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Sleep

266 studies in the atlas

Unrefreshing sleep is a core feature of ME/CFS, reported by nearly all patients. Despite spending adequate or even excessive time in bed, patients consistently wake feeling unrestored. Sleep studies have documented abnormalities in sleep architecture, though these findings are not always consistent across studies.

What we know

  • Unrefreshing sleep is reported by nearly all ME/CFS patients and is included in most diagnostic criteria
  • Sleep architecture abnormalities, including disrupted slow-wave sleep, have been documented in some studies
  • Sleep quality does not improve proportionally with increased sleep duration in most patients
  • Conventional sleep disorders (apnea, insomnia) may coexist but do not explain the unrefreshing quality

What remains uncertain

  • Whether sleep dysfunction is a primary feature or secondary to autonomic, immune, or metabolic disturbances
  • The specific sleep architecture changes that distinguish ME/CFS from primary sleep disorders are not well defined
  • Whether targeted sleep interventions improve overall ME/CFS outcomes or only sleep-specific symptoms
  • The relationship between unrefreshing sleep and PEM susceptibility is poorly understood

What is emerging

  • Which aspects of sleep dysfunction are most amenable to intervention
  • Whether sleep biomarkers could contribute to ME/CFS diagnosis
  • The role of glymphatic clearance during sleep and its potential impairment in ME/CFS
  • Whether sleep interventions can reduce PEM frequency or severity

Start here

E0 ConsensusPEM requiredModerate confidence

The persistence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) after SARS-CoV-2 infection: A systematic review and meta-analysis.

Dehlia, Ankush, Guthridge, Mark A·The Journal of infection·2024

Researchers looked at studies of people with Long COVID to see how many also meet the diagnostic criteria for ME/CFS. They found that about half of Long COVID patients have symptoms that match ME/CFS, including severe fatigue, sleep problems, muscle and joint pain, and post-exertional malaise (feeling much worse after physical activity). This suggests that Long COVID and ME/CFS may be very similar conditions, at least in some patients.

Research Momentum

266 publications over 37 years. Recent trend: decreasing (7/year over the last 3 years).

All Studies

266 studies, sorted by review status and evidence level

E0 ConsensusPEM not requiredPreliminarySystematic-ReviewEditor reviewed

Evaluation of safety and effectiveness of NAD in different clinical conditions: a systematic review.

Gindri, Izabelle de Mello, Ferrari, Gustavo, Pinto, Luiz Paulo S et al.·American journal of physiology. Endocrinology and metabolism·2024

This review examined whether taking NAD+ or NADH supplements (molecules that help cells produce energy) are safe and helpful for people with different health conditions, including chronic fatigue syndrome. Researchers looked at 10 clinical trials involving 489 people and found that these supplements were generally well-tolerated, with some people reporting improvements in fatigue, quality of life, and sleep. The most common side effects were mild and included muscle pain, headaches, and sleep disturbances, but nothing serious.

Sleep
E0 ConsensusPEM unclearModerate confidenceMeta-AnalysisEditor reviewed

Objective sleep measures in chronic fatigue syndrome patients: A systematic review and meta-analysis.

Mohamed, Abdalla Z, Andersen, Thu, Radovic, Sanja et al.·Sleep medicine reviews·2023

This study looked at 24 research papers that measured sleep objectively (using devices and tests, not just patient reports) in people with ME/CFS. The researchers found that ME/CFS patients do indeed have real, measurable sleep problems—they take longer to fall asleep, wake up more during the night, and don't get good-quality sleep. Interestingly, these sleep problems looked slightly different in teenagers compared to adults with ME/CFS.

SleepAutonomic Nervous System
E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

Effects of traditional Chinese mind-body exercises for patients with chronic fatigue syndrome: A systematic review and meta-analysis.

Kong, Lingjun, Ren, Jun, Fang, Sitong et al.·Journal of global health·2023

This research review looked at whether traditional Chinese exercises like Tai Chi and Qigong help people with chronic fatigue syndrome (CFS). Researchers combined results from 13 studies involving 1,187 patients and found that these exercises probably reduce fatigue, depression, and anxiety compared to doing nothing, and may improve sleep and thinking ability. However, the benefits seem to fade over time, and these exercises work about as well as other active treatments like standard exercise programs.

Sleep
E0 ConsensusPEM requiredModerate confidenceReview-NarrativeEditor reviewed

A Comprehensive Update of the Current Understanding of Chronic Fatigue Syndrome.

Noor, Nazir, Urits, Ivan, Degueure, Arielle et al.·Anesthesiology and pain medicine·2021

This review summarizes what researchers currently understand about ME/CFS, a complex illness causing severe fatigue and other symptoms. The condition may involve problems with the immune system, stress response, or nervous system, and can be triggered by infections like Epstein-Barr virus, though not always. Diagnosis requires six months of fatigue plus four symptoms like memory problems, sore throat, or post-exertion malaise, and doctors must rule out other conditions first. Treatment options include therapy, medication, and newer approaches like electrical stimulation, though more research is needed to find the best approaches.

SleepImmune SystemPost-Exertional Malaise
E0 ConsensusPEM unclearPreliminarySystematic-ReviewEditor reviewed

Systematic Review of Sleep Characteristics in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

Maksoud, Rebekah, Eaton-Fitch, Natalie, Matula, Michael et al.·Healthcare (Basel, Switzerland)·2021

Many ME/CFS patients report that their sleep feels unrefreshing and disturbed, even when they sleep for long hours. This review looked at 20 studies that used objective sleep monitoring equipment (like devices that measure brain waves and breathing during sleep) to understand what's actually happening with sleep in ME/CFS patients. The researchers found that the results across different studies were inconsistent, meaning there's no clear pattern yet about what makes ME/CFS sleep different from healthy sleep.

Sleep
E0 ConsensusPEM not requiredPreliminarySystematic-ReviewEditor reviewed

Do evidence based interventions for chronic fatigue syndrome improve sleep? A systematic review and narrative synthesis.

Russell, Charlotte, Kyle, Simon D, Wearden, Alison J·Sleep medicine reviews·2017

This review looked at whether two common treatments for ME/CFS—cognitive behavioural therapy (CBT) and graded exercise therapy (GET)—actually help people sleep better. The researchers found only 8 studies that measured sleep as an outcome. GET showed some promise for improving sleep, but results were inconsistent across different studies. CBT had very limited evidence, with only one study out of two showing sleep improvements. Overall, we know very little about whether adding specific sleep management techniques to these treatments makes a difference.

