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Is Poor Sleep Pummeling the Immune System in ME/CFS and Fibromyalgia? A Vicious Circle Examined

August 29, 2017

Most people with chronic fatigues syndrome (ME/CFS) and fibromyalgia (FM) know the consequences of poor sleep – the fatigue and pain, the difficulty concentrating, the irritability and more. Sleep is when our body rejuvenates itself; no sleep – no rejuvenation. Given how important sleep is to our health, it’s no surprise that poor sleep is the first symptom many ME/CFS and FM doctors focus on in.

insomnia fibromyalgia

Poor sleep is often the first symptoms ME/CFS/FM practitioners focus on

The effects of poor sleep go beyond just feeling bad, though. It turns out that poor sleep can have significant effects on our immune system – effects, interestingly, which are similar to what’s been found in the immune systems of people with ME/CFS and FM. There’s no evidence yet that ME/CFS and FM are sleep disorders – that the problems ME/CFS and FM patients face are caused by poor sleep – but depriving the body of sleep can cause one immunologically, at least, look like someone with these diseases.

Why Sleep Is Important for Health: A Psychoneuroimmunology Perspective
Michael R. Irwin. Annu Rev Psychol . 2015 January 3; 66: 143–172. doi:10.1146/annurev-psych-010213-115205.

Irwin begins his review on sleep and immunology by noting the “explosion” in our understanding of the role sleep plays in health over the past decade. First, Irwin demolishes the idea that sleep studies are effective in diagnosing insomnia or sleep disturbances other than sleep apnea. Far more effective than a one or two-night sleep study is a home based sleep actigraph “study” which estimates sleep patterns and circadian rhythms over time and is coupled with a sleep diary.

In fact, Irwin points out that the diagnosis of insomnia in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is based solely on patient reports of difficulties going to sleep, maintaining sleep, having non-restorative sleep (common in ME/CFS) and problems with daytime functioning (fatigue, falling asleep, need to nap). (Problems with daytime functioning are actually required for an insomnia diagnosis).

Several effective sleep questionnaires exist including the Insomnia Severity Index, which assesses sleep quality, fatigue, psychological symptoms, and quality of life and the Pittsburgh Sleep Quality Index, a 19-item self-report questionnaire that evaluates seven clinically derived domains of sleep difficulties (i.e., quality, latency, duration, habitual efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction).

Assess Your Sleep Quality

The Immune System and Sleep

The immune system is vast and incredibly complex and has it’s own extensive set of regulatory factors, but it itself is regulated by two other systems, the HPA axis and the sympathetic nervous system. Both are involved in the stress response and both are effected in ME/CFS and FM. One – the HPA axis – is blunted in ME/CFS while the other – the sympathetic nervous system – is over-activated.

Poor sleep, it turns out activates both system. The HPA axis is generally thought to be blunted not activated in the morning in ME/CFS patients but the sympathetic nervous system (SNS), on the other hand, is whirring away at night (when it should be relaxing) in both FM and ME/CFS. (Having our “fight or flight” system acting up at night is probably not the best recipe for sleep.) ‘

sleep HRV

One study likened sleeping in fibromaylgia to a stress test (!)

Sympathetic nervous system activation, in fact, was the only factor in one Australian study which explained the poor sleep in ME/CFS. The authors of a recent FM/autonomic nervous system study went so far as to suggest that going to sleep with FM was equivalent to undergoing a stress test (!). Heart rates, muscle sympathetic nervous activation, and other evidence of an activated sympathetic nervous system response made sleep anything but restful for FM patients. In fact, the authors proposed sleep problems could be a heart of fibromyalgia.

Many questions have involved the roles pathogens play in ME/CFS and FM. That’s intriguing given the almost universally poor sleep found in the disorders and role recent studies indicate that sleep plays priming the immune systems pump to fight off invaders. During sleep pathogen fighting immune cells move to the lymph nodes where they search for evidence of pathogens. If pathogens are present those immune cells mount a furious (and metabolically expensive) immune response.

Metabolism is a big issue in ME/CFS right now but guess what? Poor sleep also appears to interfere with producing the metabolic reserves our immune cells need to fight off infections.

We often think of inflammation in negative terms but the pro-inflammatory cytokines our immune cells produce are necessary to fight off invaders. Reductions of a key pro-inflammatory cytokine called IL-6 during poor sleep hampers our immune system’s ability to destroy pathogens.

