Sleeping abnormalities. Single most important aspect of ME (Found in over 90% of ME patients)

 

Scientific and Medical Evidence - Listing of Research conducted worldwide section :
Sleep abnormalities
Serious Brain and nervous system abnormalities
Abnormal adrenal glands & Abnormal HPA axis (Hypothalmus Pituary Adrenal axis)

Scientific Findings in Primer for International Consensus Criteria (2012)

Sleep abnormalities are the single most important aspect of ME and are present in over 90% of all ME patients. Unrefreshing sleep is mentioned as one of the diagnostic criteria for ME in the CDC definition of 1994 and is also mentioned in the International Consensus Criteria and Canadian Criteria. Dr. Jacob Teitelbaum successfully treated many ME patients and he has stated that a combination of mental and physical exhaustion and an inability to sleep, chronic insomnia, is one of the main factors in ME. Unrefreshing sleep over the course of a few weeks or months adversely affects immune system function, brain function, the endocrine system, the body's repair systems and capacity to recover, one's energy levels, etc.. It has multiple negative effects on the body. Resolving the sleep problem in ME patients will bring about dramatic improvement for all patients, though not full recovery. It is just one of several abnormalities and dysfunctions which need to be rectified in ME patients to move them towards full recovery.



Source: ME Primer for Healthcare Professionals: based on Myalgic encephalomyelitis: International Consensus Criteria, 2012

  • Sleep studies into ME and Fibromyalgia confirm some serious chronic sleep abnormalities, genetic and immune system abnormalities in these illnesses, which need to diagnosed and identified in patients.
    - A retrospective review of the sleep characteristics in patients with chronic fatigue syndrome and fibromyalgia. Spitzer AR, Broadman M. Pain Pract. 2010 Jul-Aug;10(4):294-300. doi: 10.1111/j.1533-2500.2009.00352.x. Epub 2010 Mar 2.
    "Abstract
    This study characterizes findings on sleep testing and Human Leukocyte Antigen (HLA) markers in a group of patients with fibromyalgia (FM) and chronic fatigue syndrome (CFS). One hundred eighteen patients seen in a general neurology practice over 5 years meeting standard clinical criteria for FM or CFS were analyzed retrospectively. Cases of untreated sleep apnea or restless legs syndrome were excluded prior to inclusion in this study. Ninety-two patients had multiple sleep latency testing (MSLT). Seventy-three (80%) were abnormal by standard criteria. Of 57 females having positive MSLTs, 22 (39%) had one or more periods of sleep onset rapid eye movement (SOREM), and 5 of 16 (31%) males with positive MSLTs had one or more SOREM. Highly fragmented sleep, as previously described in FM, was seen but not analyzed quantitatively. HLA DQB1*0602 was obtained in 74 patients, and positive in 32 (43%), P < 0.0001 compared with published values in 228 populations. In our patients, who presented with neuromuscular fatigue or generalized pain, we found a sleep disorder characterized by objective hypersomnia. Some patients had characteristics of narcolepsy. Objective assessment by sleep studies can assist the diagnostic process, aid future research, and provide rationale for treatment."
  • Go to a Sleep clinic and check for :

    • Nocturnal Hypoxia. This is a factor in some cases of ME and CFS.

    • Lack of stage 3 and 4 REM sleep. Alpha wave intrusion into delta waves during sleep. Weak delta waves. Inability to get enough deep restorative sleep.

    • Prolonged sleep onset latency. Multiple sleep latency testing (MSLT)

    • Test for excessive NMDA activity in the brain at night.

    • Test for low GABA activity in the brain at night.

    • A Shift of Interleukin-6 and Tumor Necrosis Factor Secretion from Nighttime to Daytime

    • Test for excessive cytokine activity at night before sleep and while sleeping at night. Excess IL-6 is associated with Hypersomnia. Excess IL-10 is associated with Hyposomnia.

    • Test HLA DQB1*0602


    • Test melatonin and serotonin levels from 10pm to 2am. Most ME patients have abnormally low melatonin and serotonin levels at night which prevents sleep.

    • Test for Tryptophan destruction in ME patients
      Tryptophan the precursor of serotonin which is involved in sleep and many other functions is being depleted by high levels of neopterin and indoleamine 2,3-dioxygenase. Test blood, spinal fluids, and inflamed samples from brain, dorsal root ganglia, basal ganglia, brain stem, vagus nerve, spinal cord, cervical and lumbar nerve roots and peripheral nerves and blood for
      the following:
      • Measure levels of neopterin, indoleamine 2,3-dioxygenase, L-kynurenine, kynurenic acid and quinolinic acid. Also measure levels of tryptophan. Test for brain lesions consistent with edema, inflammatory destruction and demyelination.

