Chronic Fatigue Syndrome: Its Causes and Treatments
If we consider mainstream medical definitions of
Chronic Fatigue Syndrome, we
can easily notice that the listed symptoms include heavy breathing and chest
pain. Among other possible symptoms are: muscle pain, shortness of breath, night
sweats, chronic headaches, muscle fatigue, cramps and spasms, cold hands and
feet, extreme fatigue and weakness. These are all classical symptoms and signs
of chronic hyperventilation, which causes low body-oxygen levels.
What causes chronic fatigue syndrome?
As we explained before, heavy breathing (or breathing more than the
medical norm) reduces body-oxygen content due to 3
1) since CFS (or Chronic Fatigue Syndrome) patients are chest breathers,
chest breathing reduces oxygenation of the arterial blood due to
insufficient ventilation and oxygenation of the lower parts of the lungs
2) CO2 deficiency, due to breathing too much, causes constriction of
arteries and arterioles, reducing blood supply to tissues since CO2 is a
vasodilator (see links below).
3) Less oxygen is released by hemoglobin cells in tissues due to the
Bohr effect (caused by CO2 deficiency as
The link between chronic fatigue syndrome and ineffective breathing was
suggested by many doctors. Some of the quotes (Rosen et al, 1990; Paulley,
1990) are provided in references below. These doctors directly claim that
the label "chronic fatigue" means hyperventilation. Measured
end-tidal CO2 values are below the norm in CFS patients (Razumovsky et
al, 2003; Cook et al, 2006; Natelson et al, 2007) and end-tidal CO2 is even
less during acute episodes (Bogaerts et al, 2007).
Note. In some studies medical doctors suggested that low end-tidal
CO2, e.g., less than 30 mm Hg (!), is the criteria of hyperventilation (Naschitzet
al, 2006, Saisch et al, 1994). The typical border line is 35 mm Hg.
Furthermore, it is a known fact that hyperventilation or overbreathing can
be present, while having perfectly normal end-tidal CO2 parameters at rest
(e.g., due to predominantly chest breathing and/or ventilation/perfusion
mismatch) and that hyperventilation means to have abnormally high pulmonary
ventilation (or minute ventilation). Thus, hyperventilation is alveolar
(Are functioning alveoli ventilated in accordance
with metabolic needs and corresponding to the norm, which is 6 L/min for
minute ventilation at rest for a 70-kg man?). There are no any other types
Hyperventilation should cause symptoms of chronic fatigue syndrome
When muscle cells and other metabolically active tissues of the human
body do not get enough oxygen supply, more mitochondria switch from an aerobic
to an anaerobic energy-production mechanism. This causes elevated lactic acid
content in tissues and blood, together with the main symptoms of lactic
acid: weakness, fatigue, and pain in muscles and the chest (heart muscle
tissue also gets less oxygen and suffer from tissue hypoxia). Apart from
lowered oxygenation and blood supply to the brain, heavy breathing makes
nerve cells overexcited and irritable, causing headaches and anxiety
Chronic overbreathing creates cell hypoxia, elevated lactic acid,
constant production of free radicals in cells, free radicals damage,
possible inflammation in various areas of the body, leading to decreased vagal power (Sisto et al, 1995), blocked nose and chronic sinusitis,
digestive problems, face acne, liver inflammation (with abnormal liver test
results), and many other pathological effects. Inflammatory processes and
the mental state of chronic stress (fight-or-flight response) exhaust cortisol
reserves (cortisol is
a steroid hormone or glucocorticoid produced by the adrenal gland). This explains how
Adrenal Fatigue Syndrome and chronic insufficiency in cortisol
Particularly, for most patients, symptoms of chronic fatigue are worst
during early morning hours (Togo et al, 2008; Guilleminault et al, 2008).
Therefore, the cause of chronic fatigue syndrome is
overbreathing or hyperventilation. There were many doctors who suggested
this link, but Dr. Buteyko and his medical colleagues went further, developing the medical program for natural
treatment of chronic fatigue syndrome using the Buteyko breathing method of
When the cause is removed (due to breathing normalization or breathing
retraining), all symptoms of fatigue, including chest pain, shortness of
breath, night sweats, muscle pain and fatigue, chronic headaches, and
weakness, naturally disappear.
