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[[File:Insomnia_sleep_remedies.jpg|alt="Sleep easy" tea bags containing valerian, lemon balm capsules and a bottle of melatonin.|thumb]] '''Sleep dysfunction''' is very common in [[ME/CFS]] patients and can take a very wide range of forms, with [[unrefreshing sleep]] being particularly common.<ref name="CDC-symptoms">{{Cite web|url = https://www.cdc.gov/me-cfs/symptoms-diagnosis/symptoms.html | title = Symptoms {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|website=[[Centers for Disease Control and Prevention]] | date = Jan 27, 2021|access-date = 2021-02-25}}</ref> The prevalence of sleep disorders in ME/CFS is estimated at 56%.<ref>{{Cite journal | date = 2018-07-01 | title = Chronic fatigue syndrome and sleep disorders: Clinical associations and diagnostic difficulties|url=https://www.sciencedirect.com/science/article/pii/S2173580818300038|journal=Neurología (English Edition)|language=en|volume=33|issue=6|pages=385–394|doi=10.1016/j.nrleng.2015.11.020|issn=2173-5808}}</ref><ref name="ICC2011primer" /><ref name="canadianconsensus-CCC" /><ref name="CDC-symptoms" /> [[Fibromyalgia]] patients also suffer from sleep disorders.<ref name="ACR2010">{{Cite journal|url=https://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf | title = American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia | last = Wolfe | first = Frederick | date = May 2010|volume =62 | issue = 5 | pages = 600–610| doi = 10.1002/acr.20140|type=PDF|archive-url=|archive-date=|access-date= | author-link =| last2 = Clauw | first2 = Daniel | authorlink2 = |journal=Arthritis Care & Research | last3 = Fitzcharles | first3=Mary-Ann | first4 = Don| last5 = Katz | last4 = Goldenberg | first5 = Robert | last6 = Mease | first6 = Philip | last7 = Russel | first7 = Anthony | last8 = Russel | first8 = I. Jon | first9 = John | last9 = Winfield | first10 = Muhammad | last10 = Yunus|quote=}}</ref> == Types of sleep dysfunction == Some of these sleep dysfunctions or disorders include: *[[dysania]]<ref>{{Cite web|url=https://ammes.org/symptoms-of-mecfs/ | title = Symptoms of ME/CFS – American ME and CFS Society|website=[[American ME and CFS Society]]|language=en-US|access-date=2018-08-29}}</ref> (a state of finding it hard to get out of bed in the morning; in [[ME/CFS]] it can an extended period lasting several hours after awakening) *[[hypersomnia]] (excessive sleeping, inability to stay awake) *[[agogia]] (transitional state from wakefulness to sleep during which lucid thought, lucid dreaming, hallucinations and, sleep paralysis can occur) *[[insomnia]]<ref>{{Cite journal | date = 2015-05-01 | title = The role of insomnia in the treatment of chronic fatigue|url=https://www.sciencedirect.com/science/article/pii/S002239991400422X|journal=Journal of Psychosomatic Research|language=en|volume=78|issue=5 | pages = 427–432|doi=10.1016/j.jpsychores.2014.11.022|issn=0022-3999}}</ref> (difficulty falling asleep, staying asleep, and/or waking up too early in the morning) *[[light sleep]] (a non-REM stage and the easiest sleep stage to awaken from) *[[Periodic limb movement disorder]]/nocturnal myoclonus - involuntary jerking or leg movements when sleeping or when falling asleep<ref name="UScoal-2020">{{Cite web | title = Diagnosing and Treating Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | last=U.S. ME/CFS Clinician Coalition |edition=2 | date = July 2020 | url= https://bridgesandpathways.org.au/wp-content/uploads/2021/02/DiagnosingAndTreatingMECFSV2_USCoalition_2020.pdf | pages = 4}}</ref> *[[nightmare]]s (a frightening or unpleasant dream) *[[night sweat]]s (excessive sweating while you sleep) *[[Restless