Sleep, Chronic Fatigue, and Fibromyalgia
| < Back to Prolotherapy Article Index |
We have often written about sleep problems in our newsletters. Our goal whenever possible is to find and correct the cause. For example chronic pain, stress, or depression have solutions in Prolotherapy, proper nutritional and hormonal balance, and amino acid or anti-depressant therapy respectively. In these cases the sleep disorder is secondary to something else. However in Chronic Fatigue/Fibromyalgia syndrome the sleep disturbance may actually lie at the root of the many symptoms.
Sedative antidepressant drugs have been tried with some success in some cases. We also know that many of these patients have low growth hormone levels, which may connect to the sleep disorder. Recently a new drug called Xyrem has become available, and has begun to attract attention among physicians treating this syndrome. The drug is a reborn derivative of GHB (gamma hydroxy butyric acid), a natural substance banned by the FDA because of some date rape incidents when it was used in a sexually sinister manner, and in combination with alcohol. Never-the-less, it is available again in a stringently controlled manner with its labeled indication being for narcolepsy, and is probably one of the safest and most effective sleep aids that we know of.
Certainly we have experience with herbs, melatonin, and 5-HTP and each of these natural substances works for some patients. We have recently had some consistent in-service training on the use and benefits of Xyrem, and already have enough patients benefiting that I wanted to write about it.
Xyrem enhances the deeper slow wave sleep, sedates without morning hangover, and may work by doubling the output of human growth hormone at night (so anti-aging benefits are probably a “side effect” of the drug). Expected effects are more energy, reduction in fibromyalgia pain, and a good night sleep every night. Dr. Brad Weeks has extensive experience with Xyrem and he has also described benefits with autoimmune disorders like Lupus and MS. Depression and anxiety also frequently respond. The drug is safe as long as it is not combined with other sedatives, and the prescribed dose is not exceded. Although it is fairly expensive ($200 per month), most of the prescription plans out there will cover it. There are many chronic insomniacs and chronic faigue/fibromyalgia patients who have tried everything without success. Xyrem is worth looking into for almost anyone with symptoms that are associated with a chronic sleep disturbance.
Other Fibromyalgia information of interest:
While we are talking about CF/FMS (chronic fatigue/fibromyalgia syndrome), I wanted to report some other interesting theories from physicians working on different treatments that were written up in the recent Brewer Science Library journal “New Horizons”.
Dr. William Wong reported good results from administering testosterone replacement to both men and women with FMS. When the problem is muscles, it pays to think about testosterone. Dr. Bernard Bihari found 22/24 FM patients responded dramatically to low dose naltrexone at 4.5mg at bedtime. Naltrexone is a narcotic antagonist medication that raises the body’s own levels of pain fighting endorphins. A related treatment is D,L phenylalanine 1,000mg three times daily. This very safe amino acid may inhibit enzymatic breakdown of endorphins in the body, thus enhancing their pain killing effects. Dr. Vliet observed that most female FM patients have subnormal estrogen levels which may be the background cause of the sleep disorder all these patients experience. Our experience confirms that sleep can be improved when estrogen is given to deficient women, and that perimenopusal women complaining of pain often improve when given bio-identical estrogen replacement therapy. Her unique perspective is that estrogen deficiency may contribute to FM through various pathways: trouble absorbing magnesium, diminished production of hyaluronic acid needed for collagen synthesis, limbic system dysregulation, increased neuronal sensitivity to pain impulses, and finally sleep disruption. We routinely check hormone levels in our fibromyalgia patients, including growth hormone. Getting to the bottom of fibromyalgia requires innovative thinking, and flexibility of approach. I have been amazed at how unimaginative and ineffective the treatment for FM is at medical center’s that tout themselves as specialists in this disorder. Although enigmatic, it is very unusual for us at Caring Medical to have a FM patient we cannot help.
< Back to Prolotherapy Article Index
 |
 |
