Should You Take Part in a Sleep Study? Chronic Fatigue Syndrome and Sleep Disorders
By Dr. Richard L. Bruno •
April 3, 2002
I don't know what happened. I was sound asleep and the next thing I know
my wife is yelling and blood was running out of her nose. She screamed,
"Bob, you hit me! " I was asleep, I swear! She said my arm flew out
sideways and smacked her in the face. I know I snore. And she's been
telling me for years that I stop breathing and my muscles twitch when I
sleep. But why would I hit her?
Why, indeed, would Bob hit his wife? We wanted to know...and so did she.
With the help of Elizabeth Dowsett in the UK and Lydia Nelson of Canada's
National ME/FM Action Network, we conducted the 2001 International Survey of
586 individuals with ME and CFS.
In one part of the Survey we asked Americans, Britons and Canadians with chronic fatigue if their muscles twitched or jumped while they were falling asleep or during the night. We also asked if they had symptoms of sleep-disordered breathing: if they snored, woke in the middle of the night with anxiety, heart racing, choking, or shortness of breath, had headaches or weren't rested in the morning.
Sixty-seven percent of ME/CFS patients reported that they knew their
muscles twitched or jumped at night. This percentage is only slightly higher
than the 63% of polio survivors in our 1985 National Post-Polio Survey who
reported twitching and jumping. But muscle movements at night are sneaky.
Bob didn't know he was twitching until his wife told him. In our 2001 review
of all the sleep studies performed on Post-Polio Institute patients,
one-third were found to have muscle movements that disturbed their sleep.
However, only 40% of those knew that twitching and jumping were waking their
brains, sometimes hundreds of times each night, even though they thought they
were sleeping soundly.
Forty-seven percent of ME/CFS patients reported symptoms of sleep-disordered breathing that could be evidence of central sleep apnea, where breathing stops because the diaphragm isn't moving; obstructive sleep apnea where muscles in the back of the throat become relaxed during sleep, closing off the throat and physically preventing air from entering the lungs; or hypopneas where air flows freely but oxygen in your blood decreases anyway
because the diaphragm is not able to move enough air in and out of the lungs.
This 47% is identical to the percentage of polio survivors with
sleep-disordered breathing in our 2001 review of Post-Polio Institute
patients' sleep studies, and one percent higher than in a study of CFS
researcher Kenny De Meirleir's Belgian CFS patients who'd had sleep studies.
In our polio survivors, 10% had central sleep apnea, 15% had obstructive
apnea and a whopping 60% had hypopneas. Hypopneas are even sneakier than
twitching and jumping as a cause of disturbed sleep; even if someone were
looking they couldn't tell that you weren't moving enough air in and out of
your lungs, that your blood oxygen was dropping and that your brain was being
awakened hundreds of times a night.
In PPS patients, the combination of twitching and breathing problems
resulted in our patients losing 60% of their deep sleep and 20% of dream
sleep. Is it any wonder that folk with these kinds of sleep disorders would
feel fatigued during the day?
Our findings add to the growing body of research suggesting that post-polio fatigue and chronic fatigue have a similar origin, that is damage to brain neurons that activate the brain. The poliovirus certainly doesn't cause CFS or ME today, but other similar viruses -- such as the Coxsackie viruses -- chew up brain neurons exactly as the polioviruses do. And it's brain neuron damage that is thought to cause both nighttime twitching and abnormal breathing during sleep.
Although a sleep disorder may not be the primary cause of daytime fatigue
in ME/CFS patients, it may be making fatigue much worse. We have found that
a very low dose of Xanax (alprazolam) taken 30 minutes before sleep stops
twitching and jumping, and even stops flailing arms. But breathing problems
have to be treated before taking Xanax, since any muscle relaxant can cause
decreased breathing. The most effective treatment for apneas and hypopneas
is positive airway pressure (PAP) where a bread-box sized machine blows air
into the nose, mouth or both during the night to prevent floppy muscles from
closing off the throat and keeps the lungs fully inflated.
Anyone who has muscle twitching, snores, wakes in the middle of the night
with anxiety, heart racing, choking, or shortness of breath, has headaches or
isn't rested in the morning should have a sleep study. You shouldn't wait
until you've hit your spouse before having your sleep evaluated.
Dr. Richard Bruno is Director of Fatigue Management Programs and The
Post-Polio Institute at Englewood (NJ) Hospital and Medical Center. His new
book, THE POLIO PARADOX: UNCOVERING THE HIDDEN HISTORY OF POLIO TO UNDERSTAND
TREAT "POST-POLIO SYNDROME" AND CHRONIC FATIGUE, will be published by Warner
Books in June. AOL Keyword POLIO PARADOX. E-mail questions to him at
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