legs syndrome]]<ref>{{Cite journal | last = Viola-Saltzman | first = Mari | last2 = Watson | first2 = Nathaniel F. | last3 = Bogart | first3=Andy | last4 = Goldberg | first4 = Jack| last5 = Buchwald | first5 = Dedra | date = 2010-10-15 | title = High prevalence of restless legs syndrome among patients with fibromyalgia: a controlled cross-sectional study|url=https://www.ncbi.nlm.nih.gov/pubmed/20957840|journal=Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine|volume=6|issue=5 | pages = 423–427|issn=1550-9389|pmid=20957840|via=}}</ref> (a strong urge to move one's legs) *[[Sleep apnea]] (pauses in breathing or periods of shallow breathing) *[[Reversed or chaotic diurnal sleep rhythms|sleep phase shifting]] or [[sleep reversal]]<ref name="Cambras2018">{{Cite journal | last = Cambras | first=Trinitat | last2 = Castro-Marrero | first2 = Jesús | last3 = Zaragoza | first3=Maria Cleofé | last4 = Díez-Noguera | first4 = Antoni| last5 = Alegre | first5 = José | date = 2018-06-06 | title = Circadian rhythm abnormalities and autonomic dysfunction in patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis|url=https://doi.org/10.1371/journal.pone.0198106|journal=PLOS ONE|language=en|volume=13|issue=6| pages = e0198106|doi=10.1371/journal.pone.0198106|issn=1932-6203|pmid=29874259|via=}}</ref> ([[reversed or chaotic diurnal sleep rhythms]]) (circadian abnormalities: delayed sleep phase, non-24hr sleep cycle, loss of rhythm) *[[somnolence]] (sleepiness) *[[unrefreshing sleep]] (poor-quality sleep that doesn't relieve fatigue)<ref name="ICC2011primer" /><ref name="canadianconsensus-CCC">{{Citation | last1 = Carruthers | first1 = Bruce M. | authorlink1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | authorlink6 = Martin Lerner | last7 = Bested | first7 = Alison C. | authorlink7 = Alison Bested | last8 = Flor-Henry | first8 = Pierre | authorlink8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip| authorlink9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | authorlink10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | authorlink11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | authorlink12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols| journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid = | doi = 10.1300/J092v11n01_02| url = http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf}}</ref> ==Prevalence== *Depending on the criteria used for diagnosis, prevalence can vary greatly. *In a 2001 Belgian study, 91.9% of patients meeting the [[Fukuda criteria]] and 94.8% of patients meeting the [[Holmes criteria]], in a cohort of 2073 [[chronic fatigue syndrome|CFS]] patients, reported sleep disturbances.<ref>{{Cite journal | last = De Becker | first=Pascale | authorlink = Pascale De Becker | last2 = McGregor | first2 = Neil | authorlink2 = Neil McGregor | last3 = De Meirleir | first3=Kenny | author-link3 = Kenny De Meirleir | date = December 2001 | title = A definition‐based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome|url=https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2796.2001.00890.x?sid=nlm%3Apubmed|journal=Journal of Internal Medicine|volume=250|issue=3|pages=234–240|doi=10.1046/j.1365-2796.2001.00890.x|quote=|via=}}</ref> *A 2017 study by Davidson, et al, found up to 96.8% of people with CFS report [[unrefreshing sleep]] and many describe changes in sleep over the course of their illness.<ref name="Davidson, 2017" /> According to the published evidence, the mean prevalence of sleep disorders in patients with CFS is '''estimated at 56%.'''