Sleep Disorder

Inability to fall asleep, stay asleep and/or experiencing other disruptions during sleep are just a few of the types of sleep problems experienced by patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and Fibromyalgia (FM). One of the most serious disruptions that warrants sleep study and special intervention is sleep apnea. 

Periodic limb movement, unusual sensations, and/or restless legs syndrome (RLS) are other problems that can disrupt sleep and are treated with specific medications that affect dopamine release. Due to the complexity of these distinct disorders, they are not included under general sleep aids and medications.

Some simple things that patients can try on their own (or with the help of a sleep specialist) are to develop good sleep hygiene habits—like avoiding caffeine late in the day, going to bed and getting up around the same time each day, keeping the room comfortably cool, and using the bed primarily for sleep.

Some find having a small snack of bananas, warm milk, oatmeal or whole-wheat toast with a little honey will help to relax them for sleep because of the tryptophan or other soothing brain chemicals that are released by these foods. There are several herbal products that can be used to help with sleep and relaxation—please refer to our Supplements section.

Several over the counter products, like Benadryl (diphenhydramine hydrochloride) or Unisom (doxylamine) are occasionally used because as antihistamines that cross the blood/brain barrier, they tend to make people drowsy/sleepy.

These are found to be more effective for occasional use rather than long-term use because sedating effects will start to decrease. The most common treatments to help with sleep will be medications (often more than one) that help to initiate sleep and promote deeper sleep (stages 3 and 4). There are four primary groups of medications which are used for their specific effects, such as:

• Antidepressants—often the first line of treatment prescribed will be one of tricyclic antidepressants and a few examples of these are Elavil (amitriptyline), Norpramin (desipramine), and Sinequan (doxepin). The latter is often prescribed in liquid form at a very low dose (only a few drops) along with another medication. As the primary sleep medication starts to wear off, doxepin helps to keep patients asleep longer mainly by its ability to block histamine. Another group of antidepressants, classified as 5-HT receptor antagonists, may also be prescribed, like Desyrel (trazodone) or Remeron (mirtazapine). These belong to the triptans, a family of medications that include migraine treatments. Generally, antidepressants are used to take advantage of certain neurochemical changes they can provide to help with sleep (aside from how they work for depression). Dosage for sleep is usually lower than for treatment of depression. Due to a frequent lower threshold of dosage tolerance, physicians may start a prescription at a lower dosage in order to find the right level to induce sleep.
  
  
• Benzodiazepines—these are central nervous system suppressants and are used for their overall sedating or muscle relaxing properties and may include Xanax (alprazolam), Ativan (lorazepam) and Valium (diazepam). Klonopin (clonazepam) is one of the more frequently prescribed medications from this group because it also has anticonvulsant properties. Klonopin works by balancing the firing of certain neurons and thereby, helping to reduce sensory overload. It also has been found to relieve myoclonus (sudden jerking while sleeping) in many patients. If or when it needs to be discontinued, this should be done slowly by tapering the dose down over several weeks (or as determined by prescribing physician).
  
  
• Non-benzodiazepine agents—these are the newer formulations which are described as shorter-acting hypnotic sleep aids and some of these are Ambien (zolpidem), Sonata (zaleplon), and Lunesta (eszopiclone). Though these are promoted as medications that can be taken with less concern about duration of use or dependence, some can still cause very unusual side effects. One in particular has been Ambien which has been found to cause sleep-walking and amnesia in some individuals.
  
  
• Muscle relaxants—this line of medication may be prescribed for night-time use, as these are usually quite sedating and can provide some level of pain relief. A few of the most commonly used products are Flexeril (cyclobenzaprine) and Soma (carisprodol).
  
  
• Xyrem (a sleep agent derived from gamma-hydroxybutyrate (GHB) and already used in treatment of daytime sleepiness in narcolepsy) is occasionally prescribed for sleep. It is a very potent/aggressive type of sleep agent and one must work with a doctor who has good knowledge and experience with it. It is currently being studied for FM pain and daytime symptoms.