So, I finally followed up on something I read on Cort´s blog a while back. I couldn´t find the article again, but I just googled ´Trazodone microglia´ and came up with this: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4666178/
As Cort´s blog stated, it seems that Trazodone might be working for some of us not just because it is a sleep promoter and sleep sustainer, but also because of its regulatory effects on the microglia. This makes sense in my case, since how much sleep I get is a product of what food and I eat (and whether I take Trazodone). So if I eat stuff that I can´t digest well I wake up earlier. This has become utterly predictable to me now, so much so that I really have no one to blame but myself and my own greed for a bad night´s sleep.
This is how I believe it works (this is not my model, rather I have pieced it together from several articles covering different aspects of it): if I eat stuff that I can´t digest well this leads to inflammation in my gut, and this inflammation causes an increase in gut permeability; this increases the translocation of bacterial products into my bloodstream and eventually across the blood brain barrier, which leads to disruption of the HPA and therefore disrupted sleep. So the Trazodone and sticking to my diet work in two different, complimentary ways: the diet by decreasing translocation of bacterial products, and the Trazodone by stopping these products from activating the microglia (notice that its antinflammatory effects in the study above were on astrocytes stimulated by LPS).
I used to think Trazodone helped my sleep because of its effects on serotonin (this seemed to fit with the reports of low levels of serotonin in some ME patients, but apart from in the first few months of my illness I have not noticed the amount of sunlight I get having an effect on my sleep, which is what I would expect if the improvements in sleep were serotonin-based since serotonin levels positively correlate with exposure to sunlight. I would have thought that if this was the mechanism, moving from the UK to Spain should have a beneficial effect on my sleep, but this has not noticeably been the case.
Of course, ME is most likely a heterogenous disorder, and just because it helped me doesn´t mean it will help you, but if you have gut AND sleep problems I think Trazodone is definitely worth trying. I think most people WILL have tried it already, but I wonder if they took it at a high enough dose - I found that 75mg was not enough to ensure a good night´s sleep, so I now take 150mg, although I might try going down to 100mg as I have lost quite a lot of weight since then (it´s hard to stay fat when you can´t eat any junk food). Lastly, I would suggest that if you try taking Trazodone again, pay attention to what you eat and how that affects your sleep, as both Trazodone and sticking to the FODMAP diet are necessary for me to get a good night´s sleep.
As Cort´s blog stated, it seems that Trazodone might be working for some of us not just because it is a sleep promoter and sleep sustainer, but also because of its regulatory effects on the microglia. This makes sense in my case, since how much sleep I get is a product of what food and I eat (and whether I take Trazodone). So if I eat stuff that I can´t digest well I wake up earlier. This has become utterly predictable to me now, so much so that I really have no one to blame but myself and my own greed for a bad night´s sleep.
This is how I believe it works (this is not my model, rather I have pieced it together from several articles covering different aspects of it): if I eat stuff that I can´t digest well this leads to inflammation in my gut, and this inflammation causes an increase in gut permeability; this increases the translocation of bacterial products into my bloodstream and eventually across the blood brain barrier, which leads to disruption of the HPA and therefore disrupted sleep. So the Trazodone and sticking to my diet work in two different, complimentary ways: the diet by decreasing translocation of bacterial products, and the Trazodone by stopping these products from activating the microglia (notice that its antinflammatory effects in the study above were on astrocytes stimulated by LPS).
I used to think Trazodone helped my sleep because of its effects on serotonin (this seemed to fit with the reports of low levels of serotonin in some ME patients, but apart from in the first few months of my illness I have not noticed the amount of sunlight I get having an effect on my sleep, which is what I would expect if the improvements in sleep were serotonin-based since serotonin levels positively correlate with exposure to sunlight. I would have thought that if this was the mechanism, moving from the UK to Spain should have a beneficial effect on my sleep, but this has not noticeably been the case.
Of course, ME is most likely a heterogenous disorder, and just because it helped me doesn´t mean it will help you, but if you have gut AND sleep problems I think Trazodone is definitely worth trying. I think most people WILL have tried it already, but I wonder if they took it at a high enough dose - I found that 75mg was not enough to ensure a good night´s sleep, so I now take 150mg, although I might try going down to 100mg as I have lost quite a lot of weight since then (it´s hard to stay fat when you can´t eat any junk food). Lastly, I would suggest that if you try taking Trazodone again, pay attention to what you eat and how that affects your sleep, as both Trazodone and sticking to the FODMAP diet are necessary for me to get a good night´s sleep.
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