    • Sleep apnoea, obstructive central sleep apnoea. Studies show that 40-50% of ME patients and Fibromaylgia patients have sleep apnea.
      How significant are primary sleep disorders and sleepiness in the chronic fatigue syndrome? Le Bon O, Fischler B, Hoffmann G, Murphy JR, De Meirleir K, Cluydts R, Pelc I. Sleep Res Online. 2000;3(2):43-8.
      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.

    • Test for high Histidine levels, and high trans-urocanate levels at night

    • Test for high Histamine levels at night

    • Test for excessive Mast cells and Mast cell activation at night

    • Test blood sugar levels at night

    • Test for abnormal fall in blood pressure during sleep

    • Test for heart arrythmias and abnormal heart beats during sleep

    • Test for narcolepsy, primary sleep disorder

    • Test for night epilepsy, restless leg syndrome, night panic attacks, sleep walking

  • The following papers provide guidance on how to operate sleep studies
    • Iber C, Ancoli - Israel S, Chesson A, Quan SF. The AASM manual for the Scoring of sleep and associated events: rules, terminology, and technical specifications. 1st ed. Westchester, IL: American Academy of Sleep Medicine ( 2007 ) .
    • Dumermuth G, Lange B, Lehmann D, Meier CA, Dinkelmann R, Molinari L. Spectral analysis of all - night sleep EEG in healthy adults. Eur Neurol ( 1983 ) 22 : 322 - 339. doi: 10.1159/000115579.
    • Lo CC, Nunes Amaral LA, Havlin S, Ivanov C, Penzel T, Peter JH, et al. Dynamics of sleep - wake transitions during sleep. Europhys Lett ( 2002 ) 57 : 625 - 631. doi: 10.1209/epl/i2002 - 00508 - 7.
  • Neuroinflammation

    • Test for Kynurenine and Serotonin levels.
      New research has found a reliable biomarker A bloodspot-based diagnostic test for fibromyalgia syndrome and related disorders. Hackshaw KV, Rodriguez-Saona L, Plans M, Bell LN, Buffington CA Analyst. 2013 Aug 21;138(16):4453-62. It involves use of infrared micro spectroscopy to analyse ‘spectra’ to determine the chemical composition of tissue or blood. Test for:
    • indoleamine-2,3-dioxygenase (IDO)
    • high levels of kynurenine (KNN)
    • low levels of serotonin
    • low levels tryptophan
    • high levels of pyridine carboxylateathy
    • high levels of quinolinic acid

    • Neopterin
      Measure levels of neopterin, indoleamine 2,3-dioxygenase, L-kynurenine, kynurenic acid and quinolinic acid. Also measure levels of tryptophan. Test for brain lesions consistent with edema, inflammatory destruction and demyelination.
      Neopterin/Biopterin Profile http://www.metametrix.com/test-menu/profiles/vitamins/neopterin-biopterin

    • Tryptophan destruction in ME
      Tryptophan the precursor of serotonin which is involved in sleep and many other functions is being depleted by high levels of neopterin and indoleamine 2,3-dioxygenase. Test blood, spinal fluids, and inflamed samples from brain, dorsal root ganglia, basal ganglia, brain stem, vagus nerve, spinal cord, cervical and lumbar nerve roots and peripheral nerves and blood for
      the following:
      Measure levels of neopterin, indoleamine 2,3-dioxygenase, L-kynurenine, kynurenic acid and quinolinic acid. Also measure levels of tryptophan. Test for brain lesions consistent with edema, inflammatory destruction and demyelination.
  • Dr. Byron Hyde one of the top ME doctors in the world recommends several sleep related tests for ME
    • "One of many common problem areas is the nasopharynx and temporomandibular joints, a.k.a. the mandibular or jaw articulation. Several M.E. and CFS patients have significant pharyngeal and other obstructive airway problems that prevent adequate sleep function that in turn causes chronic fatigue syndromes and the associated chronic decrease in physical and cognitive stamina...............................They include treating (1) enlarged tonsils that obstruct the respiratory tract when sleeping by surgery, (2) treating nasal obstructions, (3) treating chronic sinusitis with night time post nasal drip, and understanding (4) anatomically small pharyngeal box, (5) palate dysfunction and (6) temporomandibular dysfunctions that include mandibles that fall back to obstruct the pharynx when the patient sleeps.
      Source: Diagnostic Tests


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