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Sleep is very important to all people. The
amount and quality of sleep is important to proper functioning of our brain and our immune
system. In some regards, the relationship between sleep and the immune system is an
obvious one. Almost everyone is familiar with the desire to sleep during an acute
infection. For centuries, physicians have even prescribed sleep for a variety of
illnesses. However, despite this indistinct wisdom, scientific evidence to support this
relationship has only recently been appearing.
SLEEP STUDIES
A comparison of symptoms in both Fibromyalgia Syndrome (FMS) and Chronic Fatigue
Syndrome (CFS) patients reveals that more than 90% of patients complain of disturbed sleep
in addition to their other symptoms. Sleep studies of FMS patients began in the mid
1970's. These studies identified an abnormal EEG recording in the alpha- wave area during
non rapid eye movement sleep (NREM). Alpha waves are normally present during relaxed
wakefulness or the early stages of sleep when people are most easily aroused. These waves
are considered to be indicative of a vigilant state. The alpha abnormality found in the
FMS study was related to the patient's unrefreshed sleep and overnight increase in muscle
tenderness. This was interpreted as an indication of an arousal disorder within sleep and
the subjective experience of non-restorative sleep. These same findings were subsequently
found in CFS patients as well. Some CFIDS patients have also shown to have such primary
sleep disorders as periodic involuntary limb movements or sleep apnea. Disturbed sleep and
consequent sleep deprivation results in fatigue, daytime sleepiness, impaired cognitive
functioning, muscle aches and joint pains, and mood alterations (most of our CFIDS
symptoms!).
In addition, studies have shown that animals that were artificially infected with an
infectious organism, and developed an acute infection/fever showed the similar sleep
pattern demonstrated in CFIDS. With recovery, the animals normal sleep physiology returned
accompanied with quiet and refreshing sleep.
Based on these earlier (and subsequent) studies, it has been proposed that altered sleep
physiology and its relationship to the waking daytime symptoms are primary ingredients to
the pathophysiology of CFIDS. Specifically, theories have been generated that the symptoms
of unrefreshed sleep, fatigue, diffuse muscle and joint aches, and mood changes involve a
disorder in the chronobiology of the immune, neuroendocrine and sleep-wake systems of the
brain.
RESEARCH
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Chronobiology
Chronobiology (or biological time keeping) is the study of circadian rhythms. The
word "circadian" comes from the Latin 'circa' (about) and 'dias' (a day). It is
used to describe the systematic variations in activity of various physiological systems
that occur in the body over approximately 24 hours. For example, a person's body
temperature has a distinct rhythm so that it is not constantly fixed at 98.6 degrees F,
but is actively maintained near 100 degrees at mid-afternoon and near 96 degrees in the
early morning hours before awakening. A similar pattern can be seen in levels of hormones,
heart rate, blood pressure, and, it is becoming clear, immune functions.
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| The Immune System
The immune system is fundamentally involved in guarding against disease, but is
also important in regulating certain bodily functions. Of special interest in this regard
are cytokines, which are chemical messengers produced by the body's immune system in
response to an acute infection. They are divided into two groups: those, which act
locally, and those that have more widespread effects, such as interleukin-1 (IL-1). IL-1
is a protein that is produced by a variety of cells including the brain, and is considered
to be a key factor in maintaining homeostasis or equilibrium within all the body systems.
It acts via the central nervous system (CNS) to induce fever and the general inflammatory
response associated with infection. It also causes the release of other hormones involved
in the regulation of the immune system and circadian processes.
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| Sleep and the
Immune System
Over the last several years, research studies have demonstrated that certain
cytokines and products of infectious organisms have sleep-promoting effects. Of these,
IL-1 has been investigated most thoroughly due to its importance to the immune system and
its sleep promoting capabilities.
Beginning in the 1980's, Dr. Moldofsky from the University of Toronto, Canada,
has been investigating changes in IL-1 activity and related immune and endocrine functions
over the sleep-wake cycle. For example, the activity of certain natural killer cells (NK),
which are an important part of fighting off an infection and are thought to have a major
role in CFIDS pathology, (Most of us have abnormally low levels of NK cell activity.)
declines with sleep and reaches its lowest levels in slow wave sleep ( SWS, or deepest
sleep) during the night. In women, the timing of the SWS and decline with NK cell activity
also differ with plasma progesterone levels during the menstrual cycle. The diurnal
pattern of these cytokine, immune, and endocrine function are altered with 40 hours of
nocturnal sleep deprivation, however. In addition, studies of CFIDS patients which
measured sleep, immune, endocrine and other levels, demonstrated a correlation between
severity of symptoms reported and reduced levels of SWS recorded in their sleep. Thus, a
direct correlation can be demonstrated between lack of quality, restful sleep and CFIDS
symptoms, as well as, increasing immune and endocrine abnormalities.