Sleep
E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

Exercise therapy for chronic fatigue syndrome.

Larun, Lillebeth, Brurberg, Kjetil G, Odgaard-Jensen, Jan et al.·The Cochrane database of systematic reviews·2017

This review looked at eight research studies testing whether exercise therapy helps people with ME/CFS feel less fatigued and improve their daily functioning. Overall, patients who did exercise therapy felt less tired and reported better sleep and physical function compared to those who received standard care or relaxation therapy. Exercise therapy appeared to work about as well as cognitive-behavioral therapy (talking therapy), though more research is needed to figure out the best type, intensity, and duration of exercise for each patient.

Sleep
E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

Exercise therapy for chronic fatigue syndrome.

Larun, Lillebeth, Brurberg, Kjetil G, Odgaard-Jensen, Jan et al.·The Cochrane database of systematic reviews·2016

This review looked at eight studies involving 1,518 people with ME/CFS to see if exercise therapy helps. Most studies showed that exercise reduced fatigue and improved sleep and physical function compared to no treatment or relaxation. Exercise therapy seemed to work about as well as cognitive-behavioral therapy, though the quality of evidence varied.

Sleep
E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

Exercise therapy for chronic fatigue syndrome.

Larun, Lillebeth, Brurberg, Kjetil G, Odgaard-Jensen, Jan et al.·The Cochrane database of systematic reviews·2016

This review looked at eight studies testing whether exercise therapy helps people with ME/CFS feel less fatigued. Overall, exercise therapy reduced fatigue more than doing nothing or standard care, and patients also reported improvements in sleep, physical function, and general health. The review found no evidence that exercise made things worse, though more research is needed to determine the best type and intensity of exercise for each person.

Sleep
E0 ConsensusPEM not requiredPreliminarySystematic-ReviewEditor reviewed

Sleep Disturbances in Pediatric Chronic Fatigue Syndrome: A Review of Current Research.

Snodgrass, Kelli, Harvey, Adrienne, Scheinberg, Adam et al.·Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine·2015

Children and teens with ME/CFS commonly struggle with sleep problems, but we don't know much about exactly what types of sleep issues they experience or how severe they are. This review looked at six studies comparing sleep in young people with ME/CFS to healthy children, and found that most studies showed children with ME/CFS have more sleep disturbances. However, the researchers note that more high-quality studies are needed to truly understand sleep problems in pediatric ME/CFS.

Sleep
E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

Exercise therapy for chronic fatigue syndrome.

Larun, Lillebeth, Brurberg, Kjetil G, Odgaard-Jensen, Jan et al.·The Cochrane database of systematic reviews·2015

This review looked at eight studies involving 1,518 people with ME/CFS to see whether exercise therapy helps. The researchers found that people who did exercise therapy reported feeling less fatigued and experienced improvements in sleep, physical functioning, and overall health compared to those receiving no special treatment. Exercise therapy appeared safe, with no serious harmful effects reported, though the studies had some limitations.

Sleep
E0 ConsensusPEM unclearModerate confidenceReview-NarrativeEditor reviewed

Review of clinical and psychobiological dimensions of the chronic fatigue syndrome: differentiation from depression and contribution of sleep dysfunctions.

Fischler, B·Sleep medicine reviews·1999

This review examined how ME/CFS differs from depression and what role sleep problems play in the condition. The researchers found that ME/CFS is a distinct illness with its own biological features—not just depression wearing a different mask. While sleep problems are common in ME/CFS, they don't fully explain why patients feel so exhausted and unwell.

Sleep
E0 ConsensusPEM requiredModerate confidenceSystematic-ReviewEditor reviewed

The persistence of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) after SARS-CoV-2 infection: A systematic review and meta-analysis.

Dehlia, Ankush, Guthridge, Mark A·The Journal of infection·2024

Researchers looked at studies of people with Long COVID to see how many also meet the diagnostic criteria for ME/CFS. They found that about half of Long COVID patients have symptoms that match ME/CFS, including severe fatigue, sleep problems, muscle and joint pain, and post-exertional malaise (feeling much worse after physical activity). This suggests that Long COVID and ME/CFS may be very similar conditions, at least in some patients.

Severe MESleepPost-Exertional Malaise
E0 ConsensusPEM not requiredPreliminarySystematic-ReviewEditor reviewed

Exploring the Effects of Qigong, Tai Chi, and Yoga on Fatigue, Mental Health, and Sleep Quality in Chronic Fatigue and Post-COVID Syndromes: A Systematic Review with Meta-Analysis.

Fricke-Comellas, Hermann, Heredia-Rizo, Alberto Marcos, Casuso-Holgado, María Jesús et al.·Healthcare (Basel, Switzerland)·2024

This review looked at 13 studies testing whether qigong, tai chi, and yoga help reduce fatigue in people with ME/CFS and long COVID. Overall, these gentle movement practices appeared to help reduce fatigue and improve mood and sleep compared to doing nothing. However, the studies had various quality issues that make it hard to know how much we can trust these results.

Sleep
E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

Effects of yoga on depressive symptoms, anxiety, sleep quality, and mood in patients with rheumatic diseases: Systematic review and meta-analysis.

de Orleans Casagrande, Pedro, Coimbra, Danilo Reis, de Souza, Loiane Cristina et al.·PM & R : the journal of injury, function, and rehabilitation·2023

This review examined whether yoga can help patients with rheumatic diseases (like arthritis and fibromyalgia) feel better emotionally and sleep better. Researchers combined results from 27 studies and found that yoga did help reduce depression and anxiety symptoms and improved sleep quality compared to no treatment. However, yoga was not clearly better than other types of exercise.

Sleep
E0 ConsensusPEM not requiredModerate confidenceSystematic-ReviewEditor reviewed

Identification of mental health and quality of life outcomes in primary care databases in the UK: a systematic review.

Carreira, Helena, Williams, Rachael, Strongman, Helen et al.·BMJ open·2019

Researchers reviewed 120 studies that used UK patient medical records to track mental health and quality of life problems like depression, anxiety, fatigue, and cognitive issues. They found that different studies used different definitions and coding systems to identify these conditions, making it hard to compare results across studies. The authors recommend that researchers agree on standard definitions and validated code lists so findings are more consistent and reliable.

Pain and SensitizationSleepCognitive Impairment
E0 ConsensusPEM unclearModerate confidenceReview-NarrativeEditor reviewed

Psychiatric aspects of chronic fatigue syndrome and fibromyalgia.