Getting your circadian rhythms (sleep and wake times) out of whack isn’t doing you any good either. Having insomnia or altered sleep patterns (very late bedtimes) appears to cause deficits in two hormones (growth hormone (GH) and prolactin) produced during early sleep which enhance T-cell activity and promote pathogen defense. That suggests that anyone with an altered circadian rhythm (i.e. late bedtimes) might want to do their best to get to bed earlier.

While pro-inflammatory cytokine production at night primes the immune system to fight off pathogens, the day time is a different story. Chronic sleep deprivation is associated increased daytime levels of several immune and endothelial factors ((IL-6, TNF) and endothelial markers (E-selectin, sICAM-1) that are associated with chronic inflammation.

One study found IL-6 levels actually became flipped in sleep deprived people; they were low at night (thereby hampering their pathogen fighting ability) and high during the day (adding to inflammation).

pathogens sleep

Pathogens love it when you get a night of poor sleep

The situation may be even worse if a sleep deprived person is fighting off an infection.  One study found skyrocketing levels of damaging pro-inflammatory cytokines when sleep deprived people were given a toxin (LPS) associated with infections. Those damaging cytokines did not show up in healthy people. That suggested that besides the infection they probably weren’t doing too well at fighting off, sleep-deprived people now had inflammation to deal with.

As it often happens, women seem to have gotten the short end of the stick with immune issues and it’s no different with sleep. Women appear to be more susceptible than men to inflammation that occurs as the result of poor sleep; it’s women, not men, who show elevations of pro-inflammatory cytokines the day after getting less than eight hours of sleep. (Men show elevations of pro-inflammatory cytokines after getting less than six hours of sleep).

Many people with ME/CFS/FM get too little sleep but sleeping more than normal, it turns out, is not such a great idea either. People sleeping much longer than normal tend to show the same kinds of elevations of pro-inflammatory cytokines as do people who get too little sleep.

The C-reactive Protein Sleep, ME/CFS and Fibromyalgia Connection

CRP is associated with a variety of inflammatory states resulting from infection, cancer and stress. Increased levels of the inflammatory marker, C-reactive protein (CRP), are increasingly being associated with sleep disturbance.

The CRP – sleep connection is intriguing given Jarred Younger’s preliminary finding of increased C-reactive protein (CRP) levels in a subset of ME/CFS patients, and a recent finding in increased CRP in FM.

See Early Results Suggest Two Radically Different Immune Subsets Present in Chronic Fatigue Syndrome (ME/CFS)

Those findings might not be so surprising. Ten days or so of partial sleep deprivation in healthy controls caused “robust” increases in CRP levels. In fact, the CRP-poor sleep connection is so robust that simply scoring above five on the Pittsburg Sleep Quality Index (PSQI >5) strongly suggests that your CRP levels are elevated. A huge nurses study (n=10,908) found that non-restorative sleep – probably the most common sleep issue in ME/CFS/FM – was associated with increased CRP levels even in these healthy individuals.

The early or innate immune response has long been thought to play a special role in ME/CFS. This immune response involving NK cells, neutrophils, macrophages, dendritic cells and others constitutes the immune system’s first defense against pathogens. Immune cells involved in the early immune response called monocytes/macrophages also play a key role in producing chronic inflammation.

NK cell activity hits a low during sleep but then begins to rise. That the rise is blunted in people with poor sleep probably comes as no surprise to NK cell challenged ME/CFS patients.

ME/CFS isn’t the only disease associated with NK cell problems; depression is as well and having poor sleep increases your risk of being depressed twofold. Plus, for reasons that are not understood, poor sleep appears to trigger stress and depression initiated reductions in NK cell activity; i.e. if you’re having poor sleep and are under considerable stress or are depressed – it’s likely that your NK cells are punking out when it’s time to defend the body from invaders.

We know that having a chronic illness increases ones chances of becoming depressed markedly, but so does poor sleep. In fact, Irwin reports that having insomnia for over a year increases your risk of becoming depressed 14-fold. That finding is leading some of the more progressive psychologists to focus on preventing or ameliorating sleep problems.

Sleep disturbance also induces a shift toward a type-2 immune response often seen in ME/CFS and in allergic and autoimmune diseases. Just one poor night’s sleep the night before a person is given a vaccine is enough markedly reduce the effectiveness of that vaccine. A study showing just how frighteningly malleable the immune system can be to stressors such as poor sleep found that a 50% reduction in the effectiveness of an influenza vaccine persisted over a year. Even after three doses of the vaccine and a booster shot were given adults getting fewer than six hours of sleep a night still received less protection from a hepatitis B vaccination than normal.