Chronic fatigue syndrome and body-oxygen levels
The degree of chronic fatigue syndrome in an individual can be found using a stress-free body-oxygen test,
which measures one's body oxygenation in seconds
(see links below).
||Symptoms (Chronic Fatigue Syndrome)
||Extreme fatigue syndrome; severe chest tightness; night sweats;
severe dyspnea; severe muscle pain; severe chronic headaches
||Moderate fatigue; chest pain; weakness; mild chest pain;
shortness of breath; muscle pain
||Moderate level of energy; possible desire to slouch;
muscle pain; night sweats and headaches are very rare
|Over 40 s
||Craving and joy of physical exercise; the attention is focused
on the outer world instead of bodily pains and aches
As an additional test, measure your heart rate since
the pulse of chronic
fatigue disorder patients is above the norm. The normal pulse rate is about
60-70 beats per minute. Patients with a moderate degree of chronic fatigue
syndrome often have more than 80 beats per minute at rest, while sitting.
When the body oxygenation is below 10 s, the heart rate is often more than
90 beats per minute.
When a person suffers from Adrenal Fatigue Syndrome with an insufficient
blood cortisol level, the
adrenal gland does not recover if his body-oxygen content is below 20 s.
Once a person has more than 20 s, any additional supplementation in cortisol
is not required. Note that some patients with chronic and extreme fatigue,
if they decide to improve their breathing, require cortisol supplementation
so that they can progress and get higher body oxygenation numbers.
Natural Treatment for Chronic Fatigue Syndrome
All symptoms of
chronic fatigue syndrome including muscle pain,
breathlessness, night sweats, headaches, and weakness will disappear if one
normalizes his or her automatic or uncosncious breathing pattern. Breathing retraining, so that one
breathe differently 24/7, requires lifestyle changes for better body
oxygenation and breathing exercises that can make breathing lighter and
slower. It is a serious project, which is explained in detail in the
Learn here Section. Note that many western MDs also
consider breathing retraining as the way to deal with the chronic fatigue
disorder (Nijs et al, 2007; Vasiliauskas et al, 2008).
How to increase body oxygenation
There are many breathing techniques and methods in order to normalize
breathing and increase body-oxygen levels. The Buteyko breathing technique
has the most powerful arsenal of lifestyle changing tools, which are described
in detail in the Section Learning.
The same Section also describes the Buteyko breathing exercises, which are
difficult to learn. Furthermore, there are breathing exercises that are more powerful
(in comparison with the Buteyko breathing exercises) to increase body oxygenation.
Oxygen remedy is such a program that is based on using the Buteyko lifestyle
program and the application of breathing devices (the Amazing DIY breathing device,
Frolov device and some others) that trap exhaled air with high CO2 levels for inhalations
to boost body-oxygen content. More info about these alternative respiratory techniques
can be found here:
* Amazing DIY breathing device
* Frolov breathing device.
References and quotes
Hyperventilation in chronic fatigue syndrome
Rosen SD, King JC, Wilkinson JB, Nixon PG, Is chronic fatigue syndrome
synonymous with effort syndrome? Journal of the Royal Society of Medicine, 1990
Dec; 83(12): 761-764.
"Chronic fatigue syndrome (CFS), including myalgic encephalomyelitis (ME)
and postviral syndrome (PVS), is a term used today to describe a condition
of incapacity for making and sustaining effort, associated with a wide range
of symptoms. None of the reviews of CFS has provided a proper
consideration of the effort syndrome caused by chronic habitual
In 100 consecutive patients, whose CFS had been attributed to ME or PVS,
the time course of their illness and the respiratory psychophysiological
studies were characteristic of chronic habitual hyperventilation in 93...
It is suggested that the labels 'CFS', 'ME' or 'PVS' should be withheld
until chronic habitual hyperventilation - for which conventional
rehabilitation is available - has been definitively excluded."
Paulley JW, Hyperventilation, Recent Progress in Medicine 1990 Sep;
"Physicians’ and specialists’ continued failure to recognize, diagnose
and treat adequately the majority of hyperventilators is a disgrace.
