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Meg Mangin R.N.
Research Team
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Posted: Fri Dec 2nd, 2005 21:24 |
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I have insomnia and fatigue. What should I do?
Many persons with Th1 inflammation complain of fatigue, inability to sleep, anxiety or depression. These symptoms will resolve with MP treatment but may occasionally exacerbate to intolerable levels due to immunopathology. Recognizing them as a immunopathology is the first step. Then you can take appropriate measures to mitigate the immune system reaction. Please see:
My immune response is too strong. What should I do?
To keep these symptoms under control it is also important to be fully compliant with restrictions regarding natural light, bright lights and avoidance of ingested vitamin D. See Why does exposure to natural light increase symptoms?
"Intolerable" is a subjective assessment. This level will be different for everyone and you are the only person who can decide what is intolerable for you. If you need extra help controlling the above symptoms, the following suggestions may help.
Fatigue
Fatigue is very common in all Th1 diseases and is unrelated to sleep or rest. It will resolve with the Marshall Protocol but often takes quite awhile. In the meantime, these tips and the following might help:
-Develop your own "energy conservation" program.
-Re-define "necessary" and sort out the really important activities from those that can wait.
-Keep a journal to learn your energy patterns.
-Pace yourself through the day, saving necessary activities for the time of day you tend to have more energy.
-When you have periods of increased energy, try not to overexert yourself.
-Forgo jobs that need not be done every day, such as making beds.
-Ask your doctor about an occupational therapy evaluation to teach you energy-saving strategies.
-Keep a "Wish I Could" list near your phone. When a neighbor or friend asks what they can do to help, tell them!
Quercetin may help reduce intolerable fatigue if taken regularly. Keep in mind, that we have recently concluded that quercetin does interfere, somewhat, with the action of the antibiotics and should not be used at the beginning of the MP or routinely at any time.
Fatigue may be slow to resolve. See Greg Blaney, MD (cardiac arrhythmia, psoriasis, RLS, fatigue)
Provigil
We have serious concerns about the use of Provigil for fatigue. The October 05 issue of the Readers Digest has an article about the alarming increase in the use of Provigil by people who just want to stay awake longer. It suggests the use of Provigil may be appropriate for someone in an emergency situation such as firefighters or rescue workers. But it is being used by tired new parents, students needing to pull an 'all-nighter', truckers with deadlines and employees who want to impress the boss with their productivity. It works remarkably well to increase alertness without becoming 'wired' but it appears to be addicting (at least psychologically) and there are no long term studies regarding its safety. Side effects include depression, anxiety, hallucinations, psychosis, mania and suicidal thoughts.
According to the Food and Drug Administration, provigil should be used only in patients who have had a complete evaluation of their excessive sleepiness, and in whom a diagnosis of either narcolepsy, Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS), and/or Shift-Work Sleep Disorder (SWSD) has been made.
Members' experiences
Your fatigue sounds pretty normal to me, although I can't speak to the sarc aspect. I've been fatigued ever since starting mino. I think it's just that your body is working hard ridding itself of the bugs and the toxins they produce when they die. Your basic herx/IPR response. There just isn't much energy left over for being active! Personally, I think that is a "tolerable" level. As long as I can get through the day and do the things I absolutely have to, it's good. If I can't, then it's gone over the line and something needs to be done. You'll have to set your own levels and expectations.
Sometimes my fatigue has been a general malaise, and others it has been specific muscles or been more muscular in general. Feels like you have been lifting weights and the muscles are just wiped out. I still get that in the shoulders after more than a year on the MP. Not as bad as it was, but it's there. Sometimes it's my ribs - feels like I was picked up by a giant, given a squeeze and set back down in a slightly squashed condition. It moves around.
Pace yourself, and decide what things are "must do" and what are "nice to do" and get your herxing to a level where you can treat yourself once in a while. It will vary as you move through the doses anyway, so you'll have some good days. And some of them will be very good indeed, if my experience is any indication.
Do more sitting down when cooking. That seems to help with conserving energy. Get your minions to help (if you've got minions). As they say in the old song, "Every little bit added to what you've got, makes just a little bit more". ~Knochen
Insomnia
Restful sleep helps to cope with other symptoms. It is not necessary to get all your restful sleep at night. In fact, if you can, sleeping during the day may give you the energy you need for excursions outside after dark. If you do not have work or family obligations that require feeling rested, it is okay to tolerate a lack of restful sleep while still getting enough rest. Adequate rest is essential for physical, mental & emotional well-being.
Insomnia may have many causes. There are many non-medical ways to treat insomnia. If none of these work for you and your insomnia is intolerable, please consult your doctor. The American Insomnia Association explains the pros and cons of various medications used to treat insomnia. No sleep remedies are specifically contraindicated on the Marshall Protocol. They should be considered temporary palliative aides and used judiciously only as needed. As always, your doctor is your best guide as to what palliative medications you should use.
"I have traditionally told people to be wary of Clonazepam. All of these neuro-active drugs are to be avoided, IMO. Nobody can say precisely what their mode of action is, and they all seem to affect the immune system a little. We know the immune system profoundly affects the brain.