The common cold, of course, is no joke to some people with chronic fatigue syndrome (ME/CFS) and FM when it lingers and lingers. Studies suggest that poor and fragmented sleep – which is, of course, common in ME/CFS/FM – significantly increases one’s susceptibility to the common cold. If you’re catching a lot of colds or if they linger and linger, poor sleep could be one reason why.

What To Do?

OK – so poor sleep places a big hurt on our immune system’s effectiveness. What to do about it?  No studies, unfortunately, have examined the effect of sleep drugs on immune factors so we’re not going to go there.

stress reduction ME/CFS fibromyalgia

A little stress reduction could play dividends…

Several studies have, however, assessed the efficacy of stress reduction therapies. Dr. Irwin notes reports that practices such as cognitive behavioral therapy, Tai Chia and yoga which tamp down sympathetic nervous system hyper-arousal can help improve immune functioning. Tai chi has even been found to improve vaccine effectiveness and reduce inflammation.

Other studies point to the ability of mindfulness based meditations and/or yoga to reduce the cytokine levels and pro-inflammatory gene expression caused by poor sleep.  One remarkable study showed a 50% reduction in CRP levels in insomnia patients after a year of cognitive behavioral therapy.

Poor sleep, then, doesn’t just make you feel tired and irritable; it takes a pretty good whack at your immune system, as well.  Getting better sleep through better sleep hygiene, supplements (melatonin), calming botanicals (valerian root, L-theanine, passifloraMelissa, Scutellaria, etc.), stress reduction techniques (meditation, mindfulness, meditation), and sleep medications might just give your immune system a boost.

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31 Comments

  • gg

    August 30, 2017 at 1:45 am - Reply

    I sleep with a cPAP machine for at least 8 hour a night, usually 10, up to 12! I dream now since being on Remeron (2009) wake up feeling better, not great, but better! My immune system is still out of whack!

  • Rebecca

    August 30, 2017 at 2:57 am - Reply

    I m reading this at 3 am…

    • Cort Johnson

      August 30, 2017 at 11:03 pm - Reply

      :)….

  • LondonPots

    August 30, 2017 at 8:22 am - Reply

    I wish yoga, meditation etc would smooth me down: sadly, I get more irritated by the end than I am at the start. The more I try to relax, the more my system ramps up. This was actually the first objective sign I had of a problem, when my bio-feedback gadget started going consistently in the wrong direction…

  • Glenna

    August 30, 2017 at 10:37 am - Reply

    Interesting the sleep connection and FMS. I have been on a CPAP machine for just about 120 days now. I feel so much better. I was diagnosed with FMS in 1994. Towards the end, I was sleeping 20 out of 24 hours a day. Now I get 8 hours sleep and most days I do not need a nap. I walked for 2 hours the other day. The next day my knees were a little sore when I first got up but it seems to have repaired itself because I walked again for an hour yesterday. I feel great this morning. I have energy now.

    • Cort Johnson

      August 30, 2017 at 11:06 pm - Reply

      More people need to do sleep studies, that’s for sure. Everybody might want to check out the story below:

      https://www.healthrising.org/blog/2013/07/31/when-its-not-all-me-cfs-fm-how-a-sleep-study-turned-one-chronic-fatigue-syndrome-patients-life-around/

      I did a sleep study and don’t have much sleep apnea but for those who do a CPAP machine can be really helpful. Thanks for passing that on 🙂

    • gg

      August 31, 2017 at 1:25 am - Reply

      How much energy? Enough to hold a job down? Do you think you are “cured” now?

      I only napped when I was working (Over 3 years ago), would actually take a nap in my car before going in to get groceries or when I got home. These days only nap when I have been pushing myself hard for over 1 day. I can push “hard” for a day, but I get to sleep lots now, at least 8 hours and up to 12 some times.

  • Denise

    August 30, 2017 at 1:10 pm - Reply

    Great article! As a fibromyalgia warrior, I know my sleep – or lack thereof – contributes immensely as to how I feel. Half of the night I feel like I’m in a very light sleep. so light it’s almost as if I haven’t fallen asleep yet! I can lie there for hours, literally, and am surprised by the amount of time that has passed if I open my eyes and look at the clock .I think I’ve been lying there for only 15 minutes and it’s actually been two hours. Bizarre! But then again, so is this illness.