<ref>{{Cite journal | date = 2018-07-01 | title = Chronic fatigue syndrome and sleep disorders: Clinical associations and diagnostic difficulties|url=https://www.sciencedirect.com/science/article/pii/S2173580818300038|journal=Neurología (English Edition)|language=en|volume=33|issue=6|pages=385–394|doi=10.1016/j.nrleng.2015.11.020|issn=2173-5808}}</ref> {| class="wikitable" ! !Year !N !Prevalence !Sleep disorders included |- |Krupp et al.<ref>{{Cite journal | last = Krupp | first = Lauren B. | last2 = Jandorf | first2 = L. | last3 = Coyle | first3 = P.K. | last4 = Mendelson | first4 = W.B. | date = 1993-05-01 | title = Sleep disturbance in chronic fatigue syndrome|url=http://www.sciencedirect.com/science/article/pii/0022399993901342|journal=Journal of Psychosomatic Research|language=en|volume=37|issue=4|pages=325–331|doi=10.1016/0022-3999(93)90134-2|issn=0022-3999}}</ref> |1993 |16 |62% |OSAHS, PLMD, narcolepsy, hypersomnia |- |Morriss et al.<ref>{{Cite journal | last = Morriss | first = R. | last2 = Sharpe | first2 = M. | last3 = Sharpley | first3 = A.L. | last4 = Cowen | first4 = P.J. | last5 = Hawton | first5 = K. | last6 = Morris | first6 = J. | date = 1993-05-01 | title = Abnormalities of sleep in patients with the chronic fatigue syndrome.|url=https://www.bmj.com/content/306/6886/1161|journal=British Medical Journal|language=en|volume=306|issue=6886|pages=1161–1164|doi=10.1136/bmj.306.6886.1161|issn=0959-8138|pmid=8499816}}</ref> |1993 |12 |58% |Maintenance insomnia |- |Buchwald et al.<ref>{{Cite journal | last = Buchwald | first=Dedra | last2 = Pascualy | first2 = Ralph | last3 = Bombardier | first3=Charles | last4 = Kith | first4 = Phalla | date = 1994-01-01 | title = Sleep Disorders in Patients with Chronic Fatigue|url=https://doi.org/10.1093/clinids/18.Supplement_1.S68|journal=Clinical Infectious Diseases|volume=18|issue=Supplement_1|pages=S68–S72|doi=10.1093/clinids/18.supplement_1.s68|issn=1537-6591}}</ref> |1994 |59 |81% |OSAHS, hypersomnia |- |Le Bon et al.<ref>{{Cite journal | last = Le Bon | first = O. | last2 = Fischler | first2 = B. | last3 = Hoffmann | first3=G. | last4 = Murphy | first4 = J.R. | last5 = De Meirleir | first5 = K. | last6 = Cluydts | first6 = R. | last7 = Pelc | first7 = I. | date = 2000 | title=How significant are primary sleep disorders and sleepiness in the chronic fatigue syndrome?|url=https://pubmed.ncbi.nlm.nih.gov/11382899/|journal=Sleep research online: SRO|volume=3|issue=2 | pages = 43–48|issn=1096-214X|pmid=11382899}}</ref> |2000 |53 |46% |OSAHS |- |Fossey et al.<ref>{{Cite journal | last = Fossey | first = Myrtis | last2 = Libman | first2 = Eva | last3 = Bailes | first3=Sally | last4 = Baltzan | first4 = Marc| last5 = Schondorf | first5 = Ronald | last6 = Amsel | first6 = Rhonda | last7 = Fichten | first7 = Catherine S. | date = 2004-12-01 | title = Sleep Quality and Psychological Adjustment in Chronic Fatigue Syndrome|url=https://doi.org/10.1007/s10865-004-0004-y|journal=Journal of Behavioral Medicine|language=en|volume=27|issue=6|pages=581–605|doi=10.1007/s10865-004-0004-y|issn=1573-3521}}</ref> |2004 |37 |58% |OSAHS, narcolepsy |- |Reeves et al.<ref>{{Cite journal | last = Reeves | first=William C. | last2 = Heim | first2 = Christine | last3 = Maloney | first3 = Elizabeth M. | last4 = Youngblood | first4 = Laura Solomon| last5 = Unger | first5 = Elizabeth R. | last6 = Decker | first6 = Michael J. | last7 = Jones | first7 = James F. | last8 = Rye | first8 = David B. | date = 2006-11-16 | title = Sleep characteristics of persons with chronic fatigue syndrome and non-fatigued controls: results from a population-based study|url=https://doi.org/10.1186/1471-2377-6-41|journal=BMC Neurology|language=en|volume=6|issue=1 | pages = 41|doi=10.1186/1471-2377-6-41|issn=1471-2377|pmc = 1660569|pmid=17109739}}</ref> |2006 |43 |25% |OSAHS, PLMD |- |Majer et al.