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Medical Matters - ​Tackling sleep problems

Medical Matters - ​Tackling sleep problems

Do you struggle with your sleep? Our Medical Advisor, Dr Gregor Purdie, explores the problem, and some of the available solutions.

Dr Purdie says: People with M.E often report sleep problems, ranging from oversleeping (hypersomnia) to insomnia to sleep apnea (a sleep disorder that occurs when people’s breathing is interrupted during sleep).

The type of sleep problem encountered varies from person to person, and can change over the course of the illness. Hypersomnia is noted to be more of a problem in the early days of the illness, generally.

Further studies into the sleep problems of people with M.E. are needed before specific, formal guidance can be developed. In the meantime, there is a series of general NHS recommendations known collectively as “sleep hygiene.” Some are of value to people with M.E., some less so. We shall look at them each in turn.

Sleep at regular intervals

This is standard advice to encourage getting into a regular sleeping pattern. However, this can be problematic for people with M.E., who need to respond to fluctuating energy levels. Indeed, many people with mild to moderate M.E. say they rely on daytime and weekend sleep to allow them to work, or at least undertake essential activities.

Make sure you wind down

Advice is to consider having a warm bath before bed. This brings the body temperature to the right level for falling asleep. However, not everyone with M.E. can tolerate warm baths. Some find it helpful to write lists for the following day, do relaxation exercises, read a book or listen to relaxing music or talk radio. The important thing is to do something that helps you wind down, so you are not feeling stressed at bedtime.

Make your bedroom ‘sleep- friendly’

Advice is that the bedroom should be a relaxing environment, associated with sleeping – as opposed to working, watching TV, etc. People with M.E. have reported increased difficulties sleeping after using screens that emit ‘blue light’, such as TVs, laptops and mobile phones. Switching them off two hours before bedtime can be beneficial in getting off to sleep.

Bedrooms should be dark, quiet, tidy and ideally kept between 18° and 24°C. Also make sure you have a supportive, comfortable mattress.

Keep a sleep diary

This is helpful for many, but may not always be so useful for people with

M.E. whose sleep pattern can be affected by fluctuating energy levels.

Exercise regularly

Needless to say, this is very difficult for people with M.E.

Cut down on caffeine

Having caffeinated drinks, particularly later in the day, can impair sleep – as can eating too much food in the evenings. Alcohol may cause some people to fall asleep, but it tends to then interrupt sleep later on into the night.

Other remedies

People with M.E. often report that they feel “tired but wired.” Although physically exhausted, their system is still fully alert. Standard advice then is to get up out of bed, and do something relaxing. Go back to bed when feeling sleepy.

Distraction can be helpful. Traditionally this is counting sheep! The important thing is to switch the mind off from stressful thoughts and promote relaxation. Meditation can be most helpful in this situation, and can be practiced through self- hypnosis or mindfulness for example. There is a wide range of meditation CDs on offer, and many free, guided meditations online, particularly on YouTube.

Certain essential oils, such as lavender oil, have also been put forward as aiding relaxation and sleep.

Medication and sleep

Medication can play a part, but should be treated as a short-term aid to kick-start the process of improving sleep. Using medication long term leads to dependency, and feeling the need to increase the dose to maintain its effect.

There are three main types of prescription medication for sleep disorders:

1. Hypnotics

These are the traditional sleeping tablets. The shorter-acting ones, such as Zopiclone, tend to be less addictive, but should still only be used in short courses (around two weeks) and beyond that, only used intermittently. They are helpful if you have difficulty getting off to sleep.

2. Tricyclic antidepressants and Trazodone

Amitriptyline is the most often prescribed of these medications. That and Trazodone were developed many years ago as antidepressants; it was noted, however, that they also helped promote a better sleep pattern. Furthermore, it has become increasingly recognised that they can help in the management of chronic pain. As pain can be a major factor for people with M.E. in reducing quality of sleep, these medications may prove useful.

3. Melatonin

Melatonin is a naturally occurring hormone produced in the body. It is produced in the pineal gland, and its function is to regulate sleep. It is now available as a medication, and can be prescribed on the NHS (it is currently licensed for people over 55). Again, it is recommended that it be used short term to help promote a better sleep pattern. Some people with M.E. have reported benefits from taking it. It has been noted, though, that it can adversely affect diseases of the immune system.

Action for M.E. Medical Advisor Prof Julia Newton, adds: "The team in Newcastle has performed a number of sleep studies in those with M.E. We've looked at both sleep quality and quantity and have shown that both are affected. One of the strategies people with M.E. use to manage their symptoms is to have daytime naps. Our research has shown that daytime napping might worsen the brain fog that is so characteristic of M.E., so is something that might aggravate rather than improve symptoms."