Sleep Disturbance “Maximizing Sleep” (From the IC Primer, page 14)
“Sleep disturbance is typically expressed by prolonged sleep, sometimes extreme in the acute phase, and often evolves into marked sleep reversal in the chronic phase.”
Items with quotations are from the IC Primer, page 14. Other information is from discussions with patients.
1.“Reduce stimulants such as coffee, alcohol, and decongestants.”
“Create a quiet environment.”
Make sure that light, noise and temperature are the best for good sleep. This might take some time to get this right. Some might want it warm, others cooler. Many like sleeping or resting in a recliner to elevate the legs and possibly help with back pain.
2.“Pace day-time activities and incorporate rest periods. Over-exertion can increase insomnia.”
3. “Listen to the body and rest or sleep when needed. Sleep dysfunction and an inability to produce sufficient energy on demand makes it essential that low energy reserves are not depleted."
This one is probably the most important. This one is also probably the hardest for people with ME to do if you have responsibilities to others or don’t have a caregiver to help with daily chores. As most people with ME know, just getting up or brushing your teeth can take all your energy for the day.
4. “Establish a regular bedtime as much as possible. However sleeping when needed takes priority. In the chronic phase, incorporating short naps into the day may assist in being able to establish a regular bedtime.’’
5. “Quiet activities or listening to a relaxation DVD before bedtime are helpful.”
“Those who are severely ill or in the acute phase may sleep much of the time but sleep is non-restorative.”
6. "Have a warm bath prior to bed and keep the body warm at night." Some find that being cooler at night helps them sleep better.
7. “Keep the bedroom dark and quiet: use black-out curtains, turn the face of clocks away from the bed, use eye masks and/or ear plugs if necessary.”
8. “Postural support: make sure the mattress and pillow give proper postural support.”
A good mattress and pillows are really important. They are also expensive. This is one area that is a concern for many on limited income.
9. “Keep the bedroom as a ‘worry free sanctuary’ reserved for sleep and sex.”
Stress and worry can often lead to tension and make falling asleep difficult. Relaxation methods might help.
10. “If sleep is impossible, get up and go to another room and do calming meditations or relaxing activities."
Other sleep problems to address include:
Medication side effects
Discussion on Medications for sleep -These are only suggestions. It is always important to discuss medications with your physician.
Over-the-counter (non-prescription) products like melatonin and valerian, simple antihistamines such as Benadryl (diphenhydramine) and Tylenol PM and Advil PM, or doxylamine (used in Nyquil and ZzzQuil) might be helpful. Other suggestions are passion flower and chamomile. Amino acids, such as L-theanine and L-tryptophan are sometimes helpful.
Kava Kava tea
B12 and CoQ10 in the morning in order to "wake up" helps improve sleep at night for some people.
Magnesium Oil Spray for restless legs and also general aches and pains.
ReMag Lotion is fantastic! It isn’t sticky and goes on like a lotion. It can be found at www.RnAReSet.com, Carolyn Dean also has ReMag that will help to keep your magnesium up. Pam Lutey says "I have taken it for years and it has helped to keep me in the normal range." It is available at the link above.
Prescription medications are also another approach. This should be under the supervision of your physician. They need to work with you since people with ME are extremely sensitive to medications. It is usually best to start low and increase slowly.
Some suggestions from members include:
Klonopin (clonazepan) with a dosage of 0.5-lmg to initiate sleep along with trazodone (25-50mg) or a tricyclic antidepressant to help maintain sleep.
Lunesta (eszopiclone), Rozerem (ramelteon), or Sonata (zaleplon).These work to naturally stimulate the sleep center of the brain, and are not thought to be addicting.
Sonata has the benefit of being short acting (3-4 hours, so it can be taken for early awakening).
Belsomra (suvorexant) is the newest sleep medication. It works uniquely by suppressing orexin, a neurotransmitter that promotes wakefulness. Belsomra has been alleged to help patients not only fall asleep but stay asleep.
The hypnotic drug Ambien® (zolpidem) is useful for both sleep initiation and maintenance.
Zolpidem increases the depth of sleep but users may adapt to the drug over time, and some people experience amnesia and/or sleep walking.
Analgesics and/or non-steroidal anti-inflammatory drugs (NSAIDs) can be used for pain and often benefit sleep as well.
Xyrem (socium oxybate) has some appealing properties, because it increases slow wave sleep and restores rapid-eye-movement (REM) sleep.
Drugs that might make sleeping worse;
benzodiazepines (except low-dose Klonopin)
antidepressants such as Prozac and Wellbutrin.
More suggestions for Problems with Sleep
Have a Neurologist interpreted sleep study done. (In the IC Primer,p.12)
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