<ref>{{Cite journal | last = Majer | first = Matthias | last2 = Jones | first2 = James F. | last3 = Unger | first3=Elizabeth R. | last4 = Youngblood | first4 = Laura Solomon| last5 = Decker | first5 = Michael J. | last6 = Gurbaxani | first6 = Brian | last7 = Heim | first7 = Christine | last8 = Reeves | first8 = William C. | date = 2007-12-05 | title = Perception versus polysomnographic assessment of sleep in CFS and non-fatigued control subjects: results from a population-based study|url=https://doi.org/10.1186/1471-2377-7-40|journal=BMC Neurology|language=en|volume=7|issue=1 | pages = 40|doi=10.1186/1471-2377-7-40|issn=1471-2377|pmc = 2231384|pmid=18053240}}</ref> |2007 |35 |30% |OSAHS, PLMD, ISS |- |Libman et al.<ref>{{Cite journal | last = Libman | first = Eva | last2 = Creti | first2 = Laura | last3 = Baltzan | first3=Marcel | last4 = Rizzo | first4 = Dorrie| last5 = Fichten | first5 = Catherine S. | last6 = Bailes | first6 = Sally | date = 2009-10-26 | title = Sleep Apnea and Psychological Functioning in Chronic Fatigue Syndrome|url=https://journals.sagepub.com/doi/10.1177/1359105309344895|journal=Journal of Health Psychology|language=en|doi=10.1177/1359105309344895}}</ref> |2009 |66 |68% |OSAHS |- |Creti et al.<ref>{{Cite journal | last = Creti | first = Laura | last2 = Libman | first2 = Eva | last3 = Baltzan | first3=Marcel | last4 = Rizzo | first4 = Dorrie| last5 = Bailes | first5 = Sally | last6 = Fichten | first6 = Catherine S. | date = 2010-05-11 | title = Impaired Sleep in Chronic Fatigue Syndrome: How Is It Best Measured?|url=https://journals.sagepub.com/doi/10.1177/1359105309355336|journal=Journal of Health Psychology|language=en|doi=10.1177/1359105309355336}}</ref> |2010 |49 |69% |OSAHS, PLMD |- | | | |65% |Chronic insomnia |- |''Mean'' | | |''56.2%'' | |} ==Symptom recognition== Sleep dysfunction is a core diagnostic symptom required in the 2003 [[Canadian Consensus Criteria]] diagnostic criteria for [[ME/CFS]],<ref name="CCC">{{Cite journal | last = Carruthers | first=Bruce M. | last2 = Jain | first2 = Anil Kumar | last3 = De Meirleir | first3=Kenny L. | last4 = Peterson | first4 = Daniel L. | last5 = Klimas | first5 = Nancy G. | last6 = Lerner | first6 = A. Martin | last7 = Bested | first7 = Alison C. | last8 = Flor-Henry | first8 = Pierre | last9 = Joshi | first9 = Pradip | date = 2003 | title=Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://doi.org/10.1300%2Fj092v11n01_02 |journal=Journal of Chronic Fatigue Syndrome|language=en|volume=11|issue=1 | pages = 7–115|doi=10.1300/j092v11n01_02|issn=1057-3321|via=}}</ref> the 2007 [[Nightingale definition]],<ref>{{Cite web|url=http://www.investinme.org/Documents/PDFdocuments/Byron%20Hyde%20Definition%20Booklet.pdf | title = The Nightingale, Myalgic Encephalomyelitis (M.E.) Definition | last = | first = | date = Jan 2007 | website = investinme.org|archive-url=|archive-date=|url-status=|access-date=}}</ref> and the 2015 [[Systemic Exertion Intolerance Disease|Institute of Medicine report]].<ref>{{Cite web|url=http://iom.nationalacademies.org/~/media/Files/Report%20Files/2015/MECFS/MECFS_ProposedDiagnosticCriteria?