Introduction: Good Sleep is Essential to Chronic Fatigue Resolution

You now know that sleep is powerful medicine and absolutely a non-negotiable part of chronic fatigue resolution. It is a key player for all sufferers of chronic fatigue and chronic fatigue syndrome (CFS). 

This is good news because sleep is a part of your lifestyle that you get to control. There may be problems with sleep that you need help with (and we’re going to explore those!), but there are many key aspects of sleep that you are completely in charge of. You’ll learn to leverage those.

In this article, you will learn the fundamentals for optimizing sleep as part of your chronic fatigue resolution plan.

Ask for Help

As you’ve learned, there are many health conditions that can make sleep difficult. It is important that you work with a trusted health practitioner to get those problems solved.

Sleep deprivation is a common partner to chronic fatigue and doctors often can’t help with a solution. Never let “we don’t know what’s wrong with you” discourage you. What one healthcare practitioner doesn’t know another one surely does. There’s always a solution.

Aside from the testing a professional can order for you, it’s good to have a partner to help sort things out. Work with someone trained in Functional Medicine—they look at things in a very comprehensive way to seek-out the root causes of your problems.

You May Need Help Ordering Lab Tests to Help Identify Physiological Problems Effecting Sleep:

Thyroid Function:

Order TSH, Free T4, Free T3, and thyroid antibodies: antimicrosomal and antithyroperoxidase.

Adrenal Function:

Order 7-8 am cortisol, DHEA-S, aldosterone, or diurnal cortisol and DHEA-S saliva levels.

Nutrient Assessment:

Order urine organic acid test, urine or plasma amino acids, blood fatty acid levels, blood oxidative stress markers, RBC mineral levels, iron studies (serum iron, TIBC, % saturation, ferritin), blood homocysteine and methylmalonic acid levels.

Markers of Inflammation and Autoimmunity:

Consider ordering hsCRP, ESR, TGFB-1, ANA, anti-CCP Ab.

Tests for Persistent Infections, Allergies, or Toxicities:

This may include (but not limited to) Lyme western blot, plasma histamine, urine provoked heavy metal levels.

Sleep Studies:

This may include overnight oxymetry or an overnight in-lab polysomnography.

13 Natural Sleep Solutions for Chronic Fatigue

Make Good Sleep a Practice

When we were kids, sleep came so easily. We didn’t have to think about it. But life gets complicated, and we have to turn to intentional commonsense practices to make good sleep happen. We’ve got to have a plan and make space for it in our lives. We’ve got to make sleep one of our core self-care habits.

We know sleep is the boss. Nothing turns us around faster than beautiful sleep.

Plan a regular bedtime that makes sense for your life and stick to it. The brain likes habitual behavior, sets up neural pathways, and will get into the groove. Your clock genes will adjust to support you.

Plan for enough sleep. Stay in bed long enough to meet your unique sleep needs. This will be different for everyone. If you experience tiredness or lack of restoration after a night of sleep, you’re either not getting enough or the quality of sleep is lacking. If you are recovering from an illness, you’ll need more sleep than usual.

Eat Well

A richly nutritious diet leads to a healthier body and brain and establishes the foundational biology for good sleep. Follow an energy nutrition-rich healthy food plan, like my Foundational Intensive Nutrition Energy (FINE) food plan. Eat lightly at night, not within two hours of going to bed.

Experiment with intermittent fasting—a prolonged overnight fast that nourishes the brain. Start with no food (water only) for twelve to fourteen hours overnight from the time of your last meal. Work up to sixteen to eighteen hours. Make sure you’re getting enough protein. Avoid all commercial animal products, which are high in proinflammatory fats that can disrupt sleep. Don’t rush eating.

Create a Healthy Microbiome

Our gut microbiome—the communities of bacteria that reside within our intestines and support health—affect our sleep, and our sleep in turn affects the microbiome. Gut microbes influence our sleep patterns through their effect on clock genes—potentially impacting hormone balance, energy metabolism, detoxification, immune regulation, and circadian rhythm.

When we don’t sleep well, our microbiome is disrupted due to negative effects of stress hormones, low energy, and oxidative stress, creating a vicious cycle of dysfunction.

Follow the FINE food plan, eat plenty of soluble fiber and fermented foods, and take a high quality probiotic (60-100 billion organisms or more per day of a mixture of lactobacilli, bifidobacterial, saccharomyces boulardii, and soil-derived organisms).

