“Eighty percent of my patients make their sleep worse.” Dr. Lucinda Bateman

We’re not used to thinking of good sleep ‘protocols’, but the fact is there are things we do that inadvertently disturb sleep and things we can do that don’t involve drugs or expensive supplements that can help you sleep better.

With sleep problems rampant in chronic fatigue syndrome (ME/CFS),  fibromyalgia (FM) and long COVID, doing everything you can do to snatch as much deep sleep as you can only makes sense.

It turns out that the way you enter sleep makes a difference in how deep of a sleep you get. If you enter sleep in a deeply relaxed state you’re more likely to experience the deep sleep stages that are so rejuvenating. If, on the other hand, you enter sleep in a frazzled state, you’re more likely to experience fitful, unrefreshing sleep.

Good sleep practices aren’t ‘the answer’ to the sleep problems in ME/CFS, but they can definitely help.

THE DAY

A neuroscientist, Dr. Huberman, breaks the day up into three sections – each of which is important for getting good sleep.

Early Morning –  Getting outside into natural light in the early morning as the sun is rising provides a natural trigger that tells the brain and body to wake up and start a clock that tells your body to go to sleep at the right time at night. Exposure to early sunlight boosts three important factors that are almost certainly messed up in these diseases: cortisol, serotonin, and melatonin.

As little as five minutes will do it when it’s cloudy, 10 minutes when it’s cloudy, and 20-30 minutes when it’s really cloudy. Because windows block some of the wavelengths it’s best to get outside.

Eating something will raise your cortisol levels and increase your body temperature – a necessary factor in getting fully awake. Don’t take any caffeine for the first 90 minutes in order to wash the adenosine out of your system and to help avoid an afternoon crash.

Mid-day – it may be time for a nap and naps can be really helpful – just don’t nap for more than 45 minutes to avoid having trouble going to sleep later.

Evening – no caffeine after 4 pm.

Third Critical Period – late afternoon and evening. Once again get some exposure to sunlight as the sun is going down to help regulate your circadian clock and prepare your body for sleep. Taking a 20-30 minute hot bath or sauna in the evening will cool the core of your body down and ready you for sleep. Sleeping in a cool environment is very helpful.

Raise the Head of Your Bed Several Inches – Simply raising the head of your bed 10-30 degrees can be very effective for some people and it can increase blood volume as well. Find out more here. 

Keep the Light Levels Low. Because darkness activates the release of melatonin which tells the brain to go to sleep, keep your light levels in your bedroom. Use curtains or blinds to block street lights or consider using a mask.  Instead of using overhead lights use lamps with low wattage or clip-on reading lights.

Use Your Bedroom Only to Sleep – One of the goals of sleep hygiene is to get your body/mind to enter into ‘sleep mode’ when you enter your bedroom. You can do this by removing objects it associates with activity such as the television and computer from the room.

Background noises generated by a fan or radio with sound generators (rainstorms, waves, wildlife) or sleep meditation tapes can be very soothing.

Invest in a Really Good Mattress mattress – Find a firm but comfortable mattress that you feel comfortable with.  The Cuddle Ewe Sleep pad is another alternative that can give you relief fibromyalgia trigger points that can keep you awake.

GOOD SLEEP BEHAVIOR

Nap During the Day – Not After Dinner – When you nap don’t do it in your bedroom. (You want to train your mind to associate deep sleep with your bedroom – not napping.)

Take a Nice Warm Bath – several hours before going to sleep to get into a relaxed state. Studies indicate that insomniacs sleep better when they take a bath several hours before sleep. Warm baths/showers actually cool our core temperature down, triggering the production of sleep-inducing chemicals in our body. Dr. Teitelbaum highly recommends Epsom salts in your bath water.

Develop a Consistent Sleep Schedule – some people with ME/CFS/FM feel better at night so they stay up later …and later … and later until their normal sleep circadian rhythm is wrecked. Train your body to go to sleep at a certain time.

Exercise If You Can But Don’t Over Do It – It’s simple – exercise is a sleep inducer; lying in bed is a sleep reducer.  Try to get in as much exercise as you can without exacerbating your symptoms, Too much exertion can put you into the ‘tired but wired’ state that makes it difficult to attain meaningful sleep.

Knock Off the TV and Computer Games Before Bed – Engage in less stimulating activities two hours before bed

Stay Away from Liquids Before Bedtime to Avoid Night Time Trips to the Bathroom

Do Calming Exercises Just Before Bed – Dr. Friedberg found that 30 minutes or more of relaxation exercises (focused breathing, progressive muscle relaxation, visualization exercises)  helps ME/CFS and FM patients sleep better and have more energy the next day.

Write Down Disturbing Thoughts in a Notebook – Johannes Starke recommends writing down to do’s and other thoughts that are keeping you  up in a notebook to put your mind at ease just prior to sleep. Then tell your brain that ‘that issue’ has been taken care of for now and it’s OK to sleep.

Waking up in the Middle of the Night. –  Dr. Friedberg recommends trying relaxation exercises (focused breathing,  progressive muscle relaxation, guided imagery or listening to a relaxation audiotape).  If that doesn’t work within 30 minutes then  get out of bed and into a  comfortable chair and  try again. When you start to feel sleepy get back in bed. If you don’t go to sleep then start the process over again.