_ga=1.14761526.1865741811.1437002921 | title = Proposed Diagnostic Criteria for ME/CFS | last = | first = | date = 2015 | website = nationalacademies.org|archive-url=|archive-date=|url-status=|access-date=}}</ref> Sleep dysfunction is an optional symptom in the 1988 [[Holmes criteria]],<ref>{{Cite journal | last = Holmes | first=G. P. | last2 = Kaplan | first2 = J.E. | last3 = Gantz | first3 = N.M. | last4 = Komaroff | first4 = A.L. | last5 = Schonberger | first5 = L.B. |last6 = Straus | first6 = S.E. | last7 = Jones | first7 = J.F. |last8 = Dubois | first8 = R.E. | last9 = Cunningham-Rundles | first9 = C. | date = 1988 | title = Chronic fatigue syndrome: a working case definition|url=https://www.ncbi.nlm.nih.gov/pubmed/2829679|journal=Annals of Internal Medicine|volume=108|issue=3|pages=387–389|issn=0003-4819|pmid=2829679|via=}}</ref> the 1991 [[Oxford criteria]],<ref>{{Cite journal | last = Sharpe | first = M. C. | last2 = Archard | first2 = L.C. | last3 = Banatvala | first3 = J.E. | last4 = Borysiewicz | first4 = L.K. | last5 = Clare | first5 = A.W. | last6 = David | first6 = A. | last7 = Edwards | first7 = R.H. | last8 = Hawton | first8 = K.E. | last9 = Lambert | first9 = H.P. | date = 1991 | title = A report--chronic fatigue syndrome: guidelines for research|url=https://www.ncbi.nlm.nih.gov/pubmed/1999813|journal=Journal of the Royal Society of Medicine|volume=84|issue=2|pages=118–121|issn=0141-0768|pmid=1999813|via=}}</ref> the 1994 [[Fukuda criteria]],<ref>{{Cite journal | last = Fukuda | first = K. | last2 = Straus | first2 = S.E. | last3 = Hickie | first3 = I. | last4 = Sharpe | first4 = M.C. | last5 = Dobbins | first5 = J.G. |last6 = Komaroff | first6 = A. | date = 1994-12-15 | title = The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group | url = https://www.ncbi.nlm.nih.gov/pubmed/7978722|journal=Annals of Internal Medicine|volume=121|issue=12 | pages = 953–959|issn=0003-4819|pmid=7978722}}</ref> the 2005 [[Reeves criteria]],<ref>{{Cite journal | last = Reeves | first=William C. | last2 = Wagner | first2 = Dieter | last3 = Nisenbaum | first3 = Rosane | last4 = Jones | first4 = James F. | last5 = Gurbaxani | first5 = Brian | last6 = Solomon | first6 = Laura | last7 = Papanicolaou | first7 = Dimitris A. | last8 = Unger | first8 = Elizabeth R. | last9 = Vernon | first9 = Suzanne D. | date = 2005-12-15 | title = Chronic fatigue syndrome--a clinically empirical approach to its definition and study|url=https://www.ncbi.nlm.nih.gov/pubmed/16356178|journal=BMC medicine|volume=3|pages=19|doi=10.1186/1741-7015-3-19|issn=1741-7015|pmid=16356178|via=}}</ref> the 2007 [[NICE guidelines]],<ref>{{Cite web|url=https://www.nice.org.uk/guidance/CG53/chapter/1-Guidance#diagnosis | title = Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management {{!}} Guidance and guidelines {{!}} NICE | last = | first = | date = Aug 2007 | website = nice.org.uk|language=en-GB|archive-url=|archive-date=|url-status=|access-date=2018-08-29}}</ref> the 2012 [[International Consensus Criteria]].<ref>{{Cite journal | last = Carruthers | first=B. M. | last2 = Sande | first2 = M. I. van de | last3 = Meirleir | first3=K. L. De | last4 = Klimas | first4 = N.G. | last5 = Broderick | first5 = G. | last6 = Mitchell | first6 = T. | last7 = Staines | first7 = D. | last8 = Powles | first8 = A.C.P. | last9 = Speight | first9 = N. | date = 2011-10-01 | title = Myalgic encephalomyelitis: International Consensus Criteria|url=http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02428.x/full|journal=Journal of Internal Medicine|language=en|volume=270|issue=4|doi=10.1111/j.1365-2796.2011.02428.x/full|issn=1365-2796}}</ref>, and the 2014 [[London criteria]].<ref>{{Cite web|url=http://www.axfordsabode.org.uk/me/mecrit2014.htm | title = ME/CFS Medical Update (Layman's version) Winter 2001 | website = axfordsabode.org.uk|access-date=2018-08-29}}</ref> Sleep dysfunction is not a criteria listed for diagnosis with the 1986 [[Ramsay definition]].