Hyperventilation Syndrome (H.V.S.), incorrectly labelled myalgic
encephalomyelitis (M.E.), is the latest example of the profession’s
Behav Res Ther. 2007 Nov; 45(11): p. 2679-2690. Epub 2007 Jul 20.
Hyperventilation in patients with chronic fatigue syndrome: the role
of coping strategies.
Bogaerts K, Hubin M, Van Diest I, De Peuter S, Van Houdenhove B, Van
Wambeke P, Crombez G, Van den Bergh O.
Research Group on Health Psychology, Department of Psychology,
University of Leuven, Tiensestraat 102, 3000 Leuven, Belgium.
Hyperventilation has been suggested as a concomitant and possible
maintaining factor that may contribute to the symptom pattern of chronic
fatigue syndrome (CFS). Because patients accepting the illness and
trying to live with it seem to have a better prognosis than patients
chronically fighting it, we investigated breathing behavior during
different coping response sets towards the illness in patients with CFS
(N=30, CDC criteria). Patients imagined a relaxation script (baseline),
a script describing a coping response of hostile resistance, and a
script depicting acceptance of the illness and its (future)
consequences. During each imagery trial, end-tidal PCO2 (Handheld
Capnograph, Oridion) was measured. After each trial, patients filled out
a symptom checklist. Results showed low resting values of PetCO2
overall, while only imagery of hostile resistance triggered a decrease
and deficient recovery of PetCO2. Also, more hyperventilation
complaints and complaints of other origin were reported during hostile
resistance imagery compared with acceptance and relaxation. In
conclusion, hostile resistance seems to trigger both physiological and
symptom perception processes contributing to the clinical picture of CFS.
Medicina (Kaunas). 2008;44(12):911-21.
[Impact of a long-term complex rehabilitation on chronic fatigue and
cardiorespiratory parameters in patients with chronic heart failure]
[Article in Lithuanian]
Vasiliauskas D, Kavoliūniene A, Jasiukeviciene L, Grizas V,
Statkeviciene A, Leimoniene L, Tumyniene V, Kubilius R.
Institute of Cardiology, Kaunas University of Medicine, Sukileliu 17,
50161 Kaunas, Lithuania. firstname.lastname@example.org
The aim of the study was to evaluate the impact of a long-term
rehabilitation on chronic fatigue and cardiorespiratory parameters in
patients with chronic heart failure.
MATERIAL AND METHODS: One hundred seventy patients with class III-IV (NYHA)
chronic heart failure were examined. The study population was divided
into two groups: long-term rehabilitation group and control group. They
underwent cardiopulmonary exercise test and completed questionnaires on
chronic fatigue (MFI-20L, DUFS, and DEFS). Measurements were repeated 3
and 6 months after long-term complex rehabilitation.
RESULTS: According to the data of MFI-20L, DUFS, and DEFS
questionnaires, 170 patients (100%) with class III-IV (NYHA) chronic
heart failure complained of fatigue. Overall daily fatigue was 56.828.5
points on a 100-point scale, and after 6-month rehabilitation, this
parameter was statistically significantly reduced on all scales
(P<0.05). Physical fatigue and self-care improved in controls.
Cardiopulmonary exercise test showed that parameters of
hyperventilation, ventilatory equivalents, and pCO2 were significantly
improved in rehabilitation group after 6 months as compared to baseline
data (P<0.05), but not in the control group.
CONCLUSION: Patients with class III-IV (NYHA) chronic heart failure
experience chronic fatigue, which reduces their motivation and self-care
abilities. Long-term complex rehabilitation programs improve all
parameters of chronic fatigue, respiratory efficiency, and prognostic
indicator of chronic heart failure--ventilatory equivalent for carbon
Hypocapnia or low end-tidal CO2 in chronic fatigue syndrome
Dyn Med. 2007 Jan 30; 6: p.2.
Hypocapnia is a biological marker for orthostatic intolerance in some
patients with chronic fatigue syndrome.
Natelson BH, Intriligator R, Cherniack NS, Chandler HK, Stewart JM.
Department of Neurosciences, UMDNJ-New Jersey Medical School, Newark NJ,
CONTEXT: Patients with chronic fatigue syndrome and those with orthostatic
intolerance share many symptoms, yet questions exist as to whether CFS
patients have physiological evidence of orthostatic intolerance.