    • Cort Johnson

      August 31, 2017 at 7:07 pm - Reply

      Have you tried a sleep study? FitBit’s, I think, can also help monitor your sleep; tell you how much you tossed and turned and how much you actually slept.

      Poor sleep, by the way, has been well-documented to increase pain sensitivity (!)

      • Chris Pfeiffer

        September 10, 2017 at 1:10 pm - Reply

        Hi,

        The Fitbit type devices don’t work well. There was a product called Zeo which you wore on your head and would measure your different stages of sleep. I experimented with it and tested it on other people. I found that I was only getting 15-30 minutes of deep sleep (stage 4 healing sleep) while the other healthy people mainly my age and older were getting between 2-3 hours of deep sleep. On those few nights where I would sleep what I considered well for me and got 30+ minutes of deep sleep, I would be able to manage a day much better, Teitelbaum recommends using a variety of supplements to make sure you get 8 hours of sleep and to use as much medication as necessary to sleep for 8 months.. I think based on years of sleep issues, sleep is still the cornerstone of healing. Sadly, the Zeo company went out of business, it was nice to have a qualitative measure of sleep. In the meantime, I struggle with having to take bigger drug cocktails to have effective sleep as I don’t want to take the drugs. I have tried tons of combinations of natural sleep aids and not found them effective for me, The most harrowing thing is when I take these cocktails and then still don’t sleep for 48 hours at which point I become willing to take more and then I sleep. On a normal day, I say I function like someone with the flu who has not slept for 24 hours,so not sleeping for 48 or more hours, I border on psychotic. My current sleep medications are .5 mg Klonopin, 100mg Trazodone, 25 mg Nortriptylene and 200 mg phostidylserine. I found sleep studies to be useless unless you have sleep apnea and sleep doctors not willing to describe medication just good sleep hygiene which helps. Find a good psychophamacologist.

  • Pam

    August 31, 2017 at 8:17 am - Reply

    Good article with plenty to think about. It is now 1:09 am. Exhausted by 7 this evening and actually went to bed. Awakened at mid-night, in pain, emotional and disgusted with myself. It is not that I am not tired (always!), just can’t get back to sleep. Excessive heat and poor air quality due to several fires close by add to challenge of getting comfortable. Tomorrow is another day and thank goodness I am retired….AND yes I will take a nap tomorrow. Thanks for letting me vent.

    • Cort Johnson

      August 31, 2017 at 7:05 pm - Reply

      Of course. I am finding high THC cannabis to be a wonderful relaxant and sleep inducer for me.

  • suzanne

    August 31, 2017 at 1:26 pm - Reply

    My daughter has ME and my husband (her father) has heart disease and severe sleep apnea. A genetic link, I’m sure.

  • Jiki

    September 1, 2017 at 3:35 am - Reply

    Even though I was improving from ME/CFS, my sleep patterns worsened to the point where I was going out of my mind. I started taking Zolpidem 5 mg (Ambien) a year ago. No hangover at the 5 mg level. Circadium rhythm is still screwed up and I am quite groggy in the afternoon, 2-4. (I start really perking up about 11 p.m.) Bottom line is that I feel the best I have in 10 years and may take the Zolpidem forever! Also started taking Hyperzine A about that time too, which I credit with kicking the malaise and lack of motivation. 200 mcg every three or four days. Ashwagandha for anxiety and I am doing pretty darn good these days, except for fibromyalgia symptoms. Luckily I have the energy to keep moving which helps with periodic pain.

    • Cort Johnson

      September 3, 2017 at 10:08 pm - Reply

      Glad to hear it Jiki!….These drugs don’t help everyone but when they do they can be a godsend. Thanks for passing what helped along. Congrats on the hyperzine A and Ashwagandha. Ashwagandha is on my list 🙂

      • Chris Pfeiffer

        September 10, 2017 at 1:14 pm - Reply

        If you have a genetic study and know your COMT status, that can help you decide what can be helpful. Ashwaganda is a good adaptogen, but Phostidylserine helps to blunt excess cortisol and can be more effective.

  • Dawn

    September 1, 2017 at 5:06 am - Reply

    I’m still waiting for researchers to study the phenomenon of some people, such as my self, who need slow release STIMULANTS in order to obtain stages 3 and 4 sleep…I wonder how many PWMEs are being harmed by physicians who prescribe sedatives when what they actually need is a stimulant.