Jumpstart Your Morning

Start each day with something hot to drink like pure water, tea, or bone broth (save coffee, if allowed on your food plan, for later in the morning, when cortisol levels are dropping naturally—it will be more effective). This wakes up the gut and signals the body that a new day is beginning. Rest a bit while consuming rather than leaping right out of bed and into action. The process of waking up is the most stressful event of the day physiologically. This is a good time to meditate, write in your journal, or review affirmations that set a positive tone to start your day.

Boost Natural Daytime Light Exposure and Nighttime Darkness

Spend time outdoors or near windows to benefit from natural sunlight. When possible, an hour of sunlight at noon every day is best.

Avoid excesses of light and electronics for at least a couple of hours before bedtime. This allows for your brain’s circadian rhythm to get in sync, optimizing clock gene expression and releasing melatonin to calm your nervous system, preparing for deep sleep.

Use blue light filters on your electronic screens or glasses and read on devices with a black background (or read paper books!) because blue light interferes with melatonin production.

Sleep in the dark—use blackout shades and remove all sources of light, such as phones, clocks, and all electronic devices.

Remove all mirrors, which can amplify light, from your sleeping spaces. Even small amounts of light will inhibit melatonin production, a key driver of sleep.

Remove Electromagnetic Field (EMF) Sources

While inadequately studied to date, there is an abundance of anecdotal evidence that EMF may be disruptive to sleep via its effects on electrical communication within the body. It is hypothesized that EMF exposure would especially affect the brain and nervous system—the main control centers for sleep.

To help optimize sleep, experiment with removing all electronic devices and cordless phone bases from your sleeping area. Turn off the wireless communication networks within your home during sleep.

Stay Well Hydrated Throughout the Day

To improve sleep, drink ample fluids—a minimum of two to three quarts per day for most people. However, avoid drinking too close to bedtime or your full bladder may awaken you during the night. Hold off on fluids for at least two hours before going to sleep.

Move and Exercise Your Body Every Day

Movement throughout the day supports a healthy body and brain and helps moderate excesses of stress. Intense exercise early in the day helps with deeper sleep, but avoid it late in the day as the increase in stress hormones can interfere with falling to sleep.

Do you have difficulty with movement due to severe fatigue, illness, or disability? Try this powerful body-mind exercise:

How to Move When You are Chronically Fatigued, Ill, or Debilitated

For some the idea of moving vigorously, or at all, feels overwhelming, and perhaps impossible. No problem. We can gain energy and function by varying our postures, or adding loads in novel ways, whether you can actively move much or not. Try these:

  • Walk slowly and mindfully, in bare feet, to your tolerance level. Repeat throughout the day as you can.
  • Shift your lying position as often as possible. Challenge yourself with positions you may not normally use, such as front lying, perhaps with upper body bent up, resting on elbows—a good position to read or write for short intervals.
  • Try seated positions on the floor: cross-legged, side lying, with pillows, without pillows.
  • Try novel or non-uniform surfaces to load and stimulate body parts in new and different ways. For example, roll the bottoms of your feet out on a tennis ball, or stand/rest your feet on a pebble mat or similar textured surface.
  • Roll out all of your muscle groups on a foam roller.
  • Receive bodywork: massage, chiropractic, physical therapy. These all introduce forces that help mobilize muscles, stimulate circulation, and improve cellular energy production.

In addition to actual movement, consider imagining yourself moving. By actively visualizing movement, we induce neuroplastic changes in the brain (neuroplasticity is our brains’ potential to develop both structurally and functionally) that lead to enhanced physical mass, strength, and function. Athletes and musicians employ this technique to improve performance. It has also benefited people unable to move due to paralysis or neurodegenerative disorders. Actively imagining movement of the affected limb—or the entire body—leads to measurable improvements in strength and function.

Exercise: Move Your Body with Your Mind

If you are experiencing a period of enforced immobility, spend time imagining yourself performing the movement of your choice. What you imagine yourself doing will activate neuroplasticity by recruiting dormant movement-related parts of your brain, increasing blood flow to your brain, and strengthening your brain’s connections with the rest of your body.

Have a specific movement goal in mind, like hiking on your favorite trail in the woods. Be there. See yourself clearly in your mind, fully mobile and enjoying your hike. Hold onto that scene as if it is happening at this very moment and include as much detail as possible, engaging all of your senses. What are you wearing and how do those clothes feel on your body? Who are you with? Feel the breeze against your skin. Hear the leaves rustle and the birds singing. See the deer and squirrels. Smell the dirt and the flowers. Feel the uneven surface of the trail and the effort in your thighs as you climb those hills. How do you feel—what emotions are you experiencing?