OBJECTIVE: To determine if some CFS patients have increased rates of
orthostatic hypotension, hypertension, tachycardia, or hypocapnia relative
to age-matched controls.
DESIGN: Assess blood pressure, heart rate, respiratory rate, end tidal CO2
and visual analog scales for orthostatic symptoms when supine and when
standing for 8 minutes without moving legs.
SETTING: Referral practice and research center.
PARTICIPANTS: 60 women and 15 men with CFS and 36 women and 4 men serving as
age matched controls with analyses confined to 62 patients and 35 controls
showing either normal orthostatic testing or a physiological abnormal test.
MAIN OUTCOME MEASURES: Orthostatic tachycardia; orthostatic hypotension;
orthostatic hypertension; orthostatic hypocapnia or combinations thereof.
RESULTS: CFS patients had higher rates of abnormal tests than controls (53%
vs 20%, p < .002), but rates of orthostatic tachycardia, orthostatic
hypotension, and orthostatic hypertension did not differ significantly
between patients and controls (11.3% vs 5.7%, 6.5% vs 2.9%, 19.4% vs 11.4%,
respectively). In contrast, rates of orthostatic hypocapnia were
significantly higher in CFS than in controls (20.6% vs 2.9%, p < .02). This
CFS group reported significantly more feelings of illness and shortness of
breath than either controls or CFS patients with normal physiological tests.
CONCLUSION: A substantial number of CFS patients have orthostatic
intolerance in the form of orthostatic hypocapnia. This allows
subgrouping of patients with CFS and thus reduces patient pool heterogeneity
engendered by use of a clinical case definition.
Arthritis Rheum. 2006 Oct; 54(10): p. 3351-3362.
The influence of aerobic fitness and fibromyalgia on cardiorespiratory
and perceptual responses to exercise in patients with chronic fatigue
Cook DB, Nagelkirk PR, Poluri A, Mores J, Natelson BH.
University of Wisconsin, Madison, WI 53706, USA. email@example.com
OBJECTIVE: To investigate cardiorespiratory and perceptual responses to
exercise in patients with chronic fatigue syndrome (CFS), accounting for
comorbid fibromyalgia (FM) and controlling for aerobic fitness.
METHODS: Twenty-nine patients with CFS only, 23 patients with CFS plus
FM, and 32 controls completed an incremental bicycle test to exhaustion.
Cardiorespiratory and perceptual responses were measured. Results were
determined for the entire sample and for 18 subjects from each group
matched for peak oxygen consumption.
RESULTS: In the overall sample, there were no significant differences in
cardiorespiratory parameters between the CFS only group and the
controls. However, the CFS plus FM group exhibited lower ventilation,
lower end-tidal CO2, and higher ventilatory equivalent of carbon dioxide
compared with controls, and slower increases in heart rate compared with
both patients with CFS only and controls. Peak oxygen consumption,
ventilation, and workload were lower in the CFS plus FM group. Subjects
in both the CFS only group and the CFS plus FM group rated exercise as
more effortful than did controls. Patients with CFS plus FM rated
exercise as significantly more painful than did patients with CFS only
or controls. In the subgroups matched for aerobic fitness, there were no
significant differences among the groups for any measured
cardiorespiratory response, but perceptual differences in the CFS plus
FM group remained.
CONCLUSION: With matching for aerobic fitness, cardiorespiratory
responses to exercise in patients with CFS only and CFS plus FM are not
different from those in sedentary healthy subjects. While CFS patients
with comorbid FM perceive exercise as more effortful and painful than do
controls, those with CFS alone do not. These results suggest that
aerobic fitness and a concurrent diagnosis of FM are likely explanations
for currently conflicting data and challenge ideas implicating metabolic
disease in the pathogenesis of CFS.
J Neuroimaging. 2003 Jan; 13(1): p. 57-67.
Cerebral and systemic hemodynamics changes during upright tilt in
chronic fatigue syndrome.
Razumovsky AY, DeBusk K, Calkins H, Snader S, Lucas KE, Vyas P, Hanley
DF, Rowe PC.