Van Houdenhove, Boudewijn, Kempke, Stefan, Luyten, Patrick·Current psychiatry reports·2010

This review examines how ME/CFS and fibromyalgia are connected to psychiatric symptoms like depression and stress. The authors explain that these conditions involve overlapping physical symptoms—extreme tiredness, difficulty with activity, brain fog, and widespread pain—that often start after infections or injuries. They suggest that the best approach for patients is personalized lifestyle management and self-care tailored to individual needs, rather than a one-size-fits-all treatment.

Sleep
E0 ConsensusPEM not requiredModerate confidenceEditorialEditor reviewed

Central nervous system abnormalities in fibromyalgia and chronic fatigue syndrome: new concepts in treatment.

Gur, Ali, Oktayoglu, Pelin·Current pharmaceutical design·2008

This review examines how ME/CFS and fibromyalgia may both involve problems in the nervous system—specifically in how the brain processes pain, manages stress hormones, and controls automatic body functions. The authors discuss why current treatments are limited and explore new medication approaches that target brain chemicals involved in pain and fatigue.

SleepAutonomic Nervous SystemCognitive Impairment
E0 ConsensusPEM not requiredModerate confidenceReview-NarrativeEditor reviewed

Fibromyalgia and chronic fatigue syndrome: similarities and differences.

Buchwald, D·Rheumatic diseases clinics of North America·1996

This review compared ME/CFS and fibromyalgia (FM), two conditions that cause fatigue, muscle pain, and sleep problems. The researchers found that these two illnesses are very similar in their symptoms and how they affect people's lives, even though doctors use different criteria to diagnose them. Some patients have both conditions at the same time, which makes their suffering worse.

SleepDiagnostics
E0 ConsensusPEM unclearModerate confidenceSystematic-ReviewEditor reviewed

Effects of traditional Chinese exercise on sleep quality: A systematic review and meta-analysis of randomized controlled trials.

Liu, Haoyu, Liu, Siling, Xiong, Lu et al.·Medicine·2023

This review examined whether traditional Chinese exercises like Tai Chi and Qigong can help improve sleep quality. Researchers analyzed 20 studies and found that these exercises did help people sleep better, especially those with fibromyalgia, chronic fatigue-like illness, and insomnia. However, the benefit wasn't seen in all groups studied, such as stroke patients or college students.

Sleep
E0 ConsensusPEM not requiredWeak / uncertainSystematic-ReviewEditor reviewed

Homeopathic treatments in psychiatry: a systematic review of randomized placebo-controlled studies.

Davidson, Jonathan R T, Crawford, Cindy, Ives, John A et al.·The Journal of clinical psychiatry·2011

This review looked at 25 studies testing whether homeopathic treatments help with psychiatric conditions like anxiety, depression, and sleep problems. The researchers found some evidence that homeopathy might help with chronic fatigue syndrome and fibromyalgia, but it did not help with anxiety or stress. Overall, the quality of the studies was mixed, and more research is needed to draw firm conclusions.

Sleep
E0 ConsensusPEM not requiredModerate confidenceReview-NarrativeEditor reviewed

Sleep disturbances in multiple sclerosis.

Caminero, Ana, Bartolomé, Manuel·Journal of the neurological sciences·2011

This review examined how often people with multiple sclerosis (MS) experience sleep problems and how these problems affect their daily life. The researchers found that sleep disorders are much more common in MS patients than in the general population, and that sleep problems and MS can make each other worse. The review discusses many types of sleep issues including insomnia, restless legs, and sleep apnea, and emphasizes that treating sleep problems should be an important part of caring for MS patients.

Sleep
E0 ConsensusPEM not requiredPreliminaryReview-NarrativeEditor reviewed

Clinical uses of melatonin: evaluation of human trials.

Sánchez-Barceló, E J, Mediavilla, M D, Tan, D X et al.·Current medicinal chemistry·2010

This review looked at 20 years of clinical trials testing whether melatonin (a natural hormone that regulates sleep) could help treat various diseases. The researchers found that melatonin appears to be safe and helpful for sleep problems and certain conditions, but more research is needed to confirm whether it helps with chronic fatigue syndrome and other illnesses.

Sleep
E0 ConsensusPEM unclearPreliminaryReview-NarrativeEditor reviewed

Approved and investigational uses of modafinil : an evidence-based review.

Kumar, Raminder·Drugs·2008

This review looked at studies testing modafinil, a medication that promotes wakefulness, in different conditions including sleep disorders and fatigue-related illnesses. The authors found that modafinil works well for approved conditions like narcolepsy and sleep apnea, but studies testing it for chronic fatigue syndrome were very small and gave unclear results. The medication can cause side effects like insomnia, headaches, and appetite loss, and may interact with other drugs.

SleepCognitive Impairment
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Tuina therapy for patients with chronic fatigue syndrome: a randomized controlled trial.

Wang, Shoujian, Ren, Jun, Zhou, Xin et al.·Journal of translational medicine·2026

This study tested whether Tuina, a hands-on therapy from traditional Chinese medicine, could help people with ME/CFS feel less tired. Over 4 weeks, people who received Tuina three times per week alongside their usual care felt significantly better than those who received usual care alone. The improvement was especially noticeable for physical tiredness, and people also reported better sleep and less anxiety.

Sleep
E1 ReplicatedPEM not requiredPreliminaryRCTEditor reviewed

Acupoint massage at Shenque (CV 8) for chronic fatigue syndrome: a randomized controlled trial.

Li, Zhijun, Ji, Rong, Yan, Chaoqun et al.·Zhongguo zhen jiu = Chinese acupuncture & moxibustion·2024

Researchers tested whether massaging a specific acupuncture point called Shenque (located on the abdomen) could help people with chronic fatigue syndrome. Patients in the treatment group received 10-minute massages three times a week for four weeks, while the control group received no treatment. The treatment group showed meaningful improvements in fatigue and sleep quality compared to the control group.

Sleep
E1 ReplicatedPEM not requiredPreliminaryRCTEditor reviewed

Effects of Yijinjing Qigongin Alleviating Fatigue, Sleep Quality, and Health Status on Patients with Chronic Fatigue Syndrome: A Randomized, Controlled, and Parallel Group Clinical Study.

Xie, Fangfang, Dong, Wenjun, Guan, Chong et al.·Complementary medicine research·2023

This study tested whether Yijinjing, an ancient Chinese exercise practice with 12 movements, could help patients with ME/CFS. Forty patients either practiced Yijinjing six times per week for 12 weeks or received cognitive behavioral education. The Yijinjing group showed greater improvements in fatigue, sleep quality, and quality of life compared to the education group.

