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• W2012330607 abstract "Introduction CAP and alpha-EEG are markers of sleep instability which are commonly seen in patients suffering from FMS/CF. Sleep instability is associated with autonomic instability and generally does not respond longer-term to hypnotic medication. Patients with FMS/CF with PSG evidence of CAP and alpha-EEG suffer from intractable, debilitating fatigue and nonrestorative sleep, in addition to variable musculoskeletal pain symptoms, poor memory and concentration, and low or irritable mood. It has been observed that patients with CAP and alpha-EEG have a history of significant stressors (psychological and/or physical) and often exhibit marked anxiety. States of stress and high anxiety, stimulate the sympathetic nervous and increase adrenal output. It can be postulated that if these high- output states persist, there sleep quality is affected; possibly predisposing them to developing significant sleep instability with the presence of CAP and/or alpha-EEG and adrenal fatigue. Materials and methods We have identified FMS/CF patients with CAP and/or alpha-EEG, who have abnormally high scores on an Adrenal Fatigue Questionnaire and have clinical evidence of low saliva cortisol throughout the day. In addition, on the Symptom Checklist-90 (SCL-90), which is a self-report instrument used in evaluating a broad range of psychological symptoms, patients report moderate to excessive psychological distress with anxiety and depressive symptoms. In these same patients, the Wahler Physical Symptoms Inventory revealed self-reported evidence of marked physical fatigue and discomfort. Over a 1 year treatment period, 8 out of 9 patients with FMS/CFS and PSG evidence of CAP and/or alpha-EEG responded clinically to a multimodal approach addressing the biochemical, physical, and psychological factors influencing their clinical presentation. The patients were assessed and treated by a naturopathic doctor for adrenal fatigue and nocturnal hypoglycemia, as well as addressing any other biochemical abnormalities. Their physical therapy included optimizing sleep hygiene and engaging, on a weekly basis, in activities which enhance parasympathetic nervous system tone. Such activities include restorative yoga, tai chi, swimming, and/or Mindfulness Based Stress Reduction (MBSR). Brief psychodynamic psychotherapy and Neuro Emotional Technique (NET) were used as psychological treatment modalities. Patients had monthly follow-up with a psychiatrist and regularly scheduled visits with a certified NET practitioner. NET is a psychotherapeutic/chiropractic system that combines a number of techniques and principles from the meridian system in traditional Chinese. Results One patient was lost to follow-up. On self-report, 8 patients reported a subjective improvement in their sleep, feeling more refreshed upon awakening and improvement in their daytime fatigue and daytime functioning. There was also an improvement in the scores of self- report inventories. In 5 of the patients there was PSG evidence of a decrease in CAP and/or alpha-EEG. Conclusion These preliminary findings warrants further investigation and offers potential avenues for treatment with FMS/CFS patient with nonrestorative sleep and debilitating fatigue. ACKNOWLEDGEMENTS We wish to acknoledge the ongoing academic guidance and inspiration of Dr. Havey Moldofky and his contributions to Sleep Medicine." @default.
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• W2012330607 date "2013-12-01" @default.
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• W2012330607 title "A multimodal appraoch to treating patients with psg evidence of cycling alternating pattern (CAP) and/or alpha electroencephalography pattern (alpha-EEG): strategies for fibromyalgia syndrome and chronic fatigue (FMS/CF)" @default.
• W2012330607 doi "https://doi.org/10.1016/j.sleep.2013.11.694" @default.
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