Departments of Anesthesiology/Critical Care Medicine, Neurology, Johns
Hopkins Medical Institutions, Baltimore, Maryland, USA. firstname.lastname@example.org
BACKGROUND AND PURPOSE: During head-up tilt (HUT), patients with chronic
fatigue syndrome (CFS) have higher rates of neurally mediated
hypotension (NMH) and postural tachycardia syndrome (POTS) than healthy
controls. The authors studied whether patients with CFS were also more
likely to have abnormal cerebral blood flow velocity (CBFV) compared
with controls in response to orthostatic stress.
METHODS: Transcranial Doppler monitoring of middle cerebral artery (MCA)
CBFV was performed during 3-stage HUT prospectively in 26 patients with
CFS and 23 healthy controls. At the same time, continuous monitoring of
arterial blood pressure (BP), heart rate (HR), end tidal CO2 (ET-CO2)
were performed. Results are reported as mean SD.
RESULTS: NMH developed in 21 patients with CFS and in 14 controls (P =
.22). POTS was present in 9 CFS patients and 7 controls (P = .76).
Supine HR was higher in CFS patients, but all other hemodynamics and
CBFV measures were similar at baseline. The median time to hypotension
did not differ, but the median time to onset of orthostatic symptoms was
shorter in those with CFS (P < .001). The CBFV did not differ between
groups in the supine posture, at 1 or 5 minutes after upright tilt, at 5
or 1 minute before the end of the test, or at termination of the test.
Mean CBFV fell at termination of tilt testing in those with CFS and
controls. ET-CO2 was lower at termination of the test in those with
CFS versus controls (P = .002).
CONCLUSIONS: The results of this study are not consistent with the
hypothesis that patients with CFS have a distinctive pattern of MCA CBFV
changes in response to orthostatic stress.
Am J Med Sci. 2006 Jun;331(6): p. 295-303.
Patterns of hypocapnia on tilt in patients with fibromyalgia, chronic
fatigue syndrome, nonspecific dizziness, and neurally mediated syncope.
Naschitz JE, Mussafia-Priselac R, Kovalev Y, Zaigraykin N, Slobodin G,
Elias N, Rosner I.
Department of Internal Medicine A, the Bnai-Zion Medical Center and
Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of
Technology, Haifa, Israel. Naschitz@tx.technion.ac.il
OBJECTIVES: To assess whether head-up tilt-induced hyperventilation is
seen more often in patients with chronic fatigue syndrome (CFS),
fibromyalgia, dizziness, or neurally mediated syncope (NMS) as compared
to healthy subjects or those with familial Mediterranean fever (FMF).
PATIENTS AND METHODS: A total of 585 patients were assessed with a
10-minute supine, 30-minute head-up tilt test combined with capnography.
Experimental groups included CFS (n = 90), non-CFS fatigue (n = 50),
fibromyalgia (n = 70), nonspecific dizziness (n = 75), and NMS (n =160);
control groups were FMF (n = 90) and healthy (n = 50). Hypocapnia,
the objective measure of hyperventilation, was diagnosed when end-tidal
pressure of CO2 (PETCO2) less than 30 mm Hg was recorded consecutively
for 10 minutes or longer. When tilting was discontinued because of
syncope, one PETCO2 measurement of 25 or less was accepted as
RESULTS: Hypocapnia was diagnosed on tilt test in 9% to 27% of patients
with fibromyalgia, CFS, dizziness, and NMS versus 0% to 2% of control
subjects. Three patterns of hypocapnia were recognized: supine
hypocapnia (n = 14), sustained hypocapnia on tilt (n = 76), and mixed
hypotensive-hypocapnic events (n = 80). Hypocapnia associated with
postural tachycardia syndrome (POTS) occurred in 8 of 41 patients.
CONCLUSIONS: Hyperventilation appears to be the major abnormal response
to postural challenge in sustained hypocapnia but possibly merely an
epiphenomenon in hypotensive-hypocapnic events. Our study does not
support an essential role for hypocapnia in NMS or in postural symptoms
associated with POTS. Because unrecognized hypocapnia is common in CFS,
fibromyalgia, and nonspecific dizziness, capnography should be a part of
the evaluation of patients with such conditions.
