(Note: This article was first published in Jan. 2015. It was updated on Jan. 2, 2017 to include new information about cellphone, tablet, and computer lights.)
Most people have problems with getting enough restorative sleep in Lyme disease. Lack of adequate sleep
- worsens pain,
- causes fatigue,
- increases inflammation cytokines, and
- suppresses the immune system.
In my practice I find a restorative amount of sleep is 7 to 9 hours to correct these problems.
Problems that Cause Poor Sleep in Lyme Disease Treatment
There are many factors in Lyme disease that cause sleep problems. Each of these factors should be addressed to improve sleep. These problems include
- excess inflammation cytokines produced by the immune system,
- poor sleep hygiene,
- hormone dysfunction,
- sleep apnea,
- night time urination,
- restless legs syndrome,
- anxiety about sleep,
- herbal and prescription medication side effects, and
- the use of alcohol and/or caffeine.
Regardless of the sleep problem cause there are basic steps any person with chronic Lyme disease and insomnia should take. The first is take supplements to lower inflammatory cytokines. The second is use good sleep hygiene. Third, correct underlying medical problems like depression or restless legs syndrome that lead to insomnia. Finally if all of this does not work, then try sleep supplements or medications.
First: Lower Cytokines for Sleep in Lyme Disease
Cytokines are inflammatory chemicals made by the immune system in chronic Lyme disease.
On the one hand cytokines are good because they turn on the immune system. They perform a number of functions that include:
- making antibodies work more effectively,
- increasing active white blood cells to fight infections,
- recruiting white blood cells to the location of an infection,
- turning on white blood cells to fight infections, and
- decreasing viral and bacterial replication.
On the other hand in chronic Lyme disease the immune system makes too many cytokines which is bad. Too many cytokines:
- suppress the immune system,
- cause pain,
- decrease hormone production from organs like the thyroid and the adrenal glands,
- disturb sleep,
- decrease brain function,
- increase fatigue and tiredness,
- waste muscles, cause depression, and
- decrease the function of various organs throughout the body resulting in many other symptoms and medical problems.
At the beginning of treatment or when antibiotics are changed the cytokines are made in even greater amounts causing a person to feel much worse. For more information and additional steps you can take to lower cytokines see Control Cytokines A Guide to Fix Lyme Symptoms & The Immune System.
Second: Use Good Hygiene for Sleep in Lyme Disease
The best way to get sleep is through good sleep hygiene. This includes:
- having the same sleep time each night no later than 10:00 PM,
- turning off computer, tablet or cell phone screens after dark,
- initiating sleep no more than 30 minutes from the designated sleep time nightly,
- if using sleep medicines or supplements, take them one hour before the designated sleep time,
- drinking no alcohol before bed,
- avoiding caffeine later in the day,
- limiting fluid intake before bed to avoid night-time urination,
- not performing work in bed,
- eating a small protein snack before bed time to avoid low blood sugar wakening in the middle of the night, and
- keeping your room cool and dark.
Cell phones, Tablets, and Computers. These devices use a blue light that stimulates and wakes people up. Blue light is the same kind of sunlight that shows in the morning. In our society where so many rely on these gadgets, many get blue light stimulation too late in the day. One way to combat this problem is to turn off and not use these devices after dark. One other way is to use a blue light filter on your devices. Apple and Android devices have a night time light setting you can turn on to filter out the blue light. For your computer you can download a program that will do this for you. For instance you could try the F.lux application.
Third: Correct Underlying Medical Problems for Sleep in Lyme Disease
Work with your physician to find or treat sleep apnea, restless legs syndrome, medication side effects, depression, sleep anxiety, or pain.
- In sleep apnea the airways collapse while sleeping temporarily blocking breathing. This causes light awakenings which do not allow for deep restorative sleep. If you have a bed partner they might observe that you stop breathing for short periods of time. Another sign is if you snore. To figure out if this is your problem your physician will order a sleep study. If sleep apnea is found you may require a breathing machine, an oral appliance, or surgery to correct the problem.
- In restless legs syndrome a person regularly moves the legs at night. Some report a feeling like something is crawling on the legs. If you have this problem your physician should check for low iron levels by measuring a ferritin level. If your ferritin is less then 40 take iron supplements. Some require medicines for restless legs syndrome like Mirapex (pramipexole) or Requip (ropinirole). (Be aware that restless legs syndrome is often caused by the coinfection bartonella or sometimes in babesia. Treating it will often correct this problem.)
- Depression often causes early morning wakening. For this try the natural medicines 5-hydroxy tryptophan (5-HTP) 100mg 3 times a day or St. John’s Wort 350mg 3 times a day. If these are not effective then try prescription sleep medications.
- For some anxiety about falling asleep causes insomnia. Try l-theanine 100mg 1 to 6 pills a night, lithium orotate 5mg 2 pills at bed time, or herbal combinations including nutrients such as l-theanine, valerian root, hops, magnesium. However these are often not effective and your physician should then try medicines in the valium family like Klonipin (clonezepam) or Ativan (lorazepam).
- Pain often makes it difficult to fall or stay asleep. For natural approaches to pain see Pain Pain Go Away! Natural Treatments. Your physician should also consider prescribing muscle relaxers like Flexeril (cyclobenzaprine) or Robaxin (methocarbamol). Sometimes the narcotic-like medication Ultram (tramadol) should be tried. Any as a later resort try narotic pain medications like oxycodone.
Finally: Use Supplements or Medications for Sleep in Lyme Disease
by Marty Ross MD