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Ask Oz and Roizen: Chronic Fatigue Syndrome and REM Sleep Behavior Disorder

Ask Oz and Roizen: Chronic Fatigue Syndrome and REM Sleep Behavior Disorder

Learn what the experts have to say on these important health topics.

Q: My sister may have chronic fatigue syndrome, if that’s a real thing. She’s been complaining that she’s always tired, nervous and has trouble thinking clearly. She’s only 35. Is there any way to find out what’s really going on? Rachel M., Buffalo, NY

A: Chronic fatigue syndrome, or myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a very real condition. Researchers at Columbia University in NYC have put together a test for ME/CFS that delivers a diagnosis that’s 84 percent accurate.

Not that many years ago (actually, it still happens), a lot of docs would pat their patients who complained about extreme fatigue, anxiety and forgetfulness on the head and tell them to calm down and get some rest. We now know that ME/CFS is a disabling and complex illness. The CDC estimates it affects between 836,000 and 2.5 million Americans.

We don’t know what causes ME/CFS, but one theory is that it’s caused by a change in the immune system’s response to infection or stress. ME/CFS usually affects folks age 40 to 60—most often women and Caucasians. As for treatment… well, that’s another part of the puzzle. But accurate diagnosis is the first step.

The researchers at Columbia compared and identified biomarkers or metabolites in blood and stool samples in folks with ME/CFS and those without the condition. Between 35 and 90 percent of those with an ME/CFS diagnosis had irritable bowel syndrome. In the general population, the number is 10 to 20 percent.

Previously, the only way to identify those with ME/CFS was to conduct an in-depth evaluation of the patient, considering past symptoms and medical history. Now, thanks to this new research, we will be able to identify the disease (most of the time) with a blood test. So, suggest your sister find a specialist in her area and establish a diagnosis for her symptoms. If she is diagnosed with ME/CFS, treatment focuses on managing symptoms such as fatigue that doesn’t get better with rest, difficulty concentrating, pain and dizziness.

Q: Recently my husband has started kicking and yelling during sleep. It’s very bothersome for me, but it’s torturous for him. He wakes up cranky. Should he go to a sleep specialist? Maureen D., Bethlehem, PA

A: He should go see his regular doc first, because there are any number of things from anxiety to medications that could be causing the problem. His condition is called rapid eye movement sleep behavior disorder, or RBD, and it’s twice as common in men as it is with women.

A study recently published in the medical journal of the American Academy of Neurology identifies a common cause of RBD as antidepressants. So, if he’s taking one, maybe a dosage adjustment or change in medication would help. Other associated risks are smoking, alcohol use and post-traumatic stress disorder (PTSD). All of these are modifiable risk factors.

Fortunately, RBD has as many treatment options as it has causes and even if a specific diagnosis isn’t made, treatment is possible. According to the National Sleep Foundation, clonazepam, a benzodiazepine, curtails or eliminates the disorder about 90 percent of the time. For the other 10 percent, there are other approaches.

As we mentioned, going to see your GP physician first can help your husband identify health issues he might have that are associated with RBD (chronic pain, heart disease, sleep apnea and neurodegenerative problems like early onset dementia that can produce night terrors). If the cause is emotional, cognitive behavioral therapy (CBT) may help. If the problem is physical, he can see a specialist for pain management, if that’s appropriate. Once such issues are addressed or eliminated as a cause, your doc can refer him to a sleep specialist if needed. In the meantime, make sure the bedroom is a quiet and cool place and no computers or electronic devices in bed. And he shouldn’t eat or exercise for at least two hours before hittin’ the hay.

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