When we sleep, our body cycles through five stages:
- Stage 1: Light sleep – the time between being fully awake and entering sleep
- Stage 2: Onset of sleep
- Stages 3 and 4: Deepest, most restorative sleep
- Stage 5: REM (rapid eye movement): Brain is active and dreams occur
A complete sleep cycle takes about 90 to 110 minutes and is repeated four to six times per night, with the initial REM period occurring about 70 to 90 minutes after falling asleep. The first sleep cycles each night consist of relatively short REM periods and long periods of deep sleep. As the night progresses, REM sleep periods increase in length while deep sleep decreases. By morning, most people spend nearly all of their sleep time in stages 1, 2, and REM.(1)
However, if you have FM and/or ME/CFS your body is probably not making it through the complete sleep cycle without interruption.
- A 2008 sleep study compared 26 ME/CFS patients (12 with coexisting FM) with 26 healthy controls. The researchers found that the ME/CFS patients had significantly reduced total sleep time, reduced sleep efficiency, and shorter bouts of sleep than healthy controls. They concluded that the sleep differences seen between the ME/CFS patients and healthy controls were primarily due to a decrease in the length of periods of uninterrupted sleep.(2)
- In 1975 Dr. Harvey Moldofsky first discovered that FM patients had an “internal arousal mechanism” that interrupted their stage 4 deep sleep(3), and multiple studies since then have confirmed his findings. This interruption of deep sleep by sudden bursts of awake-like brain activity is now called the alpha-EEG anomaly.
- A Danish review of research done on pain and sleep, with special reference to fibromyalgia, reported that most studies found the alpha-EEG anomaly to be very prevalent in FM patients.(4)
- A 2013 study comparing ME/CFS patients to healthy controls found that the ME/CFS patients had significant changes in heart rate variability measures during sleep. The researchers also found evidence that the reduced sleep efficiency and reduced total sleep time of ME/CFS patients might be caused by increased sympathetic nervous system activity during non-REM sleep stages.(5)
1. Herbal Sleep Support
- Ziziphus Spinosa – the most prescribed medicinal herb for sleep and relaxation support in China and throughout Asia.
- Corydalus – historically employed in traditional Chinese and Native American medicine to support relaxation and stress reduction.
- Valerian – the most researched sleep-supporting herb in the world. No herb has proven to be more effective in clinical trials for providing effective support for improved sleep. One review identified 12 studies showing that valerian by itself or in combination with hops was associated with improvements in sleep latency (the time it takes to transition from full wakefulness to sleep) and quality of sleep.(6)
- Passion Flower – provides support for stress, anxiety, and sleep. It is also has calming and restorative properties.
2. Digestive Support – Calming and supporting the digestive tract is an important first step in attaining restful, restorative sleep.
- Lemon Balm – used to promote comfort, relaxation, and calm the digestive and nervous systems. It provides synergistic sleep support when combined with Valerian.
- Ginger – a calming anti-inflammatory and digestive aid used to settle the stomach and promote peristalsis. It offers over 150 times the protein digesting power of papaya and contains at least 22 known anti-inflammatories and 12 antioxidants.
- Peppermint – traditionally used as a relaxant, it calms the muscles of the stomach, helps reduce excessive gas production, improves the flow of bile used in fat digestion, and promotes proper elimination.
- Hops – acts directly on the central nervous system to support the relaxation of smooth muscle tissue, improve central nervous system activity, and calm and soothe digestion.
3. Muscle and Nerve Support – Supporting muscle and nerve health is important for proper sleep.
- ZMA™ – a great source of extremely bioavailable magnesium and zinc that supports sleep and healing by aiding in the transport of oxygen to nerve and muscle cells. Magnesium is the number one mineral deficiency in the United States, and zinc is the most important mineral for immune system function.
- Magnesium Taurinate – a bioavailable yet gentle source of magnesium combined with the nervous-system-calming amino acid L-taurine.
4. Amino Acid Support – Amino acids are the building blocks of life and are critically important for nerve cell health as well as neurotransmitter and hormone production and balance.
- GABA – the main calming amino acid in the central nervous system, this naturally produced substance helps to induce relaxation and sleep. It is also known for supporting healthy pituitary function as well as for its calming effect on over-stimulated neurons.
- Melatonin – a natural hormone produced by the body that helps regulate other hormones and maintains the body’s circadian rhythm. It supports the body’s own production of the tranquilizing neurotransmitter serotonin, which plays a key role in healthy sleep patterns and mood. Recommended by more and more doctors as a safe and natural sleep enhancer, melatonin has become the most popular sleep-support compound in the natural food industry.
- 5-HTP – used by the body to make serotonin. Several small clinical trials have found it may provide significant support for fibromyalgia, sleep, mood, and migraines.