Spend fifteen to twenty minutes twice daily with this active visualization practice. Include as many other scenarios as you would like to deeply activate your brain, support it as it forms new connections with the rest of your body, and improve your mobility. 

Limit Caffeine Use to Early-Midmorning

Caffeine helps override the perception of tiredness from sleep deprivation by its effect on adenosine receptors (adenosine is the brain chemical responsible for making us feel sleepy). But its stimulant effects, effects on stress hormone secretion, and delay of melatonin secretion from the pineal gland can interfere with sleep, even many hours later.

Consider the half-life of caffeine. The half-life of any drug is the time it takes the body to clear out half of the dose ingested. Said another way, at one half-life of the drug, half of the dose remains. Caffeine has a half-life of five to six hours, so if you take your morning coffee at 10 a.m., you’ll still have half that dose in your body at 3 p.m,. and a quarter of that dose at 8 p.m., the time of day when most of us are winding down. Imagine if you take a cup of coffee at 3 p.m,. you still have half that amount of caffeine on board at bedtime. So, yes, your morning cup of coffee, regardless of when it is consumed, will affect you at bedtime.

Avoid Excesses of Alcohol

Any quantity of alcohol can impair sleep. Some folks are very sensitive to this effect and should avoid it all together.

Prepare Your Mind for Sleep

Start the process of letting go of the concerns of your day at least two to three hours before laying your head on your pillow. Again, you should turn down lights and turn off electronics. Decrease noise and begin to move into the more restful phase of your day.

Unload your worries and to-do list onto your peripheral brain (write them down or enter them into your electronic device). This will allow you to rest rather than worry about what needs to be done tomorrow.

Allow yourself to relax. This is especially beneficial for those stressful days when your mind is not quite ready to settle down. This practice could be as simple as reading an enjoyable book before bed, doing a calming meditation, a guided meditation, quiet prayer, listening to soothing music, or other settling, calming activity. Some meditations are energizing and may not be conducive to letting go into a deep sleep—trust your body to tell you what works best for you.

Meditate during the day. Daytime meditation, practiced in the morning or as late as early evening, balances the stress and nervous systems, making sleep more available to us at the end of the day. Meditation increases the production of melatonin from the pineal gland and creates a biochemical milieu that favors deep sleep.

If you have a hard time getting your mind to quiet down at bedtime, use affirmations about deep sleep that activate the power of your intentions:

I let go, rest my mind and sleep deeply.

Thank you for the perfect sleep and restoration.

I am safe and comfortable in my bed.

Create an Environment That Supports Good Sleep

Assess your bedding. Are your mattress, pillows, and covers perfectly comfortable? Are you warm or cool enough? Is it pitch dark and quiet? You may need light blocking shades or wear ear plugs.

Does your sleep partner snore or move excessively? If so, this needs to be addressed.

Work to remove all clutter from your bedroom. Those piles of clothes, books, or work-related stuff stress us, even when we’re not aware of them, keeping us from the deep letting go we need to sleep well.

Use Safe Sleep Aids to Support Your Sleep

Work with herbs that can calm the brain and assist with sleep: chamomile, lemon balm, valerian, kava, skullcap, passionflower. These come in combination formulas that are safe and affordable. Note that there are some people who experience paradoxical alertness when using valerian.

Try safe nutritional supplements to relax the brain: GABA, 5-HTP, l-theanine, magnesium glycinate, glycine. Follow manufactures’ guidelines or the advice of your trusted health practitioner.

Melatonin can help reestablish the internal circadian rhythm that helps regulate sleep. It can be especially helpful for time zone changes, shift workers, sleep changes associated with aging, and inflammation. Start with one to three mg taken in the evening, an hour or two prior to bedtime.

For those who are exhausted from too much stress, but too wired to sleep, adrenal supportive nutrients and herbs may be helpful. Phosphatidyl serine is an excellent neutralizer of the stimulating effects of cortisol on the brain. Work with a trusted healthcare provider who is knowledgeable about such treatments.

Therapeutic modalities such as massage, acupuncture, energy medicine, or hypnotherapy can be very helpful for sleep. Gentle restorative yoga and meditation prepare the body for deep sleep by activating the brain-calming parasympathetic nervous system and increasing melatonin levels.

How to Manage Complex Sleep Disorders

Your sleep may be particularly challenged by pain and discomfort, menopausal symptoms, periodic limb movement disorder (“restless legs syndrome”), sleep apnea, or other distressing symptoms that interfere with sleep. Work with a trusted health practitioner on these problems.

