Managing sleep dysfunction



  • Hi again everyone,

    I think the sleep discussion is so interesting. It is an issue for so many of us, and there are a range of potential sub-threads, both in terms of challenges, opportunities and approaches to management.

    We've already chatted about temperature / doonas.

    You good people, @river, @crashdummy and @Katt started chatting about sleep opportunities and melatonin. So I might put some thoughts in there too.

    I'm going to talk about an approach that helps me. It is a different approach to one given above - I hope that's ok. I am not doing it to be contrarian πŸ™‚ I understand that in different people's different situations different decisions are made, etc.

    Something I learnt in the first 5 or so years of my 30 year CFS journey was that, for me, not having day sleeps, little or big, was very important. Even if I was sleepy tired in the daytime, the decision I made was to not go with that, to stay awake, get through to night time, and try and go to sleep then.

    Whenever I did go to have an extra sleep in the day, further fatigue issues would generally result. Generally a feeling of a build up of lactic acid, with lots of related other symptoms.

    This decision making relates to a bigger conversation about diurnal rhythms. I'll save more writing for a possible other post.
    Briefly, linking to an item raised above - whether we get it all naturally, or look to have an extra boost, Melatonin - I believe - works with our natural day / night experiences.

    The approach I follow above, of choosing to generally only sleep at night and not in the day also seeks to work with the natural day / night experience.

    regards,
    Paul.



  • @PaulB it's definitely good to hear different people's approaches! That way it helps whoever reads this to understand their own condition and which ways might be best for them to manage it πŸ™‚

    I am curious about your comment on lactic acid build up as I hadn't ever really thought about this in relation to sleep. When I think about lactic acid and ME/CFS I generally think gut imbalances and D-lactate producing bacteria and IBS. I did just find an article "Sleep quality and the treatment of intestinal microbiota imbalance in Chronic Fatigue Syndrome: A pilot study" as well as "Open-label pilot for treatment targeting gut dysbiosis in myalgic encephalomyelitis/chronic fatigue syndrome: neuropsychological symptoms and sex comparisons". Both mention some possible improvement in sleep functions with reduced Streptococcus count. Anyway, sorry, I think I'm going down a rabbit hole and maybe getting too off topic but just a thought that I wonder if we should be looking also into our gut in relation to sleep.



  • @PaulB I know what you mean, if I sleep during the day (very rare for me, it usually only happens if I'm extremely sick from non-PEM causes) I wake up feeling worse, kinda poisoned. Same if I'm woken too early from night time sleep. I'm not sure if it's lactic acid, but it's definitely cycle disruption related. I always visualize it as your brain is cleaning the dirty dishes while you sleep, and if you wake up before its finished, your brain is full of dirty dishwater.



  • @Katt lactic acid is the waste product that accumulates in your muscles when you exercise and causes muscle pain and fatigue. Some research shows that people with CFS have a rapid build up of lactic acid following mild exertion because we can't clear it properly, and/or produce more of it due to inefficient energy production.



  • @river thanks for the info, much appreciated! Sorry I did go off on a complete sidetrack and I apologise for that. Recently I was delving into gut dysbiosis and saw the idea of D-lactate and it made me think (e.g. https://me-pedia.org/wiki/Dysbiosis). But you are right, unrelated here... I will stop side-tracking πŸ˜‰


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    @river I really like that "unfinished cleaning cycle" description - I have no idea how closely it relates to what's going on physiologically (not suggesting it isn't close, just that I have no idea), but I really like the analogy πŸ™‚



  • @Katt said in Managing sleep dysfunction:

    I think I'm going down a rabbit hole and maybe getting too off topic but just a thought that I wonder if we should be looking also into our gut in relation to sleep.

    Agreed that the gut is soooooo important for a lot of us - me included.

    Is there a gut thread yet?

    Any research you find @Katt on sleep and the gut would be great to hear about it! This is the thread for that.



  • @river said in Managing sleep dysfunction:

    @PaulB I know what you mean, if I sleep during the day (very rare for me, it usually only happens if I'm extremely sick from non-PEM causes) I wake up feeling worse, kinda poisoned. Same if I'm woken too early from night time sleep. I'm not sure if it's lactic acid, but it's definitely cycle disruption related. I always visualize it as your brain is cleaning the dirty dishes while you sleep, and if you wake up before its finished, your brain is full of dirty dishwater.

    I love that metaphor! haha.

    I'd expand it to say the whole body is cleaning the dirty dishes, and if you wake before the cycle is over, your body is full of dirty dishwater.

    The 'kinda poisoned' is a good line too.

    A very random / weird thing I often feel in those circumstances (which as I say, I avoid where possible) is a hollow teeth feeling. The two front teeth in particular. Weird hey. Does anyone else get that?



  • @river said in Managing sleep dysfunction:

    @Katt lactic acid is the waste product that accumulates in your muscles when you exercise and causes muscle pain and fatigue. Some research shows that people with CFS have a rapid build up of lactic acid following mild exertion because we can't clear it properly, and/or produce more of it due to inefficient energy production.