Those of us who do not need to force our body to be sleeping at certain times should not be taking drugs to do so. I recall that my sleep patterns varied widely as I recovered, and still do, depending on how hard I am working. Sleeping when you feel tired, as long as you wake refreshed, should be the goal. If you don't wake refreshed then close your eyes and nod off again."
..Trevor..
Trazadone
Trazadone is quite different than Valium and is treated in a much more complex way by the body. In the body many different forms of the drug are created causing the body to work at different ways to eliminate these various metabolites through a myriad of pathways. Though it does give some anti-anxiety relief something like Valium, it also has an anti-depressant effect due to its antagonistic affect on a specific receptor site. It is best if you can use non-generic Valium in small doses to lessen the side effects which can be difficult while managing immunopathology. ~VEZ, R.N.
Insomnia solution suggestions
-Melatonin is immunomodulatory. Use only a low dose if needed. Discontinue asap or if progress seems inhibited. See melatonin
-low dose Valium at bedtime
-avoid Ambien (it can cause sleep walking, sleep eating and other bizarre behaviour).
-if nighttime sleep is brief, nap in afternoon when there is a natural period of increased sleepiness.
-do relaxation techniques for 30 to 60 minutes (beneficial even if you do not sleep).
-establish a regular daily routine, arising at the same time and retiring at the same time.
-remove TV from bedroom.
-do not use nightlights and insure bedroom windows are completely light proof.
How can I control my anxiety and depression?
When and why should I use Valium?
Tools to check
Members' experiences with insomnia
-1 tylenol pm + 1mg sublingual melatonin before bedtime. I've effectively quenched my insomnia's thirst for awaken-ness with the above remedy. It works nicely. I fall asleep like a normal person and sleep well unless the cats and dogs don't jump on my face  ~tickbite
-When you feel fatigued are you able to lay down and sleep, or do you try to stay up and function? You might try laying down and just letting your body take a physical rest during that period and let the IPR run its course. That is what I find myself doing more and more. Then when I arise I'm able to accomplish more than I would have struggling through the fatigue. ~ToniD
-I suffered pretty bad insomnia for years, especially after my chronic fatigue diagnosis in 94. No drugs worked. Then I discovered some sleep tapes which have had a profound effect on healing the insomina. I started with one from the Monroe Institute called Continuous Deep Sleep which a friend made for me (and I'm not sure they sell it except as part of a larger tape series--I was later told this particular tape was one used for people who are dying to ease the transition!!). This worked so well I explored other types. Dr. Andrew Weil has one called Sound Healing, I believe (or something similar) which is pretty good, though it has talking at the beginning.
But then I found the real jewel, which is a CD by Stephen Halpern called Sleep Soundly. It is available from Amazon.com. I have played this CD as I go to sleep for several years now and it has virtually cured my insomina. Play it EVERY night and you will (hopefully) be amazed. ~Joy
-Update – 2 years on MP (27/12/07)
My sleep improved very early in the protocol. I felt that I generally got to sleep quicker and slept more deeply. My sleep is now very normal, with good quality sleep and few wake ups during the night. If I do wake up, I rarely have trouble falling straight back to sleep. Dreaming is also regular but I don’t move in my sleep. This is something I seem to have lost along the way and I wake up to turn over. ~Vicki SA
-Benicar made my insomnia much worse at first.I just toughed it out(not telling you to to do the same as everyone is different),and my sleep is absolutely fabulous now after years of insomnia b4 MP.It took me 6-8 weeks of Benicar before the worst of the insomnia was gone. ~Shamutooth
Members' experience with fatigue
-I still need to pace my activities but recover well and generally don’t have a lot of consequences to deal with after activity. I haven’t embarked on an exercise program yet but I have extended what I am prepared to try now. I have attempted things around the house that have waited for years for some attention. It is so nice to be able to do a bit of reorganisation. One day I pulled my PC, speakers, printer and router/modem to bits, reorganised all the wires and wiped it all down, including the table! In the past, just leaning over the table and trying to do things with my arms away from my body would have done me in very quickly! Another day, I not only washed the car, I vacuumed all the inside and the boot as well! When I started the MP I would go to work one day and then the next would be a recovery day with lots of resting and very limited activity. On the weekends I could only plan one social activity, otherwise, I would pay for the extra activity all week. Now I can do some activity every day and get away with it.
I am amazed at what I can do in one day now. The really amazing days tend to happen at the end of the cycle but all my days are more active now. At times in the past, I really dreaded ‘time off’ at home because I couldn’t do the things I wanted to do anyway and I didn’t magically feel better either. Now I can enjoy a break from work and get out and about and have a social time. ~Vicki SA
Suggestions about sleep medications from MP.com members
Mike's cautionary tale re Ambien
Gus Wilkinson (sarcoidosis, psoriasis, insomnia)
Last edited on Mon Feb 18th, 2008 17:07 by Meg Mangin R.N.
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