<ref>{{Cite web|url=http://www.cfids-me.org/ramsay86.html | title = Ramsay's Definition of M.E., 1986 | website = cfids-me.org|access-date=2018-08-29}}</ref> ==Notable studies== *2007, Paradoxical NREMS Distribution in “Pure” Chronic Fatigue Patients: A Comparison with Sleep Apnea-Hypopnea Patients and Healthy Control Subjects<ref>{{Cite journal | last = Bon | first = Olivier Le | last2 = Neu | first2 = Daniel | last3 = Valente | first3 = Filomena | last4 = Linkowski | first4 = Paul | date = 2007 | title=Paradoxical NREMS Distribution in “Pure” Chronic Fatigue Patients|url=https://www.tandfonline.com/doi/abs/10.1300/J092v14n02_05|journal=Journal of Chronic Fatigue Syndrome|language=en|volume=14|issue=2 | pages = 45–59|doi=10.1300/j092v14n02_05|issn=1057-3321|via=}}</ref> - [https://www.tandfonline.com/doi/abs/10.1300/J092v14n02_05 (Abstract)] *2012, Sleep Abnormalities in [[ME/CFS|Chronic Fatigue Syndrome/Myalgic Encephalomyelitis]]: A Review<ref name="Jackson, 2012" /> - [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3501671/ (Full Text)] *2017, Sleep Quality in Adolescents With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)<ref>{{Cite journal | last= Josev | first = Elisha K. | author-link = Elisha Josev | last2 = Jackson | first2 = Melinda L. | authorlink2 = Melinda Jackson | last3 = Bei | first3 = Bei | author-link3 = | last4 = Trinder | first4 = John | author-link4 = | last5 = Harvey | first5 = Adrienne | authorlink5 = | last6 = Clarke | first6 = Cathriona | last7 = Snodgrass | first7 = Kelli | last8 = Scheinberg | first8 = Adam | authorlink8 = | last9 = Knight | first9 = Sarah J. | authorlink9 = Sarah Knight | date = 2017-09-15 | title = Sleep Quality in Adolescents With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)|url=http://jcsm.aasm.org/ViewAbstract.aspx?pid=31079|journal=Journal of Clinical Sleep Medicine|language=en|volume=13|issue=09|pages=1057–1066|doi=10.5664/jcsm.6722|issn=1550-9389|pmc=5566461|pmid=28760189|quote=|via=}}</ref> - [[pubmed:28760189|(Full text)]] *2018, Circadian rhythm abnormalities and [[autonomic dysfunction]] in patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis<ref name="Cambras, 2018" /> - [http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198106 (Full Text)] *2018, The putative role of oxidative stress and inflammation in the pathophysiology of sleep dysfunction across neuropsychiatric disorders: Focus on chronic fatigue syndrome, bipolar disorder and [[multiple sclerosis]]<ref name="Morris, 2018" /> - [https://www.ncbi.nlm.nih.gov/pubmed/29759891 (Abstract)] *2018, Association of sleep disorders, chronic pain, and fatigue with survival in patients with chronic kidney disease: A meta-analysis of clinical trials<ref>{{Cite journal | last = Yang | first = Xiu Hong | last2 = Zhang | first2 = Bao Long | last3 = Gu | first3 = Yan Hong | last4 = Zhan | first4 = Xiao Li| last5 = Guo | first5 = Li Li | last6 = Jin | first6 = Hui Min | date = 2018 | title=Association of sleep disorders, chronic pain, and fatigue with survival in patients with chronic kidney disease: a meta-analysis of clinical trials|url=https://www.sleep-journal.com/article/S1389-9457(18)30397-6/abstract|journal=Sleep Medicine|language=English|volume=51|pages=59–65|doi=10.1016/j.sleep.2018.06.020|issn=1389-9457|via=}}</ref> - ([https://www.sleep-journal.com/article/S1389-9457(18)30397-6/abstract Abstract]) *2021, Systematic Review of Sleep Characteristics in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome<ref name="Maksoud2021">{{Cite journal | last = Maksoud | first = Rebekah | authorlink = | last2 = Eaton-Fitch | first2 = Natalie | authorlink2 = Natalie Eaton-Fitch | last3 = Matula | first3=Michael | authorlink3 = | last4 = Cabanas | first4 = Hélène | authorlink4 = Hélène Cabanas| last5 = Staines | first5 = Donald | authorlink5 = Donald