    Yeah, when I'm in a flare (which is rare nowadays, touch wood), I can get what feels to me like lactic acid buildup. It's like I've just run an 800m (I did athletics pre-CFS).
    And, to confirm, it can be after little exertion at all - it was sometimes caused by daytime sleep!

    To get out of it, I need to wait it out. Eat little, and certainly nothing problematic (avoiding FODMAPs is crucial for me).
    Like I've said above - not sleep further.
    Do no other activities that could deepen the issue.
    But wait it out, and get beyond it.



  • One more little addition from me for now, on managing sleep dysfunction.

    And sorry if I'm going on too much about this particular thing 😳
    I'll talk about different sleep stuff next time, I promise.

    One result, for me, of sleeping in the pre-sleep time is that I'd have worse insomnia in the sleep-time night.
    e.g. This could even be going to sleep at 6pm. I'd wake up at 9pm and be WIIIIREEEEDDD. And it was horrible.

    My goal is to go to bed in the approximate range of a normal bed time. For me at the moment that is 8pm-9pm.



  • @PaulB It's just so complicated trying to find a good sleep pattern/arrangement. Last year, I was referred to a sleep centre to hook me up for an overnight stay to get data. Covid put a stop to the booking and I haven't initiated re-booking. My sleepiness is constant and I was needing advice on how to stay awake during the day for longer periods of time and to train my body to rest better at night. What rings true, is the constant efforts to find what works. So far, I sleep when I have to. My body just shuts down; usually without warning. I grab the wakeful time to do whatever I am able to. Oddly I wake unrefreshed most of the time, yet I must be sleeping or I wouldn't be able to function at all. Marvellous thing the brainπŸ€“



  • @crashdummy I feel for you. I haven't had situation like that - sleepiness constant - for a long time.
    I'd love for us to workshop through it, and try and hunt for ideas.

    Probably, generally, I need to leave that your health care professionals. But if you are interested in workshopping on a "shooting the breeze" level, I'm in.

    On a different matter - I'll start up a sub-thread now: the idea of different types of tiredness.
    Probably not a profound idea to many - but it's one that has helped me lots.

    Two of the tireds are: sleepy tired. And body tired. I get leg tired at times, and I get whole body tired at times.
    There's at least another 4 tireds.

    Does any one else have different tireds?



  • @PaulB restless tired. I need to do something, I can’t do anything tired. This is the kind of tired that so often prevents me from sleeping properly.



  • Brain tired. Like brain fog, but a flavour of tiredness thrown in there.



  • @crashdummy said in Managing sleep dysfunction:

    @PaulB Last year, I was referred to a sleep centre to hook me up for an overnight stay to get data.

    I got myself a booking at a sleep centre a few years ago - was really happy when I had insomnia on the test ...

    was crazy annoyed for the following year when they gave me a sleep-apnoea diagnosis and didn't tell me about the insomnia at all.

    Long story short - the management they gave for sleep-apnoea is 1000 times worse than the problem, and costs $1500 to boot.
    Thank goodness a specialist helped me get of the stupid machine - nasal spray was all I needed, to stop sinus / glandiness. And what a great benefit that is, for more than just getting rid of sleep apnoea.

    So a bad interim from that sleep study led to a long term massive positive.



  • @PaulB I had a similar experience when I had a sleep study. I didn't sleep ALL NIGHT LONG (thanks to the exertion from getting to the appointment and back, and the discomfort from all the equipment). I go into the clinic the next day and get told I slept perfectly and just have mild sleep apnea. What?! Then I'm told the insomnia is actually a psychological phenomenon where I'm sleeping but don't realize I'm sleeping.

    I've since learnt that a) people with CFS can have EEG graphs that make them appear to be asleep when they're actually wide awake, and b) if my sleep quality is very very poor, I will just experience short periods of amnesia between longer periods of full wakefulness, instead of "sleeping". I think both of those things happened that night.

    Fortunately, I wasn't pressured into any fancy equipment, as my specialist didn't think my apnea was bad enough to warrant it.



  • @PaulB @river @RatsAreFluffy
    Just scratched Sleep Centre off my list of things to get around to doing! There's another sort of tiredness 'fed up tired'πŸ€“




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    @crashdummy Just as am example of a different outcome (and I'm not saying this relates to your situation, and it clearly doesn't to @river 's (that sleep study sounds all sorts of unpleasant 😞 ) I had a sleep study done and it turned up sleep apnea, and it was treatment for that, that got me my capacity to read a bit back. My sleep apnea symptoms weren't "normal" either (ie, I wasn't sleepy during the day), but treating it did help (although I still sleep badly - just not quite as badly as before).

    I do like (and empathise with) the "fed up tired" 😁



  • @Daffy_Dave

    Do you use a cpap machine Dave?

    Like you say, something like a cpap machine can be wonderful for some.

    It wasn't for me personally - I had a description of what it was like, but I've removed it, as - again - it could be a good thing for some, and I don't want to unnecessarily prejudice that.


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