Chronic Fatigue and Sleep Disorders

What is Chronic Fatigue Syndrome (CFS)?

This syndrome is defined by the following:

  • Severe chronic fatigue lasting for at least 6 months.
  • At least four of the following:
  • Substantial problems with short term memory or concentration
  • Sore throat
  • Tender, swollen lymph nodes (“swollen glands”)
  • Muscle pain
  • Joint pain without swelling or redness of the joints
  • Headaches different from any previous headaches
  • Unrefreshing sleep
  • Feeling poorly (malaise) after exertion
  • Other causes of fatigue must be “ruled out”: there is no specific test for chronic fatigue syndrome. It is a “diagnosis by exclusion”.
  • Many patients with CFS also report other symptoms such as:
  • Loss of appetite; nausea
  • Night sweats
  • Dizziness
  • Intolerance to alcohol and medications
  • Withdrawal from social life

Who gets CFS?

  • It can occur in both children and adults.
  • It has appeared more prevalent in women.

What causes CFS?

  • It does not appear to be a single disease but more likely, a group of different conditions that present with similar symptoms and that are likely to have different causes.
  • Immune system and nervous system abnormalities have been suspected.

Does CFS overlap with any other chronic medical problems?

Yes. Studies have shown that at least some patients with CFS also have:

  • Fibromyalgia
  • Irritable bowel syndrome
  • TM joint syndrome
  • multiple chemical sensitivity syndrome

What is wrong with the sleep of patients with CFS?

  • Complaints about sleep vary among CFS patients and there are no consistent findings.
  • However, many of them report more difficulty falling asleep, more interrupted sleep and a greater tendency to nap during the day.
  • Some studies showed increased alpha activity (the EEG rhythm of the brain characteristic of wakefulness) during deep non-REM sleep in CFS patients but other studies have not confirmed that finding.
  • While measures to improve sleep quality are advisable to help CFS patients, there is not a good correlation between the severity of sleep complaints and the severity of fatigue.

What about major sleep disorders in patients with CFS symptoms?

  • This is an extremely important consideration, because specific treatments are available for most sleep disorders but not for CFS.
  • Some (but not all) investigations have found primary sleep disorders in patients with CFS:

-One study of 72 patients with CFS found that ten of them had primary sleep disorders (sleep apnea, narcolepsy and periodic limb movement syndrome).

-Another study of thirty patients being evaluated for complaints of chronic fatigue reported ten had primary sleep disorders (sleep apnea, narcolepsy and periodic limb movement syndrome).

  • Thus, it would appear advisable to take a careful sleep history in all patients complaining of persistent fatigue or who have been given a diagnosis of chronic fatigue syndrome and also to obtain observations from bed partners, friends and family members regarding the patients’ sleep and alertness levels. Then, if there is any reason to suspect that a primary sleep disorder may be present, formal sleep center assessment should be done. Click here to see if you or someone close to you may have a sleep disorder.
  • Finally, it should be remembered that many people with excessive sleepiness either are unaware of their sleepiness or underestimate its severity, such that they may complain instead of fatigue, a lack of energy and/or difficulties with memory and concentration! A high index of suspicion is advisable. If it is found that a primary sleep disorder is present–rather than true chronic fatigue syndrome–the outcome should be much better, since treatment should then be possible!
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