J Psychosom Res. 1997 Oct;43(4):371-7.
The chronic fatigue syndrome and hyperventilation.
Bazelmans E, Bleijenberg G, Vercoulen JH, van der Meer JW, Folgering H.
Department of Medical Psychology, University Hospital Nijmegen, The
Chronic fatigue syndrome (CFS) is characterized by severe fatigue,
lasting for at least 6 months, for which no somatic explanation can be
found. Because hyperventilation can produce substantial fatigue, it
seems worthwhile to investigate the relationship between it and CFS. It
might be hypothesized that hyperventilation plays a causal or
perpetuating role in CFS. CFS patients, non-CFS patients known to
experience hyperventilation, and healthy controls were compared on
complaints of fatigue and hyperventilation. CFS patients and non-CFS
patients known to experience hyperventilation offered substantial
complaints of fatigue and hyperventilation, both to a similar degree.
Physiological evidence of hyperventilation was found significantly more
often in CFS patients than in healthy controls. However, no
significant differences between CFS patients with and CFS patients
without hyperventilation were found on severity of fatigue, impairment,
number of complaints, activity level, psychopathology, and depression.
It is concluded that hyperventilation in CFS should probably be regarded
as an epiphenomenon.
Q J Med. 1994 Jan;87(1):63-7.
Hyperventilation and chronic fatigue syndrome.
Saisch SG, Deale A, Gardner WN, Wessely S.
Department of Thoracic Medicine, Kings College School of Medicine and
Dentistry, London, UK.
We studied the link between chronic fatigue syndrome (CFS) and
hyperventilation in 31 consecutive attenders at a chronic fatigue clinic
(19 females, 12 males) who fulfilled criteria for CFS based on both
Oxford and Joint CDC/NIH criteria. All experienced profound fatigue and
fatigability associated with minimal exertion, in 66% developing after
an infective episode. Alternative causes of fatigue were excluded.
Hyperventilation was studied during a 43-min protocol in which end-tidal
PCO2 (PETCO2) was measured non-invasively by capnograph or mass
spectrometer via a fine catheter taped in a nostril at rest, during and
after exercise (10-50 W) and for 10 min during recovery from voluntary
overbreathing to approximately 2.7 kPa (20 mmHg). PETCO2 < 4 kPa (30
mmHg) at rest, during or after exercise, or at 5 min after the end of
voluntary overbreathing, suggested either hyperventilation or a tendency
to hyperventilate. Most patients were able voluntarily to
overbreathe, but not all were able to exercise. Twenty-two patients
(71%) had no evidence of hyperventilation during any aspect of the test.
Only four patients had unequivocal hyperventilation, in one associated
with asthma and in three with panic. Only one patient with severe
functional disability and agoraphobia had hyperventilation with no other
obvious cause. A further five patients had borderline hyperventilation,
in which PETCO2 was < 4 kPa (30 mmHg) for no more than 2 min, when we
would have expected it to be normal. There was no association between
level of functional impairment and degree of hyperventilation. There is
only a weak association between hyperventilation and chronic fatigue
Psychosom Med. 1998 Jul-Aug; 60(4): p. 448-457.
Estranged bodies, simulated harmony, and misplaced cultures:
neurasthenia in contemporary Chinese society.
Department of Psychiatry, The Chinese University of Hong Kong, Shatin.
OBJECTIVE: To study the sociocultural transformation of neurasthenia (shenjing
shuairuo, SJSR), as both disease and illness, in Chinese society.
METHOD: This is based on a critical review of evidence drawn from the
psychiatric and anthropological literature, and the use of a single case
RESULTS: SJSR remains a ubiquitous illness in socio-politically
different Chinese societies, but the Americanization of Chinese
psychiatry has paradoxically made the "same" disease category languish
rapidly in professional practice. Although it engages bodily modes of
attention, SJSR is far from being a physical, somatoform, or chronic
CONCLUSIONS: Psychiatric disease and illness do not run a "natural"
course independent of social and historical contexts. SJSR usefully
muddles the Cartesian mind-body dichotomy and is readily compatible with
psychosocial manifestations and explanatory models. From a sociosomatic
perspective, the embodied world of SJSR may arbitrate as well as
critique the conjunctures of large-scale political, economic, and moral
transformations in Chinese communities. These macrosocial forces and
their local manifestations need to be considered in deriving a
cross-culturally valid paradigm of psychosomatic medicine.
