Do you fall asleep easily during the day, for instance while watching TV or reading (or worse yet, while driving)? Called "hypersomnolence," this is a sign you may have sleep apnea, a condition in which you repeatedly stop breathing during the night (it's like someone is repeatedly smothering you with a pillow). The result is non-refreshing sleep.
17% of the population have sleep apnea, and it's more common in CFS where it can accentuate your pain and fatigue. (Diabetics may also be more likely to have it.) Signs that you may have this include:
- High blood pressure
- Being more than 20 pounds overweight
- Having a shirt collar size of 16 ½ inches or higher
There are two main types of sleep apnea:
- Obstructive sleep apnea (OSA). In this form of sleep apnea, the more common of the two, your upper airway gets intermittently blocked. This is most often associated with being overweight and snoring. If you have high blood pressure and either chronic fatigue syndrome or fibromyalgia (where most people usually have low blood pressure) then it's especially important to consider sleep apnea.
- Central apnea. In this form, the brain trigger that controls your breathing intermittently stops working. This is more common in people with a history of traumatic brain injury, those living at high altitudes, or those who take narcotics for pain management. Unlike OSA, this form of sleep apnea is not associated with being overweight or snoring.
In OSA, your pharynx (throat) repeatedly collapses during sleep. You fight to breathe against a blocked airway, resulting in decreased oxygen levels in your blood. Eventually, the sense of suffocation wakes you, your throat muscles contract, your airway opens, and air rushes in under high pressure. When your airway opens, the rushing air allows you to once again drift back to sleep, but it creates a loud gasping sound. People with OSA are generally unaware that this is happening (though their partners lose a lot of sleep from hearing all the snoring and gasping). This repeated waking from deep sleep, along with the loss of oxygen in the blood, can cause next-day sleepiness, brain fog, poor concentration, and mood changes.
Anyone with CFS or FMS who has high blood pressure and is overweight should consider testing for sleep apnea. A simple way to check for this is to use a smartphone to record a video of yourself while sleeping. An hour or two of recording is usually enough. If you see yourself repeatedly snoring followed by a stop in breathing, then you should look into a more formal sleep study.
Treatments & Tips
The most common treatment for sleep apnea is a sleep mask called "CPAP" (Continuous Positive Airway Pressure). This gently blows air into your nose to help keep your airway from collapsing. Although only about a third of people tolerated the old machines, newer models are smaller, gentler, and much better tolerated. There are also monitors that can help adjust the pressure.
A note for those with fibromyalgia: Though most doctors recommend that people with sleep apnea avoid sleep medications and muscle relaxants, for those who have fibromyalgia the sleep treatments are more important. Because of this, I recommend these people do a sleep study while remaining on their sleep medications and supplements, and then adjust the pressure settings on the CPAP machine to compensate for the meds.
Another way to prevent your airway from collapsing is by moving your lower jaw forward. There are dentists who specialize in making a device that does this, and most people find it more comfortable than wearing the CPAP device.
Losing weight, even as little as 10-15 pounds, can be very helpful. The average weight gain in fibromyalgia is 32 pounds, and it's nearly impossible to lose this much weight until metabolic problems are corrected. Fortunately, using my research-backed CFS/FMS treatment method, the S.H.I.N.E.® protocol, makes this much easier.
Another helpful tip is to avoid sleeping in positions that cause you to snore, especially if you snore while lying on your back. A good trick for this is to put a tennis ball into a cloth pocket and sew it into the mid-back of your pajama shirt. The tennis ball makes lying on your back uncomfortable, which forces you (without waking you) to roll onto your side or stomach.
Avoid drinking alcohol excessively before bedtime, as this can aggravate sleep apnea.
Another possibility is surgery to reshape your throat so it stays open during sleep. Removing your tonsils, having nasal surgery, and surgically trimming back the soft palate and the uvula (the tiny thing that hangs down in the back of your throat) are the most common treatments for this. NOTE: Though these surgeries can be very helpful to reduce snoring, they are less likely to help resolve sleep apnea.
It's controversial whether using more aggressive treatments such as surgery are worthwhile if your episodes of sleep apnea occur at a rate less than 15 per hour. If this is you, then you should start treatment by using one or more of the less aggressive approaches, such as losing weight and avoiding sleeping on your back.