Pain and SensitizationSleep
E1 ReplicatedPEM not requiredPreliminaryRCTEditor reviewed

The Qigong of Prolong Life With Nine Turn Method Relieve Fatigue, Sleep, Anxiety and Depression in Patients With Chronic Fatigue Syndrome: A Randomized Controlled Clinical Study.

Xie, Fangfang, You, Yanli, Guan, Chong et al.·Frontiers in medicine·2022

This study tested whether a traditional Chinese exercise called Qigong (specifically the Prolong Life with Nine Turn Method) could help people with ME/CFS feel less tired, sleep better, and experience less anxiety and depression. Ninety patients tried either the Qigong exercise or cognitive behavioral therapy (a talk-based treatment) for 12 weeks, and both groups improved significantly, with Qigong showing slightly better results.

Sleep
E1 ReplicatedPEM unclearPreliminaryRCTEditor reviewed

Effect of Melatonin Plus Zinc Supplementation on Fatigue Perception in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial.

Castro-Marrero, Jesús, Zaragozá, Maria-Cleofé, López-Vílchez, Irene et al.·Antioxidants (Basel, Switzerland)·2021

This study tested whether taking melatonin (1 mg) and zinc (10 mg) together could help reduce fatigue in ME/CFS patients. Over 16 weeks, people taking the supplement reported feeling less physically tired compared to those taking placebo, and they also reported better overall quality of life. The supplements appeared to be safe with no serious side effects reported.

Sleep
E1 ReplicatedPEM unclearModerate confidenceRCTEditor reviewed

Effect of Dietary Coenzyme Q10 Plus NADH Supplementation on Fatigue Perception and Health-Related Quality of Life in Individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial.

Castro-Marrero, Jesús, Segundo, Maria Jose, Lacasa, Marcos et al.·Nutrients·2021

This study tested whether taking two supplements together—coenzyme Q10 and NADH—could help reduce fatigue and improve quality of life in people with ME/CFS. Over 200 patients took either the supplements or a placebo for 12 weeks. The group taking the supplements reported feeling less mentally tired, slept better, and experienced improvements in their overall quality of life compared to the placebo group.

Sleep
E1 ReplicatedPEM not requiredPreliminaryRCTEditor reviewed

The effectiveness of cupping therapy on chronic fatigue syndrome: A single-blind randomized controlled trial.

Meng, Xiu-Dong, Guo, Hao-Ran, Zhang, Qing-Ying et al.·Complementary therapies in clinical practice·2020

This study tested whether cupping therapy—a traditional treatment where cups create suction on the skin—could help people with ME/CFS feel less tired. Researchers divided 112 patients into three groups that received different levels of suction and compared the results. After 10 sessions over 5 weeks, all groups reported improvements in fatigue and sleep, with 10 sessions working better than 5 sessions, though the pressure levels didn't make much difference.

Sleep
E1 ReplicatedPEM not requiredPreliminaryRCTEditor reviewed

[Effect of ginger-separated moxibustion on fatigue, sleep quality and depression in patients with chronic fatigue syndrome: a randomized controlled trial].

Lin, Yu-Fang, Zhu, Jian-Fang, Chen, Yi-Dan et al.·Zhongguo zhen jiu = Chinese acupuncture & moxibustion·2020

This study tested whether ginger-separated moxibustion (a traditional Chinese medicine technique involving burning herbs on the skin) could help ME/CFS patients feel less tired, sleep better, and feel less depressed. Over 4 weeks, patients who received moxibustion in addition to normal diet and exercise showed significant improvements in fatigue, sleep quality, and depression compared to those who only made lifestyle changes.

Sleep
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Qigong exercise for chronic fatigue syndrome.

Chan, Jessie S M, Ng, Siu-Man, Yuen, Lai-Ping et al.·International review of neurobiology·2019

This study tested whether Qigong, a gentle Chinese exercise and meditation practice, could help people with chronic fatigue syndrome (CFS). Two separate trials involving about 137 and 150 participants found that people who practiced Qigong for at least 30 minutes on at least 3 days per week experienced improvements in fatigue, depression, sleep quality, and certain biological markers related to cellular health.

Sleep
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Qigong exercise alleviates fatigue, anxiety, and depressive symptoms, improves sleep quality, and shortens sleep latency in persons with chronic fatigue syndrome-like illness.

Chan, Jessie S M, Ho, Rainbow T H, Chung, Ka-Fai et al.·Evidence-based complementary and alternative medicine : eCAM·2014

This study tested whether a gentle movement and breathing practice called Baduanjin Qigong could help people with chronic fatigue syndrome-like illness. Over 9 weeks, 150 participants either took Qigong classes and practiced at home, or waited for treatment. The Qigong group showed improvements in sleep quality, how quickly they fell asleep, fatigue levels, and anxiety and depression symptoms—and the more they practiced, the better they did.

Sleep
E1 ReplicatedPEM unclearPreliminaryRCTEditor reviewed

Pilot study investigating the utility of a specialized online symptom management program for individuals with myalgic encephalomyelitis/chronic fatigue syndrome as compared to an online meditation program.

Arroll, Megan A, Attree, Elizabeth A, Marshall, Clare L et al.·Psychology research and behavior management·2014

This pilot study tested whether an online program designed to help people manage ME/CFS symptoms could be helpful for patients. Researchers compared this specialized program to an online meditation program and tracked changes in fatigue, symptoms, and how much control people felt they had over their condition over 8 weeks. The specialized program showed some benefits, particularly in helping people feel more in control and improving sleep difficulties, though overall ME/CFS symptoms didn't change significantly.

Sleep
E1 ReplicatedPEM not requiredPreliminaryLongitudinalEditor reviewed

Agomelatine but not melatonin improves fatigue perception: a longitudinal proof-of-concept study.

Pardini, M, Cordano, C, Benassi, F et al.·European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology·2014

This study tested whether a medication called agomelatine could reduce fatigue in people with ME/CFS. The researchers compared agomelatine to melatonin (a common sleep supplement) over 24 weeks in 62 patients. Agomelatine improved fatigue and quality of life, while melatonin alone did not—and when patients switched from melatonin to agomelatine, their fatigue improved.

Sleep
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Effect of topical nasal corticosteroids on patients with chronic fatigue syndrome and rhinitis.