    • Cort Johnson

      September 3, 2017 at 10:07 pm - Reply

      Yes, yes….So interesting Dawn how stimulants can actually CALM some people down. I get it completely.

    • Greg

      September 4, 2017 at 12:05 am - Reply

      That’s quite interesting to know. Can you list what works for you, please?

      • dejurgen

        September 8, 2017 at 12:53 pm - Reply

        I have mildly positive effects from drinking weak coffee at night:
        15 grams of coffee in 1 liter of water. Every time I wake up I’ll drink some. I have to go to the bathroom once more because of it but fall asleep soon enough. Having the same amount of coffee but less water causes mild dehydration causing mild side effects. I don’t sleep more due to it, but better.

  • dejurgen

    September 1, 2017 at 1:09 pm - Reply

    I have reduced sleep quality during all my life. That is: restless sleep, taking a lot of time to fall asleep, waking up many many times a night, moving around and turning a lot during sleep, often vivid dreams and nightmares, increased anxiety…

    It didn’t got better when I got ME/FM. At mornings I was more tired then going to sleep. It took me all morning to get back to having a tiny bit of energy. My chest felt like ran over by a car. When I was still better I had a sleep test that was borderline OK/not OK. The main problem the test revealed was waking up way too much.

    I of coarse did try things to improve my sleep. The only thing that worked was sleep meds. I slept better and that was nice. But I still was as much a wreck in the morning as ever. So I quit using them as I did not wanted addiction and side effects. Trying sleep hygiene, calming myself down, taking calming supplements all didn’t work. Sometimes they did nothing at all, sometimes they made me even more hyper and restless.

    Many other patients report no improvement in health when they finally managed to improve their sleep. Some however do. Last winter I had a strong fall back in health after a flue vaccination. I did know the risk but infection rate this year was really bad. Unfortunately I had a very hard time to recover from this setback. All progress I made during an entire year seemed lost with no way out. All the little tricks and things I learned the last year did not suffice to pull me out of this swamp. I nearly gave up hope on improving again. Out of desperation I became creative.

    The past two years I made many odd observations. They often indicated the exact opposite of what logic, common sense and science learned. Most of the little things that helped me improve should by the book have made me worse. Then I saw a broadcast on dinosaurs made by Sir David Attenborough. He said that a major challenge for such huge animals was blood flow. Not pushing blood to the high head but rather letting blood return to the hart. They needed extremely strong and tense skin to push the blood back against gravity to the hart. He compared it to people sitting on a long distance flight. Not being able to move a lot for a long time, blood flow stalled and caused thrombosis in many passengers.

    Then I wondered: if otherwise healthy people can have big clots of blood in their veins causing stroke by merely not moving their legs a lot for hours a piece, what would happen to me? Having likely low blood volume (I have orthostatic intolerance) is a major challenge on its own. At night, I’ll tried and layed still for about 10 hours a piece. At night, my body temperature dropped close to or below hypothermia. I have tight muscles constricting blood vessels. I likely have increased inflammation making blood thicker… …if let on its own would that all combine to devastating low blood flow at night??? With many hours of not so mild hypoxia? With combined low blood flow and hypoxia disabling immune system and inflammation at night? Followed in the morning by very damaging re-perfusion damage going hand in hand with strong inflammation and a strong immune response to clean up those pathogens that multiplied in this environment? Does cleaning up the nightly produced toxins go hand in hand with morning lack of energy and morning sickness?

    It somehow made sense. Shivering increases blood flow. Night sweats (I lost this ability after a failed hormone therapy) increases blood flow. Anxiety, nightmares and associated high adrenaline levels redirect blood flow to the most critical organs (brain, hart, liver). It also increases breathing. That does not only increase oxygen levels in the blood but reduces CO2 levels (potentially acting to redirect blood to the organs working most) and does indirectly increase diaphragm movement helping pooled blood to flow back to the hart increasing blood supply. Moving a lot around in bed made my leg muscles help pump blood and reduce pooling. Each time I woke up I automatically turned around activating this blood pump. Having nightmares caused some fight-or-flight movements to be reflected as small and fast muscle movements during my sleep again activating this pump. Having nightmares and vivid dreams caused my brains to work harder increasing blood flow to the brains much like shivering does to the legs. Having restless legs (or better having feet shaking at speeds I can’t do at will) once again causes blood to flow again. Having my hart go “4-tact” during late night seemed to indicate severe blood flow problems. Breathing like a horse while still lacking air seemed to indicate severe problems getting oxygen to the tissues.