Staines | last6 = Marshall-Gradisnik | first6 = Sonya | author-link6 = Sonya Marshall-Gradisnik | date = May 2021 | title = Systematic Review of Sleep Characteristics in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|url=https://www.mdpi.com/2227-9032/9/5/568|journal=Healthcare|language=en|volume=9|issue=5|pages=568|doi=10.3390/healthcare9050568|pmc=|pmid=|access-date=|quote=|via=}}</ref> [https://www.mdpi.com/2227-9032/9/5/568 (Full text)] ==Treatment== Treatment can include: *perscription drugs *[[Cannabinoid|cannabiniods]] (CBD) *alternative natural remedies including [[chamomile]], [[kava]], [[hops]], [[lavender]], [[lemon balm]], and [[passiflora]] (passion flower), and [[valerian]]; kava and valerian have the most evidence *over-the-counter [[melatonin]] or sedating anti-histamines like [[diphenhydramine]] *[[vitamin B12]] *relaxation techniques e.g., [[meditation]] *good [[sleep hygiene]] practices.<ref name="Gyllenhaal2000">{{Cite journal|title=Efficacy and safety of herbal stimulants and sedatives in sleep disorders|date=2000-06-01|url=https://www.sciencedirect.com/science/article/pii/S108707929990093X|journal=Sleep Medicine Reviews|volume=4|issue=3|pages=229–251|last=Gyllenhaal|first=Charlotte|last2=Merritt|first2=Sharon L.|last3=Peterson|first3=Sara Davia|last4=Block|first4=Keith I.|last5=Gochenour|first5=Tom|doi=10.1053/smrv.1999.0093|issn=1087-0792}}</ref><ref name="Chaudhury2019">{{Cite journal|title=Chronic Insomnia: A Review|date=May 2019|url=https://journals.lww.com/mjdy/Fulltext/2019/12030/Chronic_Insomnia__A_Review.3.aspx|journal=Medical Journal of Dr. D.Y. Patil University|volume=12|issue=3|pages=193|last=Chaudhury|first=Suprakash|last2=Singh|first2=Rakesh Kumar|last3=Kumari|first3=Dolly|last4=Diwan|first4=Chetan|last5=Mujawar|first5=Swaleha|last6=Saldanha|first6=Daniel|language=en-US|doi=10.4103/mjdrdypu.mjdrdypu_76_19|issn=2589-8302}}</ref> Medications, including: *[[:Category:Benzodiazepines|Benzodiazepines]] (benzos), e.g. [[temazepam]], [[Valium]] (diazepam)<ref name="SACFS-survey">{{Cite web|url=https://www.sacfs.asn.au/news/2014/02/02_28_survey_results_insomnia.htm | website = ME/CFS South Australia Inc | title = Survey results - insomnia |access-date=2021-02-11}}</ref> *[[:Category:Non-benzodiazepine hypnotics|Non-benzodiazepine hypnotics]], commonly known as z-drugs, e.g. [[zopiclone]], [[Ambien]] (zolpidem) *Sedating [[antidepressant]]s, particularly [[amitriptyline]] *Sedating [[:Category:Antihistamines|anti-histamines]], e.g., [[diphenhydramine]] (Benadryl) *[[Melatonin]], either on prescription or as a supplement<ref>{{Cite web|url=https://www.hopkinsmedicine.org/health/wellness-and-prevention/melatonin-for-sleep-does-it-work | title = Melatonin for Sleep: Does It Work?|website=hopkinsmedicine.org|language=en|access-date=2021-02-11}}</ref> *Anticonvulsants, such as gabapentin and valproic acid *Other medications, when used off-label<ref name="ICC2011primer">{{citation | last1 = Carruthers | first1 = BM | authorlink1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | authorlink7 = Donald Staines | last8 = Powles | first8 = ACP | authorlink8 = A C Peter Powles | last9 = Speight | first9 = N | authorlink9 = Nigel Speight | last10 = Vallings | first10 = R | authorlink10 = Rosamund Vallings | last11 = Bateman | first11 = L | authorlink11 = Lucinda Bateman | last12 = Bell | first12 = DS | authorlink12 = David Bell | last13 = Carlo-Stella | first13 = N | authorlink13 = Nicoletta Carlo-Stella | last14 = Chia | first14 = J | authorlink14 = John Chia | last15 = Darragh | first15 = A | authorlink15 = Austin Darragh | last16 = Gerken | first16 = A | authorlink16 = Anne Gerken | last17 = Jo | first17 = D | authorlink17 = Daehyun Jo | last18 = Lewis | first18 = DP | authorlink18 = Donald Lewis | last19 = Light | first19 = AR | authorlink19 = Alan Light | last20 = Light | first20 = KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 = S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 = J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 = I | authorlink23 = Ismael Mena | last24 = Miwa | first24 = K | authorlink24 = Kunihisa Miwa | last25 = Murovska | first25 = M | authorlink25= Modra Murovska | last26 = Stevens | first26 = SR | authorlink26 = Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf }}</ref> Supplements and natural remedies include:<dynamicpagelist> category = Sleep aids and hypnotics category = Supplements ordermethod=sortkey order=ascending mode=inline-list </dynamicpagelist> == See also == * [[Buspirone challenge test]] (the degree of prolactin released by buspirone in ME/CFS patients correlates to the degree of shift in their sleep/wake cycle). * [[Hypersomnia]] * [[Insomnia]] * [[Unrefreshing sleep]] ==Learn more== *[https://www.drugs.com/condition/insomnia.html Medications for insomnia] - drugs.com ==References== <references> <ref name="Cambras, 2018">{{Citation | last1 = Cambras | first1 = T. | authorlink1 = | last2 = Castro-Marrero | first2 = J. | authorlink2 = Jesús Castro-Marrero | last3 = Zaragoza | first3 = MC. | authorlink3 = | last4 = Díez-Noguera | first4 = A. | authorlink4 = | last5 = Alegre | first5 = J. | authorlink5 = José Alegre | title = Circadian rhythm abnormalities and autonomic dysfunction in patients with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis | journal = PLoS ONE | volume = 13 | issue = 6 | page = e0198106 | date = 2018 | pmid = | doi = 10.1371/journal.pone.0198106 }}</ref> <ref name="Davidson, 2017">{{Citation | last1 = Davidson | first1 = Sean L. | authorlink1 = | last2 = Gotts | first2 = Zoe M. | authorlink2 = Zoe Gotts | last3 = Ellis | first3 = Jason G. | authorlink3 = | last4 = Newton | first4 = Julia L. | authorlink4 = Julia Newton | title = Two year follow-up of sleep diaries and polysomnography in chronic fatigue syndrome: a cohort study | journal = Fatigue: Biomedicine, Health & Behavior | volume = | issue = | page = | date = Mar 2017 | pmid = | doi = 10.1080/21641846.2017.1297280 }}</ref> <ref name="Jackson, 2012">{{Citation | last1 = Jackson | first1 = ML | authorlink1 = Melinda Jackson | last2 = Bruck | first2 = D | authorlink2 = Dorothy Bruck | title = Sleep Abnormalities in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Review, Journal of Clinical Sleep Medicine | journal = Journal of Clinical Sleep Medicine | volume = 8 | issue = 6 | page = 719-28 | date = 2012 | doi = 10.5664/jcsm.2276 }}</ref> <ref name="Morris, 2018">{{Citation | last1 = Morris | first1 = Gerwyn | authorlink1 = Gerwyn Morris | last2 = Stubbs | first2 = Brendon | authorlink2 = | last3 = Köhler | first3 = Cristiano A. | authorlink3 = | last4 = Walder | first4 = Ken | authorlink4 = | last5 = Slyepchenko | first5 = Anastasiya | authorlink5 = | last6 = Berk | first6 = Michael| authorlink6 = Michael Berk | last7 = Carvalho | first7 = André F. | authorlink7 = | title = The putative role of Oxidative Stress and Inflammation in the pathophysiology of sleep dysfunction across neuropsychiatric disorders : Focus on Chronic Fatigue Syndrome, Bipolar Disorder and Multiple Sclerosis | journal = Sleep Med Reviews | volume = | issue = | page = | date = 2018 | pmid = 29759891 | doi = 10.1016/j.smrv.2018.03.007 }}</ref> </references> [[Category:Signs and symptoms]] [[Category:Sleep signs and symptoms]]
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