Kakumanu, Sujani S, Mende, Cathy N, Lehman, Erik B et al.·The Journal of the American Osteopathic Association·2003

This study tested whether a nasal steroid spray could help people with ME/CFS who also have nasal inflammation and congestion. Twenty-eight patients received either the steroid spray or a placebo (fake spray) in different orders over 8 weeks. The spray did reduce daytime sleepiness, but it did not improve the core ME/CFS symptoms like fatigue, muscle pain, or problems with activity.

Sleep
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Therapy of circadian rhythm disorders in chronic fatigue syndrome: no symptomatic improvement with melatonin or phototherapy.

Williams, G, Waterhouse, J, Mugarza, J et al.·European journal of clinical investigation·2002

This study tested whether melatonin pills and bright light therapy could help ME/CFS patients feel better. Thirty patients tried both treatments (and a placebo) for 12 weeks each. Neither treatment improved fatigue, physical health, mental health, or mood compared to placebo, even though both are sometimes recommended for ME/CFS.

Sleep
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Effectiveness of a brief multicomponent intervention to improve physical activity level and functional capacity in fibromyalgia and chronic fatigue syndrome (Synchronize+).

Martín-Borràs, Carme, González Serra, Gemma, Carrasco-Querol, Noèlia et al.·Frontiers in physiology·2024

Researchers tested a 12-hour program combining physical activity guidance, nutrition advice, and sleep/timing education for people with fibromyalgia and chronic fatigue syndrome. Participants who completed the program increased their weekly activity, reduced sitting time, slept better, and showed improvements in strength and aerobic fitness compared to those receiving standard care. These improvements appeared within 3 months of completing the brief intervention.

Sleep
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Efficacy of aquatic vs land-based therapy for pain management in women with fibromyalgia: a randomised controlled trial.

Rivas Neira, S, Pasqual Marques, A, Fernández Cervantes, R et al.·Physiotherapy·2024

This study compared two types of exercise therapy for women with fibromyalgia: exercising in a pool (aquatic therapy) versus exercising on land. Both groups did 60-minute exercise sessions three times a week for 12 weeks. Six weeks after the program ended, women who did aquatic therapy reported less pain and better sleep quality than those who exercised on land, suggesting that water-based exercise may be particularly helpful for fibromyalgia.

Pain and SensitizationSleep
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

The Effect of Parenteral or Oral Iron Supplementation on Fatigue, Sleep, Quality of Life and Restless Legs Syndrome in Iron-Deficient Blood Donors: A Secondary Analysis of the IronWoMan RCT.

Macher, Susanne, Herster, Cornelia, Holter, Magdalena et al.·Nutrients·2020

This study looked at whether giving iron supplements to blood donors with iron deficiency could improve fatigue, sleep problems, and restless legs syndrome. After 8-12 weeks of taking either intravenous or oral iron supplements, patients reported significant improvements in fatigue, sleep quality, and restless legs symptoms, along with fewer headaches and dizziness. Both types of iron supplementation worked similarly well.

Sleep
E1 ReplicatedPEM not requiredModerate confidenceRCTEditor reviewed

Effects of sleep restriction and exercise deprivation on somatic symptoms and mood in healthy adults.

Ablin, Jacob N, Clauw, Daniel J, Lyden, Angela K et al.·Clinical and experimental rheumatology·2013

This study tested what happens when healthy people stop exercising or reduce their sleep for 10 days. Researchers found that cutting sleep to 6 hours per night quickly caused symptoms like widespread pain, fatigue, and difficulty thinking clearly—similar to symptoms seen in chronic fatigue syndrome. Stopping exercise alone caused less noticeable effects, mainly just fatigue. Women developed these symptoms more easily than men when sleep or exercise was restricted.

Sleep
E1 ReplicatedPEM not requiredPreliminaryObservationalEditor reviewed

[The use of melatonin in the treatment of chronic fatigue syndrome and circadian rhythm disorders in Parkinson's disease].

Datieva, V K, Rosinskaia, A V, Levin, O S·Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova·2013

This study tested whether melatonin, a natural hormone that helps regulate sleep, could help Parkinson's disease patients who also experience chronic fatigue. Thirty patients took melatonin and showed a 21% improvement in fatigue, better sleep, less anxiety, and improved quality of life. The treatment did not significantly affect movement problems, thinking abilities, or depression.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Associated factors and assessment of clinical symptoms including fatigue, insomnia, and gastrointestinal discomfort of chronic fatigue syndrome: a cross-sectional case-control study.

Xie, Fangfang, You, Yanli, Ma, Jianwen et al.·Journal of translational medicine·2026

This study compared 956 people with ME/CFS to 865 healthy people to understand what factors might contribute to the illness. Researchers measured fatigue, sleep problems, and digestive discomfort using standard questionnaires. They found that people with ME/CFS experienced all types of fatigue at roughly twice the severity of healthy controls, and that sleep and digestive problems often occurred together with ME/CFS.

Sleep
E2 ModeratePEM unclearModerate confidenceCross-SectionalEditor reviewed

The Implications and Predictability of Sleep Reversal for People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Machine Learning Approach.

Dietrich, Meghan P, Pravin, Raam, Furst, Jacob et al.·Healthcare (Basel, Switzerland)·2025

Some people with ME/CFS experience sleep reversal, where they sleep during the day and stay awake at night. This study looked at 2,313 ME/CFS patients to understand how common sleep reversal is and what symptoms go with it. People with sleep reversal reported more severe ME/CFS symptoms overall and greater difficulty with daily activities compared to those with normal sleep patterns.

Sleep
E2 ModeratePEM unclearModerate confidenceObservationalEditor reviewed

Co-occurrence of severe fatigue and insomnia: implications for the outcome of cognitive behavioural therapies.

Rauwerda, Nynke L, Kuut, Tanja A, Braamse, Annemarie M J et al.·Behavioural and cognitive psychotherapy·2025

This study looked at whether having both severe fatigue and sleep problems at the same time affects how well cognitive behavioural therapy (CBT) works. Researchers found that CBT was equally effective whether patients had just fatigue, just insomnia, or both together. Interestingly, when one symptom improved during treatment, the other often improved too—but sometimes one symptom stayed even after the other got better.

Sleep
E2 ModeratePEM not requiredPreliminaryObservationalEditor reviewed

Efficacy of Eszopiclone Plus Acupuncture Therapy by Dispersing the Stagnated Liver-Qi and Regulating the Spirit for Treating Chronic Fatigue Syndrome-Related Sleep Disorders.

Huang, Bing, Geng, Yining, Liu, Lanlan·Psychiatry and clinical psychopharmacology·2025

This study looked at whether adding acupuncture to a sleep medication (eszopiclone) could help people with ME/CFS who struggle with sleep. Researchers compared 57 patients who received both the medication and acupuncture to 50 patients who received only the medication. The combined treatment group had better sleep quality, higher levels of chemicals in the blood that support mood and brain health, and fewer side effects.