    I started !slowly and carefully! to not resist getting awake, move around, resist anxiety… Later on I started to !slowly and carefully! help my body restore blood flow and breathing. After 3 months I broke my sleep into around !10! pieces interrupted by a half hour of gently supporting blood flow and breathing according to the needs. By all logic, reason and science breaking my sleep in so many small pieces and being active between them should have made me a complete wreck even compared to my “usual” sick ME/FM person in the morning. But I was not. I had for the first time since long somewhat restorative sleep. It took me 2 to 3 hours less to get somewhat up and running in the morning. I was sharper at the morning and during the rest of the day. I also started professional breathing therapy by that time.

    Another three months later color started to reappear in my hands. It had been over a decade ago. Infection rates at night remarkably decreased. I have far less acne and cold sores. I had a lot less anxiety and nightmares. They still occured but far less. My hart was beating far more relaxed and steady on average. I slept pieces of 1 to 2 hours deeper and without waking up. I used to wake up every 5 to 15 minutes before. Sometimes I even fel asleep on bed in the cold doing my routine.

    This summer I could stand heat exceptionally well and could breath easier than in a long time. So far improvement is ongoing. I decided to not go into detail as it is still like walking in a minefield: one wrong step proves very costly from time to time. SO THIS IS NOT ADVICE! It still is a highly hazardous path!

    My aim writing this is to stir up debate: what do we do with observations “that can’t be”? Do we ignore them for not being called mental? Or could they outline the bigger picture and reveal logic where there did not to appear to be any? What are symptoms? Undesirables things to suppress? Or directions pointing to deeper lying problems? I am still searching myself. I’ll keep posting on how things evolve.

    Kind regards,
    dejurgen

    • Cort Johnson

      September 3, 2017 at 10:10 pm - Reply

      Amazing story DeJurgen! Thanks for passing that on. I think we need to look at everything we can with fresh eyes. These are, after all, very different diseases – they don’t seem to fit well with other diseases. I think we should do a blog – just to stimulate some thought 🙂

      • dejurgen

        September 11, 2017 at 9:48 am - Reply

        After your writeup of the OMF symposium I took another look at SIRS. This grabbed my attention at https://en.wikipedia.org/wiki/Systemic_inflammatory_response_syndrome:

        for SIRS: “An increased rate of breathing may be related to the increased metabolic stress due to infection and inflammation, but may also be an ominous sign of inadequate perfusion resulting in the onset of anaerobic cellular metabolism.”

        So for SIRS an increased rate of breathing is related to physiological dysfunctions rather then being fearful/anxious/a nut case for ME/FM. Also (need to further verify if wikipedia is correct here) a symptom is directly acting as a signpost to potential underlying dysfunctions. Maybe it’s about time this concept is being adopted in ME/FM too?

        When I read “but may also be an ominous sign of inadequate perfusion resulting in the onset of anaerobic cellular metabolism” I see potential to test if improved breathing can improve perfusion and therefore reduce anaerobic cellular metabolism. Anaerobic cellular metabolism sure is no stranger to ME and likely to FM too. Such test could be done cheaply by means of relatively low tech research. As improved breathing is at least for me far more difficult then it seemed, such tests could help indicate what breathing styles are more appropriate under what conditions. It wouldn’t provide a cure if successful but I’d gladly settle with a noticeable improvement in health.

        As for your question: maybe your wright; things could be kick started. See mail.

        Dejurgen

        • Cort Johnson

          September 12, 2017 at 8:31 pm - Reply

          Improving breathing is a heck of a lot more difficult for me than I think for most people. Something is going on.

          I was also taken with Dr. Systrom’s observation that just about everyone with ME/CFS hyperventilates when exercising. Something is definitely going on with the breaking.

  • Adele

    September 3, 2017 at 12:41 am - Reply

    Sugar, My Drug of Choice, will be available soon. A section on how I got better after 2 years of being in bed with chronic fatigue. #1 Eat a few tablespoons of BLACK BEANS, wait a half hour to digest, sleep will come! Black beans help balance the blood sugar! Not enough blood sugar, you toss and turn trying to sleep. Sugar causes an imbalance of insulin, causing blood sugar to drop. SUGAR SHAM, a non profit, soon to come.

    • Cort Johnson

      September 3, 2017 at 10:04 pm - Reply

      Thanks Chris!

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