Arthritis Res Ther. 2008;10(3):R56. Epub 2008 May 13.
Sleep structure and sleepiness in chronic fatigue syndrome with or
without coexisting fibromyalgia.
Togo F, Natelson BH, Cherniack NS, FitzGibbons J, Garcon C, Rapoport DM.
Pain and Fatigue Study Center, Department of Neurosciences, University
of Medicine and Dentistry of New Jersey-New Jersey Medical School, 30
Bergen Street, Newark, NJ 07103, USA. email@example.com
INTRODUCTION: We evaluated polysomnograms of chronic fatigue syndrome
(CFS) patients with and without fibromyalgia to determine whether
patients in either group had elevated rates of sleep-disturbed breathing
(obstructive sleep apnea or upper airway resistance syndrome) or
periodic leg movement disorder. We also determined whether feelings of
unrefreshing sleep were associated with differences in sleep
architecture from normal.
METHODS: We compared sleep structures and subjective scores on visual
analog scales for sleepiness and fatigue in CFS patients with or without
coexisting fibromyalgia (n = 12 and 14, respectively) with 26 healthy
subjects. None had current major depressive disorder, and all were
studied at the same menstrual phase.
RESULTS: CFS patients had significant differences in polysomnograpic
findings from healthy controls and felt sleepier and more fatigued than
controls after a night's sleep. CFS patients as a group had less total
sleep time, lower sleep efficiency, and less rapid eye movement sleep
than controls. A possible explanation for the unrefreshing quality of
sleep in CFS patients was revealed by stratification of patients into
those who reported more or less sleepiness after a night's sleep (a.m.
sleepier or a.m. less sleepy, respectively). Those in the sleepier group
reported that sleep did not improve their symptoms and had poorer sleep
efficiencies and shorter runs of sleep than both controls and patients
in the less sleepy group; patients in the less sleepy group reported
reduced fatigue and pain after sleep and had relatively normal sleep
structures. This difference in sleep effects was due primarily to a
decrease in the length of periods of uninterrupted sleep in the a.m.
CONCLUSION: CFS patients had significant differences in
polysomnographic findings from healthy controls and felt sleepier and
more fatigued than controls after a night's sleep. This difference
was due neither to diagnosable sleep disorders nor to coexisting
fibromyalgia but primarily to a decrease in the length of periods of
uninterrupted sleep in the patients with more sleepiness in the morning
than on the night before. This sleep disruption may explain the
overwhelming fatigue, report of unrefreshing sleep, and pain in this
subgroup of patients.
Sleep Med. 2006 Sep;7(6):513-20. Epub 2006 Aug 24.
Chronic fatigue, unrefreshing sleep and nocturnal polysomnography.
Guilleminault C, Poyares D, Rosa A, Kirisoglu C, Almeida T, Lopes MC.
Stanford University Sleep Disorders Clinic, 401 Quarry road, suite 3301,
Stanford, CA 94305, USA. firstname.lastname@example.org
BACKGROUND AND PURPOSE: To investigate the complaint of unrefreshing
sleep with study of sleep electroencephalogram (EEG) in patients with
PATIENTS AND METHODS: Fourteen successively seen patients (mean age:
41.1 9.8) who complained of chronic fatigue but denied sleepiness and
agreed to participate were compared to 14 controls (33.610.2 years) who
were monitored during sleep recorded in parallel. After performing
conventional sleep scoring we applied Fast Fourier Transformation (FFT)
for the delta 1, delta 2, theta, alpha, sigma 1, sigma 2, beta EEG
frequency bands. The presence of non-rapid eye movement (NREM) sleep
instability was studied with calculation of cyclic alternating pattern
(CAP) rate. Two-way analysis of variance (ANOVA) was performed to
analyze FFT results and Mann-Whitney U-test to compare CAP rate in both
groups of subjects.