Some people need sleep medication as a “bridge,” allowing them to sleep as part of their recovery plan, while the other aspects of their illness are being addressed. The need to correct sleep problems with the use of medications must be balanced with their addictive potential, habit-forming nature, and tendency to disrupt normal sleep architecture. Work with a pro.

You May Need a Sleep Study

You may have restless legs or sleep apnea. Your current symptoms may make this obvious.

Do you snore, fall asleep during the day, have headaches, or has someone observed that your breathing pauses while you’re asleep?

If you said “yes” to any of those questions, you need to have a sleep study—a home overnight oximetry test or a more extensive test performed at a professional sleep lab. In the latter, specialists monitor the quality of your sleep, oxygen levels, movements that may lead to arousals from sleep, quality of your breathing, and in some cases, brain wave activity.

I order sleep studies routinely for my clients who have symptoms suggestive of a sleep disorder such as sleep apnea or periodic limb movement (PLM) or who suffer from chronic fatigue even without an obvious cause after a thorough evaluation. PLM leads to arousals out of the deeper stages of sleep, decreasing the restorative aspects of sleep.

Sleep apnea—inappropriate pauses in breathing during sleep caused by airway obstruction or brain dysfunction—leads to oxygen deprivation as well as frequent arousals, diminishing sleep quality and impairing brain function, always leading to chronic fatigue.

Remember: there is always a solution. Mobilize your health support team. Get a new opinion if necessary.

Create a Personal Sleep Plan

Work with the following questions to help you create your initial sleep goals and a plan for better sleep. Take a moment to write these down. Remember, keep this simple and doable. Start with just three small things to work on.

Name Your Personal Sleep Goals

What do you want to accomplish? Have more energy? Feel less tired? Have more enthusiasm and vitality for the day? Feel more like yourself? Name them and write them down.

Name the Three Things You Most Need to Work On to Improve Your Sleep

Based on what you’ve read so far, contemplate what you need in your own life to achieve the sleep goals you just names. How can you sleep better? Use the power of three here. Create your list of three things to start your journey to improved sleep:

            1.

            2.

            3.

First Action Steps toward Better Sleep and Increased Vitality

Again, using the power of three, list the three action steps you will take tonight to improve your sleep:

1.

2.

3.

Resources

Karyn Shanks MD. How to Treat Chronic Fatigue for Life. 2019.

Karyn Shanks MD. How to Overcome Chronic Fatigue Syndrome (Expert Guide). 2019.

Karyn Shanks MD. How to Heal Chronic Fatigue with Beautiful Natural Sleep. 2019.

Karyn Shanks MD. How to Treat Chronic Fatigue with Energy Nutrition. 2019.

Karyn Shanks MD. How to Boost Energy with Ketosis and Intermittent Fasting. 2019.

Karyn Shanks MD. Nutritional Ketosis: Heal and Protect Your Brain. 2017.

Karyn Shanks MD. Create a Healthy Microbiome to Heal and Energize. 2017.

Figueiro MG, et al. The Impact of Light from Computer Monitors on Melatonin Levels in College Students. Neuro Endocrinol Lett. 2011; 32(2): 158-63.

Yuanyuan Li, et al. The Role of Microbiome in Insomnia, Circadian Disturbance and Depression. Front Psychiatry. 2018; 9: 669.

M Nathaniel Mead. Benefits of Sunlight: A Bright Spot for Human Health. Environ Health Perspect. 2008 Apr; 116(4): A160-A167.

Tayebeh Barsam, et al. Effect of Extremely Low Frequency Electromagnetic Field Exposure On Sleep Quality in High Voltage Substations. Iranian J Environ Health Sci Eng. 2012; 9(1): 15. Non-statistically significant higher rate of insomnia in case subjects.

National Sleep Foundation. The Connection Between Hydration and Sleep. 2019.

Michael D Stein MD and Peter D Friedmann MD MPH. Disturbed Sleep and Its Relationship to Alcohol Use. Subst Abus. 2005 Mar; 26(1): 1-13.

National Institutes for Health: National Center for Complementary and Integrative Health. Melatonin: In Depth. 2015.

Karyn Shanks, MD. What is Functional Medicine?

The Institute for Functional Medicine. Functional Medicine determines how and why illness occurs and restores health by addressing the root causes of disease for each individual.

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Karyn Shanks MD

About the Author

Karyn Shanks, MD, is a physician who lives and practices in Iowa City. Her work is inspired by the revolutionary science of Functional Medicine, body-mind wisdom, and the transformational journeys of thousands of clients over her twenty-seven year career. She believes that the bones of healing are in what we do for ourselves.

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