Sleep is not disrupted by exercise in patients with chronic fatigue syndromes

[Dolphin]

A new paper

Sleep is not disrupted by exercise in patients with chronic fatigue
syndromes

Med Sci Sports Exerc. 2010 Jan;42(1):16-22.

Togo F, Natelson BH, Cherniackdagger NS, Klapholz M, Rapoport DM, Cook DB.

1Pain & Fatigue Study Center, Department of Neurosciences, UMDNJ-New Jersey
Medical School, Newark, NJ; 2Department of Work Stress Control, Japan
National Institute of Occupational Safety and Health, Kawasaki, JAPAN;
3Department of Medicine, UMDNJ-New Jersey Medical School, Newark, NJ;
4Department of Medicine, Division of Pulmonary and Critical Care Medicine,
NYU School of Medicine, New York, NY; and 5Department of Kinesiology,
University of Wisconsin School of Education, Madison, WI.

PURPOSE:: Patients with chronic fatigue syndrome (CFS) report that exertion
produces dramatic symptom worsening. We hypothesized this might be due to
the exacerbation of an underlying sleep disorder, which we have previously
demonstrated to exist.

METHODS:: Female patients with CFS and matched healthy controls with no
evidence of major depressive disorder were studied with overnight
polysomnography on a baseline night and on a night after their performance
of a maximal exercise test.

RESULTS:: CFS patients as a group had evidence for disturbed sleep compared with controls. Although exercise improved sleep for healthy subjects, it did not do this for the group as a whole. When we stratified the sample on the basis of self-reported sleepiness after a night's sleep, the patient group with reduced morning sleepiness showed improvement in sleep structure, whereas those with increased morning sleepiness continued to show evidence for sleep disruption.

CONCLUSIONS:: Sleep is disturbed in CFS patients as a group, but exercise
does not exacerbate this sleep disturbance. Approximately half the patients
studied actually sleep better after exercise. Therefore, activity-related
symptom worsening is not caused by worsened sleep.

PMID: 20010134 [PubMed - in process]

 

[CJB]

They needed to check days 1-3 after exercise, not just the night of.

 

[Dolphin]

Authors seem to be looking for reasons to recommend exercise

Authors seem to be looking for reasons to recommend exercise

From discussion:

Data from this report and our previous report indicate
that a subset of patients with CFS have an underlying sleep
disorder characterized by sleep disruption leading to the
patients’ feeling sleepier after sleep than before it. Our
success in being able to stratify patients on the basis of selfreport
data suggests that collecting data on sleepiness before
and after a night of sleep is a useful way of stratifying
patients without the need for formal polysomnography. The
fact that patients showed no worsening in sleep architecture
after performing a maximal exercise test is useful information
for patient education. Patients are often afraid to exert
themselves because of the fear of symptom worsening after
such exertion. Although symptom exacerbation may in fact
occur, it cannot be due to further disturbances in sleep in
that at least half the patients studied here showed actual
improvement in their sleep after a rather strenuous exercise.
And importantly, the remaining patients showed no further
deterioration in their sleep patterns. Although the healthy
controls demonstrated greater improvements in sleep, CFS
patients demonstrated improvements in time spent awake
and arousals during stage 1 sleep that are similar to that
generally seen in healthy good sleepers (18). These data
strongly suggest that gentle physical conditioning, which
has been suggested as a treatment of CFS, will also not
disrupt sleep and may in fact lead to symptom improvement.
This suggestion is consistent with meta-analytic data
demonstrating that exercise does not need to be strenuous to
improve sleep. Youngstedt (18) reported similar effect sizes
on positive sleep outcomes for light, moderate, and vigorous
exercise in healthy good sleepers

Unfortunately, there is a paucity of research aimed at
determining the influence of exercise on sleep in populations
with disturbed sleep. Limited evidence suggests that
the sleep-promoting influences of exercise are more pronounced
when sleep is disrupted such as in elderly populations,
patients with depression, or patients with restless
leg syndrome (18). Further, exercise has been shown to
reduce feelings of depression and anxiety in patients with
major depressive and anxiety disorders (7) as well as in
CFS patients (1). However, these studies have relied almost
exclusively on self-report measures of sleep quality. The
present investigation extends this research by objectively
assessing sleep morphology in CFS and demonstrating
both the lack of deleterious effects of exercise in patients
with the most disturbed sleep and the benefit of sleeppromoting
effects of exercise in patients with decreased
morning sleepiness.

In conclusion, exercise improved sleep structure for
healthy volunteers as well as for CFS patients reporting
less sleepiness after a night’s sleep than before it. In contrast,
sleep structure did not change for patients reporting
more sleepiness after a night’s sleep than before it. In general,
these patients were the ones with the lowest sleep
efficiencies on baseline sleep polysomnography. The finding
that exercise did not worsen sleep leads to two conclusions:
first, that any ill effects of exercise are not due to
altered sleep; and second, that exercise does not have a
deleterious effect on sleep and in fact helps it in some CFS
patients. This latter finding should prove important in helping
patients deal with increasing their activity without
worrying about negative health consequences.

Reference:
1. Afari N, Buchwald D. Chronic fatigue syndrome: a review. Am J
Psychiatry. 2003;160(2):221–36.

Reference 1 is a review paper so I'm not sure if it mentions research that backs up the authors' claim or do Afari and Buchwald just speculate or extrapolate from fatigue samples.

I do not really know that much about human biology and exercise. But I have heard that exercise causes micro-trauma. The healthy group slept better after the exercise session but many of the CFS patients did not. Maybe it is necessary for the human body to sleep well or better after exercise for the body to heal sufficiently from the exercise. If this is the case, it may not be sufficient that the sleep for some of the CFS patients did not worsen (on most measures). It could be the case that the sleep in these CFS patients might not have been good enough to recover from the exercise and so they were left with some microtrauma in their muscles etc which might be why many patients have exercise muscle pain the day after exercise?

Unfortunately one can't send online comments to the journals and I won't be sending a letter as don't know enough to be sure.

 

[cfs since 1998]

It's really a difficult issue. I do indeed sleep better after exercise, my mental fatigue and brainfog improve, but of course there's PEM and it takes me at least 3 days to recover physically. Sometimes I can barely walk the next day. Like I've said before, it's a paradox.

 

[fresh_eyes]

"Although symptom exacerbation may in fact occur, it cannot be due to further disturbances in sleep...exercise does not have a deleterious effect on sleep and in fact helps it in some CFS patients. This latter finding should prove important in helping patients deal with increasing their activity without worrying about negative health consequences."

Huh? Even though symptom exacerbation may in fact occur, patients shouldn't worry about it because it's not caused by worse sleep? Oh, oh-kaaay then.

 

[Dolphin]

They needed to check days 1-3 after exercise, not just the night of.

Good point. In some of their previous studies the reduction in activity didn't occur the day after the exercise but later.