Dr. Martina Melzer, published: 13.02.2022


Why sleep is so important

Our sleep is divided into different stages, sometimes we sleep more lightly, sometimes really deeply, sometimes our eyes move (REM sleep), sometimes not (non-REM sleep). Approximately every 90 minutes we go through all stages once. After that, we wake up briefly, whether we notice it or not. Deep sleep seems to be particularly important for our recovery and probably takes place in the first four to five hours of sleep. After that, we start to toss and turn more.

During sleep, some of our body systems switch to the pause button to regenerate. But not all of them. Some are highly active, for example the brain. Digestion also runs at full speed, the liver detoxifies, hormones are formed, cells renew themselves, and the immune system fights pathogens.


12 hours of sleep but still exhausted?

People with chronic fatigue know this: They sleep 12 hours, get up and feel like dead. Zero recovery, as if they had partied until 4 a.m. or taken sleeping pills with alcohol (very dangerous!). At 10 o'clock they could already lie down again, at noon and in the afternoon anyway, at 8 o'clock they crawl back into bed. That's the bad thing about fatigue: sleep doesn't recover you.

Studies suggest that inflammation in the brain may play a role in this, and sleep phases may also be disturbed. For some people, too much of our body's stress hormone, cortisol, is mistakenly produced in the evening and at night. In contrast, in the morning, when it is supposed to wake us up, there is too little cortisol. A slower breakdown of the sleep hormone melatonin can also make you sleepy in the morning. In part, our internal clock goes haywire, and dysregulation of the autonomic nervous system also messes with our sleep.

Then there's the glymphatic system. Our entire body is permeated by the lymphatic system. It is part of the immune system, transports nutrients, brings tissue fluid to the bloodstream, and rids the organism of toxins. The brain also has such a system - the glymphatic system. Our brain, the nerve cells and the immune cells in the brain, the glia, consume a lot of energy. This also produces a lot of toxins and cellular waste that must be disposed of. This is done by the glymphatic system, among others. If its function is impaired, for example due to sleep disorders, you can feel as if you have Alzheimer's in the morning.


Possible reasons for bad nights

There are numerous reasons why people with the symptom fatigue or the disease ME/CFS have poor sleep (and not only them). Some examples:

  • Pain
  • Restless legs
  • Hypoglycemia
  • Nightmares
  • Sweating or freezing
  • Worry and anxiety
  • Digestive problems
  • Noise
  • Room temperature
  • Brightness in the bedroom
  • Blue light in the evening
  • Wrong mattress and pillows
  • Caffeine
  • Exciting movies and news
  • Various diseases

The list could go on and on. So you have to become a detective yourself and find out the causes that disturb your sleep. Then you can eliminate the biggest troublemakers step by step and by trial and error. Since illnesses can also be behind sleep problems, you should definitely talk to a doctor about it. For example, nocturnal breathing pauses (sleep apnea) are dangerous and should be treated. A depression or anxiety disorder also usually requires long-term psychotherapy. And hyperthyroidism or hypothyroidism can be better controlled with medication, among other things.


How to improve your sleep

Just as there are an almost infinite number of causes for bad nights, there are also an almost infinite number of possible solutions. Again, become a detective and find out what works for you. It is extremely important for people with fatigue to find more restful sleep!

Some examples that can positively influence sleep:

  • Caffeine: Either completely eliminate anything with caffeine in it, or significantly limit it (especially starting in the afternoon) and watch the potential effects for a few weeks. Caffeine, a stimulant, is not only found in coffee, but also in black and green tea and cocoa.
  • Day-night rhythm: When you get up, allow yourself some daylight as early as possible or use a daylight lamp. This signals to your organism: hey, it's daytime, time to adjust the body systems. Also during the day you should always get some sunlight. In the evening, on the other hand, it makes sense to avoid bright light with a high blue content. So dim lamps or light candles, activate the blue filter on screens, and it's best to avoid "screen work" altogether. The bedroom should be as dark as possible. If necessary, sleeping glasses can also help. This way, the body notices: Ah, it's getting dark, time to get ready for bed.
  • Rest: To get the body into rest and sleep mode, you have to stimulate the calming part of the nervous system, the parasympathetic nervous system. Therefore, scary movies, news, arguments, sports are counterproductive. More helpful is a relaxing book, calm music, mild heat applications, a nice conversation.
  • Digestion: A huge topic! I write more about the gut under the "gut" strategy. Related to sleep, for example, it's important not to eat too late and too much in the evening. Try what works best for you. Consider if a salad or other raw food is not a problem, or your digestive tract works after it - possibly all night. Are carbs good for you at dinner, or do you go to bed with a "noodle belly"?
  • Worry and anxiety: big issue too! Our thoughts often prevent us from falling asleep, make us wake up at night and then not find our way back to sleep. Again, everyone has to find their own best strategies. Whether that's meditating, a breathing exercise, journaling, EFT tapping, or whatever. From my point of view, in any case, it is important not to stress yourself out with the sleep problems! It will only make things worse.

There is also typical advice on sleep hygiene:
https://www.sleepfoundation.org/wp-content/uploads/2021/02/210525-SF-Sleep-Wake-Checklist.pdf (English)


PS: Of course, I research and check everything I write here as well as possible. Nevertheless, I am only human and make mistakes. In addition, I may draw completely different conclusions as someone else would. Simply because they fit my story. But every story is different.

Important: The content on this page is for informational purposes only and is not a substitute for talking to your doctor or other therapist. The content reflects my personal experiences, research and findings that have helped me and that I therefore want to share. However, in your personal case, completely different things may play a role and other things may help. Please talk to your doctor or therapist before making any decisions that affect your physical or mental health. Also important: I don't want to convince anyone of anything here. Rather, I want to point out possible ways that hopefully can help some people to improve or overcome their Fatigue or ME/CFS.



Jürgen Zulley: Schlafkunde

Shawn Stevenson: Sleep smarter

Dr. Anne Fleck: Energy

Dan Neuffer: CFS Unravelled

Morris G et al: The putative role of oxidative stress and inflammation in the pathophysiology of sleep dysfunction across neuropsychiatric disorders: Focus on chronic fatigue syndrome, bipolar disorder and multiple sclerosis. Sleep Med Rev 2018

Sakkas GK et al: Sleep Abnormalities in Multiple Sclerosis. Curr Treat Options Neurol 2019

Dr. Rosamund Vallings: Chronic Fatigue Syndrome

A Komaroff: Does sleep flush waste from the brain? JAMA 2021