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| Future Studies
Now that a clear-cut connection can be made between sleep and the immune/endocrine
system, it remains to be determined as to what causes the disorder in CFIDS. Infectious
agents (like Mycoplasma Incognitus, which has recently been demonstrated to be positive by
blood culture by PCR in 50% of CFIDS patients) have been proposed to trigger CFIDS. These
infectious agents are thought to cause immune dysfunction that contributes to the
pathogenesis of CFIDS. But, what remains to be studied is what came first; the chicken or
the egg? I.e., did the sleep deprivation cause CFIDS symptoms, did the immune/endocrine
abnormalities cause the sleep deprivation, or did the infectious agent cause the sleep
deprivation, which caused the immune/endocrine abnormalities and subsequent symptoms seen
in CFIDS? Further studies on this interrelationship are currently being conducted
throughout the world and are expected to provide valuable insight on the nature and
possible future treatment of CFIDS.
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SLEEP IMPORTANCE IN
CFIDS
Since 90% of CFIDS sufferers complain of some type of sleep disturbance, it would
help to review the sleep patterns that are common. During the early stages of CFIDS a
pattern of hypersomnolence (excessive sleep) is common. These people are typically sleepy
all day long and can easily fall asleep most any place or time. This group of CFIDS
patients may sleep a total of 12-18 hours a day. They are, however, very light sleepers,
and are easily aroused by light or sounds. Their nocturnal sleep is dreamless, restless
and light. They usually arise in the morning or after a nap unrefreshed (in fact, they
often say they feel worse upon arising than they did before they went to sleep). After
having CFIDS for a while, another pattern emerges, one of insomnia. These people have
difficulty falling asleep at all times, have difficulty staying asleep, and typically
sleep less than 5 hours a day. Their sleep is also dreamless, restless and light. But,
unlike the earlier pattern, they do not feel sleepy during the day and cannot nap.
Consequently, they become exhausted from lack of sleep. Both groups demonstrate a
characteristic pattern of SWS patterns on EEG, what changes is the quantity of
sleep, the elevation of immune/endocrine abnormalities, and the increase in severity of
other symptoms. When both groups of CFIDS patients have in-depth sleep studies done, one
interesting fact emerges; our sleep patterns at night look like a person who is awake
during the day and our daytime awake patterns look like a person who should be asleep. No
wonder we can't think! Our brains are asleep!
TREATMENT
After reading the studies of CFIDS and sleep problems, it becomes clear that sleep
is very important, not only for our day-to-day function, but also to recovery. Treatment
is aimed at increasing the quantity and quality of deep, restful sleep. The benefits are
improved cognition, mood, pain, immune and endocrine function.
The varieties of sleep inducers range widely from sleeping pills to the more natural
herbal products. Most products that induce sleep are taken just before bedtime. Most sleep
aides help a person fall asleep and stay asleep.
Sleeping pills require a prescription, and are often habit forming, however, few CFIDS
patients can tolerate their long-term use. Herbs, such as Valerian, and a brain hormone
called Melatonin are readily available in drug and health food stores. They come in the
form of teas, tablets, sublingual pills, and sustained release capsules. (In order to last
all night).
Our brain naturally produces another form of sleep inducer. It is called serotonin, a
brain neurotransmitter. The level of serotonin can be elevated with what are called SRI's
(serotonin reuptake inhibitors or anti-depressants). SRI's are prescribed for those who
are depressed and work by simply re-cycling the serotonin produced by the brain. The
dosage for CFIDS patients should be much lower than for that of a depressed person,
however, to avoid side effects. For those of us who can not tolerate any of the above
SRI's, there is HOPE! It is called 5-Hydroxy Tryptophan (5-HTP). 5-HTP supplies the brain
with the form of tryptophan it needs to produce serotonin and eventually melatonin (as
well as other important immune/endocrine connectors). Thus, 5-HTP helps us get to sleep
and stay asleep, reduces pain, elevates mood, and improves immune/endocrine function. And,
it does it all naturally by our own bodies!
5-HTP comes in strengths of 50mg and 100 mg. 5-HTP is best taken with juice and vitamin B6
about 30 minutes before bedtime. Your brain then uses 5-HTP to make serotonin. Natural
food sources of tryptophan can be found in Soya protein, brown rice, cottage cheese, fish,
liver, lamb, peanuts, pumpkin, sesame seeds and lentils. The body takes these food sources
and produces 5-HTP.
As with all supplements, consult with your physician before using.
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