Sleep
E2 ModeratePEM requiredModerate confidenceCross-SectionalEditor reviewed

Evaluating case diagnostic criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): toward an empirical case definition.

Conroy, Karl E, Islam, Mohammed F, Jason, Leonard A·Disability and rehabilitation·2023

This study looked at how doctors diagnose ME/CFS by analyzing symptoms reported by over 2,300 patients from around the world. Researchers used statistical methods to identify which symptoms tend to occur together, then compared their findings to three existing diagnostic guidelines. They found that the symptoms cluster into seven main groups, with post-exertional malaise (worsening after activity), cognitive problems, and sleep issues being particularly important.

SleepPost-Exertional Malaise
E2 ModeratePEM unclearModerate confidenceCross-SectionalEditor reviewed

Risk factors for suicidal ideation in a chronic illness.

Elliott, Meghan K, Jason, Leonard A·Death studies·2023

This study looked at why some people with ME/CFS experience suicidal thoughts. Researchers surveyed 559 people with ME/CFS and found that certain factors—including sleep problems, feeling stigmatized by others, loss of physical abilities, severe disability, and being unmarried—were associated with increased suicide risk. The findings suggest that better education about ME/CFS, reducing stigma, and developing effective treatments could help protect people with this illness.

Sleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Sleeping and Dietary Factors Associated with Chronic Fatigue Syndrome in Taiwanese Preschoolers.

Huang, Su-Fen, Duan, Hui-Ying·Children (Basel, Switzerland)·2023

This study looked at whether sleep habits and diet affect fatigue in young children (age 5) in Taiwan by asking parents about their children's sleep and eating patterns. The researchers found that children who slept well, got enough sleep, and had regular bedtimes felt less tired, while children with poor sleep quality felt more fatigued. Interestingly, eating regular, balanced meals seemed to help some children, but the connection wasn't as clear.

Sleep
E2 ModeratePEM unclearPreliminaryObservationalEditor reviewed

Key Features of a Multi-Disciplinary Hospital-Based Rehabilitation Program for Children and Adolescents with Moderate to Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome ME/CFS.

Hiremath, Sonya, Doukrou, Montserrat, Flannery, Halina et al.·International journal of environmental research and public health·2022

This study looked at 27 children and teenagers with moderate to severe ME/CFS who stayed in a hospital and received coordinated care from multiple medical professionals. Most patients (85%) showed improvement in at least one important area of their lives, such as being able to move around better, return to school, sleep better, or enjoy social activities. These results suggest that hospital-based rehabilitation programs can help young people with severe ME/CFS improve their quality of life.

Sleep
E2 ModeratePEM unclearPreliminaryCross-SectionalEditor reviewed

A description of the current status of chronic fatigue syndrome and associated factors among university students in Wuhan, China.

Luo, Lunbing, Zhang, Yutong, Huang, Tao et al.·Frontiers in psychiatry·2022

This study surveyed over 1,800 university students in Wuhan, China to understand how common ME/CFS is and what factors might contribute to it. Researchers found that about 6 in 100 students had ME/CFS, and identified several factors linked to the condition: pulling all-nighters, overeating, anxiety, and poor sleep quality increased risk, while being actively engaged in learning appeared protective. The study highlights that lifestyle and mental health factors may play important roles in ME/CFS among young adults.

Sleep
E2 ModeratePEM not requiredPreliminaryLongitudinalEditor reviewed

Tai Chi increases functional connectivity and decreases chronic fatigue syndrome: A pilot intervention study with machine learning and fMRI analysis.

Wu, Kang, Li, Yuanyuan, Zou, Yihuai et al.·PloS one·2022

This study tested whether Tai Chi exercise could help people with ME/CFS by looking at brain activity patterns. Researchers compared 20 ME/CFS patients with 20 healthy people, teaching both groups Tai Chi for one month. They found that Tai Chi improved fatigue, sleep quality, and overall health, and that specific brain networks became better connected after the training.

Sleep
E2 ModeratePEM not requiredModerate confidenceCase-ControlEditor reviewed

Associations of physical and psychiatric conditions with chronic fatigue syndrome in Germany: an exploratory case-control study.

Jacob, Louis, Haro, Josep Maria, Kostev, Karel·Psychological medicine·2022

Researchers in Germany studied nearly 20,000 adults to see which health conditions are linked to developing ME/CFS. They compared people newly diagnosed with ME/CFS to similar people without it, looking at health problems they had in the year before diagnosis. They found that cancer, sleep disorders, and depression were the conditions most strongly associated with ME/CFS.

Sleep
E2 ModeratePEM unclearModerate confidenceMethods-PaperEditor reviewed

Assessing sleep and pain among adults with myalgic encephalomyelitis/chronic fatigue syndrome: psychometric evaluation of the PROMIS® sleep and pain short forms.

Yang, Manshu, Keller, San, Lin, Jin-Mann S·Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation·2022

This study tested whether two questionnaires (PROMIS scales) accurately measure sleep problems and pain in people with ME/CFS. Researchers surveyed over 600 ME/CFS patients and 338 healthy people at seven clinics across the USA. The questionnaires worked well—they consistently measured what they were supposed to measure, and they clearly showed the difference between ME/CFS patients (who had worse sleep and pain) and healthy controls.

Pain and SensitizationSleep
E2 ModeratePEM unclearPreliminaryLongitudinalEditor reviewed

Impact of Life Stressors on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Symptoms: An Australian Longitudinal Study.

Balinas, Cassandra, Eaton-Fitch, Natalie, Maksoud, Rebekah et al.·International journal of environmental research and public health·2021

This Australian study followed 36 ME/CFS patients over five months to see how life stressors affected their symptoms. The researchers found that major life changes like work disruptions or money problems were linked to worsening symptoms like brain fog, stomach issues, pain, and sleep problems. Interestingly, patients who had better access to healthcare and support services experienced fewer severe symptoms.

Pain and SensitizationSleep
E2 ModeratePEM unclearPreliminaryCross-SectionalEditor reviewed

Clinical Profile and Aspects of Differential Diagnosis in Patients with ME/CFS from Latvia.