- L-Theanine – a calming amino acid found in green tea that can increase levels of GABA (gamma-aminobutyric acid). Studies suggest it may reduce feelings of mental and physical stress and may produce feelings of relaxation. It is also thought to enhance immune function and boost levels of glutathione. L-Theanine increases the brain’s alpha wave activity, which is associated with deep relaxation.
Valerian and Hops: A 1998 German study comparing the use of a hops-valerian combination with a benzodiazepine drug found them to be comparable in effectiveness for improving sleep. The one big difference was that those taking the benzodiazepine experienced withdrawal symptoms when the stopped but those taking the hops-valerian did not. The investigators concluded that a hops-valerian combination was a “sensible alternative to benzodiazepine” for treating sleep problems.(7)
Passion Flower: A 2011 Australian study of 41 participants who were given passion flower tea and a placebo, separated by a one-week ‘washout’ period, found that their sleep quality significantly improved when they used the passion flower as opposed to the placebo.(8)
Melatonin, Magnesium and Zinc: Forty-three people with primary insomnia were given either a supplement consisting of melatonin, magnesium and zinc or a placebo one hour before bedtime for eight weeks in a 2011 Italian study. The group taking the supplement had significantly better scores on three different sleep-evaluation instruments, indicating that the treatment had a beneficial effect on the restorative value of sleep. The authors concluded that the nightly administration of melatonin, magnesium and zinc appeared to improve both the quality of sleep and the quality of life of the participants.(9)
GABA and 5-HTP: In a 2010 study, 18 patients with sleep disorders were given either a preparation containing GABA and 5-HTP (hydroxytryptophan) or a placebo. The researchers reported that the differences between the two groups were significant, concluding that the GABA/5-HTP combination reduced the time to fall asleep, decreased sleep latency, increased the duration of sleep, and improved the quality of sleep.(10)
1. Brain Basics: Understanding Sleep. National Institute of Neurological Disorders and Stroke. May 21, 2007. http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm
2. Togo F, et al. Sleep structure and sleepiness in chronic fatigue syndrome with or without coexisting fibromyalgia. Arthritis Res Ther. 2008;10(3):R56. Epub 2008 May 13. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2483445/?tool=pubmed
3. Moldofsky H, et al. Musculoskeletal symptoms and non-REM sleep disturbance in patients with ‘fibrositis syndrome’ and healthy controls. Psychosom Med 1975;37:341-51. Abstract: http://www.psychosomaticmedicine.org/content/37/4/341.abstract Full text (download) http://www.psychosomaticmedicine.org/content/37/4/341.full.pdf+html
4. Drewes M. Pain and sleep disturbances. Clinical, experimental, and methodological aspects with special reference to the fibromyalgia syndrome and rheumatoid arthritis. Scandinavian Journal of Rheumatology 1999;28(2):126. http://www.ingentaconnect.com/content/apl/srhe/1999/00000028/00000002/art00014
5. Togo F, Natelson BH. Heart rate variability during sleep and subsequent sleepiness in patients with chronic fatigue syndrome. Autonomic Neuroscience. Epub 2013 Mar 14. http://www.ncbi.nlm.nih.gov/pubmed/23499514
6. Salter S, Brownie S. Treating primary insomnia – the efficacy of valerian and hops. Aust Fam Physician. 2010 Jun;39(6):433-7. http://www.ncbi.nlm.nih.gov/pubmed/20628685
7. Schmitz M, Jackel M. [Comparative study for assessing quality of life of patients with exogenous sleep disorders (temporary sleep onset and sleep interruption disorders) treated with a hops-valarian preparation and a benzodiazepine drug]. Wien Med Wochenschr. 1998;148(13):291-8. http://www.ncbi.nlm.nih.gov/pubmed/9757514
8. Ngan A, Conduit R. A Double-blind, Placebo-controlled Investigation of the Effects of Passiflora incarnata (Passionflower) Herbal Tea on Subjective Sleep Quality. Phytother Res. 2011 Feb 3. doi: 10.1002/ptr.3400. http://www.ncbi.nlm.nih.gov/pubmed/21294203
9. Rondanelli M, et al. The effect of melatonin, magnesium, and zinc on primary insomnia in long-term care facility residents in Italy: a double-blind, placebo-controlled clinical trial. J Am Geriatr Soc. 2011 Jan;59(1):82-90. http://www.ncbi.nlm.nih.gov/pubmed/21226679
10. Shell W, et al. A randomized, placebo-controlled trial of an amino acid preparation on timing and quality of sleep. Am J Ther. 2010 Mar-Apr;17(2):133-9. http://www.ncbi.nlm.nih.gov/pubmed/19417589