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Insomnia and the HPA Axis

Insomnia is a major problem for many CFS and FMS patients.

It can be difficult for CFSers to keep a normal sleep schedule. They tend to have shifted sleep patterns which lead them to fall asleep and wake up much later than healthy people.

This may be because of HPA axis dysfunction.

The HPA axis is a system of glands which regulate many body systems including the sleep/wake cycle.

A dysfunctional HPA axis could cause the body to release decreased levels of cortisol or release it at inappropriate times through out the day (like bedtime).

In normal people, levels of cortisol (released by the adrenals) rise upon wakening and reach their peak levels with 30 minutes. They lower gradually though the day and the increase again in the late afternoon.

Here – Chronic Fatigue like symptoms (including fatigue, cognitive complaints, pain, sleep disturbance) were induced in hepatitis patients when they were treated with a drug called Interferon-Alpha. Its is believed to be due to the drugs affect on the HPA axis.

If you have CFS, here are some things that may help stablize your sleep/wake cycle (and maybe the HPA stress response).

- The first thing is to wake up and go to sleep at the same time every day. (This has worked wonders for me, ive been sleeping the best that i have in years.)

- Exercise if you can. This is not an option for all people with chronic fatigue, but if you can exercise without negative effects, it can help.

- Also make sure and get light exposure everyday, via the sun or a light box.

- Dont watch t.v. in bed. Studies have shown that people who watch television or use the computer before bedtime, get less sleep. Using electronics that emit light can affect your sleep patterns when you use them before bedtime. Reading a book is a better option if you have insomnia.

Sometimes the above techniques arent enough. You might have to move on to supplements or prescription sleep aids, if you still arent able to get a decent nights sleep.

**Here are sleep aids that have been effective for me:

Benadryl: Benadryl blocks histamine at the H1 receptor. Histamine induces wakefulness and blocking it with benadryl is a safe and non-addictive way of dealing with insomnia.

Valerian: Valerian is an herbal supplement which causes sleepiness. It is believed to increase levels of an inhibitory neurotransmitter called GABA. It has a similar mechanism of action as benzodiazapenes like xanax and klonopin.

GABA: Supplements of the inhibitory neurotransmitter GABA are available in pill form at health food stores.

Melatonin: Melatonin is a naturally occuring hormone made by the pineal gland.

Klonopin: A perscription drug that is very effective for sleep among CFS patients. Is recommended by CFS doctors like Charles Lapp.

Doxepin: A tricyclic antidepressant, that is also one of the stongest antihistamines available. Chronic Fatigue patients can take it at a low dose, where it is only really effective as a sleep agent, not an antidepressant.

** If you decide you want to try these supplements, discuss them with you doctor first. Mixing sleep aids can be especially dangerous.

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One Response to “Insomnia and the HPA Axis”

  1. nicki says:


    I have Chronic Fatigue but I also believe that I suffer from “Delayed Phase Sleep Disorder”. As the name suggests it is a form of sleep disorder in which the natural circadian rhythm runs out of sync with the normal population. I am usually more alert and i used to be more energetic at night (until the CFS) and didnt want to sleep. And then I desperately wanted to keep sleeping until late morning (10:30am).

    I feel like I have suffered from it for a long time, (I have vivid memories of tossing and turning as a child until the birds started chirping in the trees) and I take sleeping pills to help me get to sleep at night. I am also a very light sleeper and need ear plugs to avoid getting woken up during the night.

    I don’t think my sleep has changed much since getting CFS, though it did used to infuriate me that I would be so unbearably physically exhausted but still would not be able to sleep. Logic would tell you being physically exhausted you will sleep better, right?!

    It is just very interesting that my two conditions may be linked.

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