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by John Addington
December 20, 2000
The sleep difficulties that plague those with chronic fatigue syndrome (CFS) and fibromyalgia (FM) often drive patients to the use of strong sedating and sometimes addictive medications. There is, however, another option, one without the use of pills, which may be considered. Described as good "sleep hygiene" this option involves changes in behavior to establish practices that are conducive to improved sleep.
Those most likely to benefit from learning healthy sleep habits are the patients who have difficulty getting to sleep or those who awake unrefreshed because of the poor quality of their rest. Although the improvements may not always be dramatic, many find implementing these good sleep practices are well worth the effort required.
Establishing Good Sleep Patterns
Researchers have established that sleep cycles become altered in CFS and FM which if un-checked can perpetuate themselves and be the cause of other symptoms which adversely effect sleep. This process unwittingly conditions the sufferer into poor sleeping habits, going to sleep later and later or staying in bed longer and longer. Thus, experts stress the importance of adhering closely to set times for going to bed and rising even on the weekends, limiting the time in bed to around eight hours if possible. As difficult as this can be, especially initially for CFS/FM patients, it can be essential to resetting the body's natural clock, otherwise known as the circadian rhythm.
Exposure to strong light can aid in correcting circadian rhythm disorders. Either outside light or the special strong indoor lighting designed to mimic outdoor light will work. For those whose bedtime has become very late, exposure to strong light in the morning for at least 15 minutes and up to a couple of hours can help.
Another morning time reconditioning aid is light activity or exercise. The problem is that the aching associated with CFS/FM, especially if you are not sleeping well, makes this challenging. Nonetheless, if kept light enough, many find the immediate benefits in reduction of pain an added impetus for this practice. If able, try a short walk, swimming or slow stationary cycling, gradually working up to 20-30 minutes in length.
Keep in mind that both the exercise and exposure to light needs be done early in the day so as not to provide over stimulation too close to your set bedtime. Also naps should be avoided, if possible, especially late in the day.
Proper Intake, The Do's & Don'ts
What you take into your body during the day, particularly in the afternoon and evening, can negatively or positively influence your ability to sleep. Foods that encourage sleep are carbohydrates or those that contain tryptophan since both of these promote the brain's production of serotonin. Tryptophan is an amino acid, which acts as a natural relaxant, soothes nerves and reduces stress. Foods high in tryptophan are milk, cottage cheese, yogurt, turkey, sardines, fish, chicken, bananas, raisins, figs, dates, peanuts, nut butter, and brown rice. A light snack made up of these foods before bed will help prime your body for rest. The emphasis on "light" is important too, since digesting large meals late can adversely impact sleep.
Certain herbal caffeine-free teas also have relaxing properties and thus are helpful at bedtime. In this category, are teas that contain valerian, chamomile, kava kava, passionflower, melatonin, and skullcap either singly or in combination. Be cautious, however, not to take in too much liquid before retiring as repeatedly needing to use the bathroom during the night obviously inter-feres with sleep quality also.
Caffeine containing foods, coffee, teas, chocolates should be avoided particularly late in the day. Jacob Teitelbaum, M.D., describes caffeine as a "loan shark for energy." He explains that despite the initial burst of energy that caffeine supplies, it actually "takes away more energy than it pro-vides." Notwithstanding the net result of feeling drained, caffeine can interfere with falling asleep and the quality of sleep. Thus doctors treating those with sleep problems often recommend their patients limit or altogether stop their intake of caffeine.
It would be good as well to avoid alcohol, nicotine, and sugar. Nicotine and alcohol both are stimulants but don't bring solid, lasting relief from fatigue. Thus smokers and alcohol users are more likely to complain of fatigue. For some alcohol does help to induce sleep but it invariably disrupts deeper sleep cycles later. While sugar may not be as detrimental as tobacco or alcohol, because it too can have stimulating action and interfere with rest, at a minimum it should be restricted.
You can view all such quick-fix stimulants like forcing an automobile engine to run without recharging the car's battery. Refreshment from improved sleep as a result of restricting intake of stimulants, is much more preferable than the short burst of energy they bring.
Relaxation Rituals
As your scheduled time to retire for the night nears, focus on reducing or avoiding stress. That may mean avoiding exciting reading or television programs. Schedule stressful situations that you must confront or taxing conversations early in the day and spend your evening winding down. If something worrisome comes to mind later in the evening or particularly when you are in bed, write it down on paper kept by your bed and then forget about it until the next day. Likewise let your answering machine take your phone messages before bedtime.
An FDA article on sleep encourages "performing relaxing rituals before bed, such as taking a warm bath, listening to relaxing music, or eating a light snack." Enhance the soothing properties of the bath by adding Epsom salts, chamomile, mint and rosemary. Others encourage sedating aromatherapy by using clary sage or jasmine essential oils near the bed.
Light reading may also help prepare you for sleep but authorities suggest not reading, working or watching TV in bed. The idea is that you are conditioning your mind to associate the bed with sleep. Therefore it is best to avoid using it for anything other than sleep or sex. Putting it simply one author commenting on a lecture by CFS specialist, Nancy Klimas, M.D., explained "if one is only in bed to sleep, then getting into bed is more likely to result in sleep."
To help in this regard your bed and bedroom should be as comfortable and restful as possible. Invest in a good mattress. Ensure the temperature is appropriate for sleeping and do what you can to reduce the noise and light. Wear earplugs or eye shades if need be.
Once you retire if you have not fallen asleep within 15 to 20 minutes get up and leave your bed. Don't lie there worrying about what your problems are or your inability to get to sleep. Instead go to another room or area and do some light reading (but not under bright illumination) or engage in something else relaxing. Return to bed only when you are sleepy. Repeat this if necessary until you fall asleep.
Conclusion
For many, implementing proper sleep hygiene may enable them to reduce or eliminate some medications. As noted earlier, however, the techniques described in this article are not appropriate for all CFS and FM patients. Even for those that are helped by these strategies the benefits may wax and wane.
Furthermore, those with CFS or FM should not construe the fact that benefits can be derived from changing their behavior to mean that they are at fault for their sleeping difficulties to begin with. The book Chronic Fatigue Syndrome: A Treatment Guide explains "CFIDS sleep disorder is not caused by bad habits. It is caused by brain disturbances. Rest is permissible whenever the body allows it."
Thus there is no merit or value in blaming yourself for sleeping difficulties. Rather simply try to enjoy the benefits adapting good sleep hygiene may occasionally bring you. If this results in better rest, more power to you.
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