Krumina, Angelika, Vecvagare, Katrine, Svirskis, Simons et al.·Medicina (Kaunas, Lithuania)·2021

This study looked at 65 people with ME/CFS in Latvia to understand their main symptoms and how the condition differs from simple tiredness. Researchers found that people with ME/CFS commonly experience fatigue, muscle pain, joint pain, and sleep problems—more often than people without ME/CFS. When patients had other health conditions alongside ME/CFS, their symptoms tended to be more severe.

Pain and SensitizationSleepDiagnostics
E2 ModeratePEM unclearPreliminaryCross-SectionalEditor reviewed

Emotional Awareness Correlated With Number of Awakenings From Polysomnography in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-A Pilot Study.

Bileviciute-Ljungar, Indre, Friberg, Danielle·Frontiers in psychiatry·2020

This study examined the connection between emotional awareness and sleep problems in ME/CFS patients. Researchers found that patients who had difficulty recognizing and understanding their own emotions also experienced more frequent awakenings during sleep. The study involved 23 ME/CFS patients and 30 healthy controls who completed questionnaires about emotions, while the ME/CFS patients also underwent overnight sleep monitoring.

Sleep
E2 ModeratePEM unclearModerate confidenceCross-SectionalEditor reviewed

Health-related quality of life in patients with myalgic encephalomyelitis/chronic fatigue syndrome: an Australian cross-sectional study.

Eaton-Fitch, N, Johnston, S C, Zalewski, P et al.·Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation·2020

This Australian study of 480 people with ME/CFS found that the condition severely impacts quality of life across all major areas—physical functioning, emotional well-being, pain, and energy levels. People with ME/CFS scored much lower on quality of life measures compared to the general population, with the lowest scores for physical activities and fatigue. The study identified specific symptoms like cognitive difficulties, sleep problems, and cardiovascular issues that are most strongly linked to reduced quality of life.

Pain and SensitizationSleepCognitive Impairment
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Associations of occupational stress, workplace violence, and organizational support on chronic fatigue syndrome among nurses.

Li, Mengyao, Shu, Qianyi, Huang, Hao et al.·Journal of advanced nursing·2020

This study examined whether workplace stress, violence, and lack of organizational support increase the risk of ME/CFS in nurses. Researchers surveyed 1,080 Chinese nurses and found that those experiencing high levels of overcommitment, workplace violence, and little support from their employers were significantly more likely to have ME/CFS. The findings suggest that improving workplace safety, support, and reducing internal stress could help prevent ME/CFS in this high-risk group.

SleepCognitive Impairment
E2 ModeratePEM not requiredModerate confidenceCase-ControlEditor reviewed

Sleep problems in adolescents with CFS: A case-control study nested within a prospective clinical cohort.

Loades, Maria Elizabeth, Rimes, Katharine A, Chalder, Trudie·Clinical child psychology and psychiatry·2020

This study looked at sleep problems in teenagers with ME/CFS compared to healthy teenagers and those with asthma. Teenagers with ME/CFS reported significantly more sleep difficulties than both comparison groups. When researchers checked in 3 months later without any treatment, sleep problems remained largely unchanged, suggesting that sleep issues in ME/CFS don't improve on their own and may need specific attention during treatment.

Sleep
E2 ModeratePEM unclearModerate confidenceCross-SectionalEditor reviewed

Unemployment and work disability in individuals with chronic fatigue syndrome/myalgic encephalomyelitis: a community-based cross-sectional study from Spain.

Castro-Marrero, Jesús, Faro, Mónica, Zaragozá, María Cleofé et al.·BMC public health·2019

This Spanish study looked at 1,086 people with ME/CFS to understand why some are unable to work. Researchers found that more than half (58.6%) were unemployed due to illness. Several factors made work disability more likely, including severe fatigue and pain, autonomic problems (like dizziness or heart issues), neurological symptoms, depression, sleep problems, and having pain start at an older age.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Prevalence and characteristics of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in Poland: a cross-sectional study.

Słomko, Joanna, Newton, Julia L, Kujawski, Sławomir et al.·BMJ open·2019

Researchers in Poland studied 1,400 people who reported feeling very tired to understand how common ME/CFS really is. They found that 69 people actually had ME/CFS based on standard diagnostic criteria. These patients experienced severe fatigue that lasted years, had trouble staying awake during the day, problems with dizziness when standing up, anxiety, and depression—all of which seriously affected their quality of life.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Sleep patterns among patients with chronic fatigue: A polysomnography-based study.

Pajediene, Evelina, Bileviciute-Ljungar, Indre, Friberg, Danielle·The clinical respiratory journal·2018

This study looked at sleep problems in people with chronic fatigue by using a sleep monitoring test called polysomnography. Researchers found that more than half of the fatigued patients who also felt excessively sleepy had treatable sleep disorders like sleep apnea, restless legs, or periodic leg movements. The authors suggest that people with these symptoms should be tested for sleep disorders and treated before being diagnosed with ME/CFS, since fixing the sleep problem might help with fatigue.

Sleep
E2 ModeratePEM unclearModerate confidenceCross-SectionalEditor reviewed

Poor self-reported sleep quality and health-related quality of life in patients with chronic fatigue syndrome/myalgic encephalomyelitis.

Castro-Marrero, Jesús, Zaragozá, Maria C, González-Garcia, Sergio et al.·Journal of sleep research·2018

This study looked at sleep problems in 1,455 Spanish ME/CFS patients and found that nearly all of them reported poor sleep quality that wasn't refreshing, even when they slept. The researchers discovered that poor sleep was strongly linked to worse pain, fatigue, anxiety, depression, and lower quality of life overall. Several factors—including pain intensity, mood problems, fibromyalgia, and autonomic nervous system dysfunction—were particularly associated with sleep difficulties.

Pain and SensitizationSleepAutonomic Nervous System
E2 ModeratePEM not requiredModerate confidenceLongitudinalEditor reviewed

Childhood sleep and adolescent chronic fatigue syndrome (CFS/ME): evidence of associations in a UK birth cohort.

Collin, Simon M, Norris, Tom, Gringras, Paul et al.·Sleep medicine·2018

This study tracked children from birth through their teenage years to see if sleep problems in childhood were linked to developing ME/CFS later on. Researchers found that children who slept less at night during early childhood were more likely to develop chronic disabling fatigue as teenagers, and those with trouble falling asleep were at higher risk. Each extra hour of sleep at age 9 or 11 was associated with a significantly lower chance of developing the condition.

Sleep
E2 ModeratePEM not requiredModerate confidenceLongitudinalEditor reviewed

Reciprocal associations between daily need-based experiences, energy, and sleep in chronic fatigue syndrome.

