depression or infertility.
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