RESULTS: Slow wave sleep (SWS) percentage and sleep efficiency were
lower, but there was a significant increase in delta 1 (slow delta)
relative power in the chronic fatigue group when compared to normals
(P<0.01). All the other frequency bands were proportionally and
significantly decreased compared to controls. CAP rate was also
significantly greater in subjects with chronic fatigue than in normals
(P=0.04). An increase in respiratory effort and nasal flow limitation
were noted with chronic fatigue.
CONCLUSIONS: The complaints of chronic fatigue and unrefreshing sleep
were associated with an abnormal CAP rate, with increase in slow delta
power spectrum, affirming the presence of an abnormal sleep progression
and NREM sleep instability. These specific patterns were related to
subtle, undiagnosed sleep-disordered breathing.
Physiother Theory Pract. 2008 Mar-Apr;24(2):83-94.
Breathing retraining in patients with chronic fatigue syndrome: a
Nijs J, Adriaens J, Schuermans D, Buyl R, Vincken W.
Department of Human Physiology, Faculty of Physical Education and
Physiotherapy, Vrije Universiteit, Brussel, Belgium. Jo.Nijs@vub.ac.be
The study aimed to 1) examine the point prevalence of asynchronous
breathing in chronic fatigue syndrome (CFS) patients; 2) examine whether
CFS patients with an asynchronous breathing pattern present with
diminished lung function in comparison with CFS patients with a
synchronous breathing pattern; and 3) examine whether one session of
breathing retraining in CFS patients with an asynchronous breathing
pattern is able to improve lung function. Twenty patients fulfilling the
diagnostic criteria for CFS were recruited for participation in a pilot
controlled clinical trial with repeated measures. Patients presenting
with an asynchronous breathing pattern were given 20-30 minutes of
breathing retraining. Patients presenting with a synchronous breathing
pattern entered the control group and received no intervention. Of the
20 enrolled patients with CFS, 15 presented with a synchronous breathing
pattern and the remaining 5 patients (25%) with an asynchronous
breathing pattern. Baseline comparison revealed no group differences in
demographic features, symptom severity, respiratory muscle strength, or
pulmonary function testing data (spirometry). In comparison to no
treatment, the session of breathing retraining resulted in an acute
(immediately postintervention) decrease in respiratory rate (p < 0.001)
and an increase in tidal volume (p < 0.001). No other respiratory
variables responded to the session of breathing retraining. In
conclusion, the present study provides preliminary evidence supportive
of an asynchronous breathing pattern in a subgroup of CFS patients, and
breathing retraining might be useful for improving tidal volume and
respiratory rate in CFS patients presenting with an asynchronous
Clin Auton Res. 1995 Jun; 5(3): p. 139-143.
Vagal tone is reduced during paced breathing in patients with the
chronic fatigue syndrome.
Sisto SA, Tapp W, Drastal S, Bergen M, DeMasi I, Cordero D, Natelson
Neurobehavioral Unit, VA Medical Center, E. Orange, NJ 07018-1095, USA.
Patients with chronic fatigue syndrome (CFS) often complain of an
inability to maintain activity levels and a variety of autonomic-like
symptoms that make everyday activity intolerable at times. The purpose
of the study was to determine if there were differences in vagal
activity at fixed breathing rates in women with CFS. Twelve women with
the diagnosis of CFS between the ages of 32 and 59 years volunteered for
the study. Healthy women, who were between the ages of 30 and 49, served
as controls. Full signal electrocardiograph and respiratory signals were
collected during a paced breathing protocol of three fixed breathing
rates (8, 12 and 18 breaths/min) performed in the sitting and standing
postures. Vagal activity was analyzed by means of heart rate spectral
analysis to determine the subject's response to specific breathing rates
and postures. Heart rate variability was used as a non-invasive method
of measuring the parasympathetic component of the autonomic nervous
system. Using this method, although there was significantly less vagal
power in the sitting versus the standing postures for both groups, the
overall vagal power was significantly lower (p < 0.034) in the CFS group
versus healthy controls. Vagal power was also significantly lower (p
< 0.01 to p < 0.05) at all breathing rates in both postures except while
standing and breathing at 18 breaths/min. Knowledge of the
differences in vagal activity for CFS patients may allow stratification
for the analysis of other research variables.
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