Campbell, Rachel, Vansteenkiste, Maarten, Delesie, Liesbeth et al.·Health psychology : official journal of the Division of Health Psychology, American Psychological Association·2018

This study tracked 120 ME/CFS patients for 14 days to understand how their daily psychological needs, energy levels, and sleep quality relate to each other. Researchers found that on days when patients felt their needs were met (feeling in control, capable, and connected to others), they had more energy and better sleep. On days when patients felt frustrated in meeting these needs, they experienced more fatigue and worse sleep quality.

Sleep
E2 ModeratePEM not requiredPreliminaryRegistry-ResourceEditor reviewed

Improvement in mood, oxidative stress, fatigue, and insomnia following supplementary management with Robuvit®.

Belcaro, Gianni, Saggino, Aristide, Cornelli, Umberto et al.·Journal of neurosurgical sciences·2018

This study tested whether a supplement made from French oak wood called Robuvit® could help people with ME/CFS who experience fatigue, sleep problems, mood difficulties, and high levels of oxidative stress (cellular damage). Eighteen patients took 300 mg of Robuvit® daily for 8 weeks, while 22 others received standard care. The Robuvit® group showed significant improvements in mood, fatigue, sleep, and oxidative stress levels, with no safety concerns reported.

Sleep
E2 ModeratePEM unclearModerate confidenceCross-SectionalEditor reviewed

Sleep Quality in Adolescents With Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME).

Josev, Elisha K, Jackson, Melinda L, Bei, Bei et al.·Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine·2017

This study examined sleep problems in teenagers with ME/CFS compared to healthy teenagers. Researchers found that teens with ME/CFS took longer to fall asleep, spent more total time in bed, slept longer overall, woke up later, and reported feeling their sleep was of poorer quality. Anxiety levels were also higher in the ME/CFS group and were connected to worse sleep quality in both groups.

Sleep
E2 ModeratePEM not requiredModerate confidenceObservationalEditor reviewed

Specialist treatment of chronic fatigue syndrome/ME: a cohort study among adult patients in England.

Collin, Simon M, Crawley, Esther·BMC health services research·2017

This study looked at how 952 ME/CFS patients fared after receiving treatment at 11 specialist NHS clinics in England. One year after starting treatment, about 27% felt much better, 37% felt a little better, but 20% felt the same or worse. Even 2-5 years later, 85% of patients still had ME/CFS symptoms, showing that this is a long-lasting condition that often continues despite specialist care.

Pain and SensitizationSleep
E2 ModeratePEM requiredModerate confidenceCross-SectionalEditor reviewed

Case definitions integrating empiric and consensus perspectives.

Jason, Leonard A, McManimen, Stephanie, Sunnquist, Madison et al.·Fatigue : biomedicine, health & behavior·2016

This study looked at 556 ME/CFS patients from three countries to understand how doctors should diagnose this condition. The researchers found that patients fall into different groups based on their symptoms: some have chronic fatigue alone, some have fatigue with other medical reasons, and some have ME/CFS with additional symptoms like problems with exercise recovery, brain fog, and sleep issues. The groups with more specific ME/CFS symptoms were significantly more disabled than those with just general fatigue.

SleepPost-Exertional Malaise
E2 ModeratePEM not requiredPreliminaryCase-ControlEditor reviewed

Stressful Events in the Onset of Chronic Fatigue Syndrome.

Gimeno Pi, Iraida, Guitard Sein-Echaluce, M Luisa, Rosselló Aubach, Lluís et al.·Revista espanola de salud publica·2016

This study looked at whether stressful life events might trigger ME/CFS by comparing 77 people with the disease to 77 healthy people of similar age, sex, and education. Researchers found that certain stressful experiences—like pregnancy, domestic abuse, workplace bullying, eating disorders, car accidents, money problems, and sleep disruptions—occurred more often in people before they developed ME/CFS. The study suggests that identifying these stressful events in at-risk people might help doctors recognize ME/CFS earlier.

Sleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Factors determining fatigue in the chronic fatigue syndrome: a path analysis.

Tobback, Els, Hanoulle, Ignace, Mariman, An et al.·Acta clinica Belgica·2016

This study looked at how different factors—sleep quality, mood, and overall health—affect fatigue in ME/CFS patients. Researchers asked 167 patients to fill out questionnaires about their fatigue, sleep, personality traits, and quality of life. Surprisingly, they found that poor sleep directly harmed both physical and mental quality of life, but didn't necessarily increase fatigue scores on standard tests.

Sleep
E2 ModeratePEM not requiredModerate confidenceLongitudinalEditor reviewed

Subjective but Not Actigraphy-Defined Sleep Predicts Next-Day Fatigue in Chronic Fatigue Syndrome: A Prospective Daily Diary Study.

Russell, Charlotte, Wearden, Alison J, Fairclough, Gillian et al.·Sleep·2016

This study found that how people with ME/CFS feel about their sleep quality matters more for next-day fatigue than what sleep monitors actually measure. When patients reported poor sleep quality or felt their sleep wasn't refreshing, they experienced worse fatigue the following day. Interestingly, people who worried or felt anxious before bed reported worse sleep, and waking up in a bad mood partly explained why poor sleep led to more fatigue.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

A Cross Cultural Comparison of Disability and Symptomatology Associated with CFS.

Zdunek, Maria, Jason, Leonard A, Evans, Meredyth et al.·International journal of psychology and behavioral sciences·2015

This study compared ME/CFS symptoms and disability between patients in the United States and the United Kingdom to see if the illness looks different depending on where people live. Researchers found that UK patients reported more mental health problems, pain, memory/concentration issues, and immune symptoms, while US patients more often experienced sudden illness onset and attributed their illness to physical causes. The study suggests that ME/CFS may present somewhat differently across these two countries.

Pain and SensitizationSleepCognitive Impairment
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Slow wave sleep in the chronically fatigued: Power spectra distribution patterns in chronic fatigue syndrome and primary insomnia.

Neu, Daniel, Mairesse, Olivier, Verbanck, Paul et al.·Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology·2015

This study looked at the deepest, most restorative type of sleep in people with ME/CFS and primary insomnia to understand why both groups feel tired and don't feel rested despite sleeping. Researchers used special brain wave measurements during sleep and found that both groups had unusual patterns of very slow brain waves during deep sleep, even though they were getting normal or sometimes even extra amounts of deep sleep. The findings suggest that the problem may not be getting enough deep sleep, but rather that the quality or type of brain activity during that sleep is different.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Sleep characteristics, exercise capacity and physical activity in patients with chronic fatigue syndrome.

Aerenhouts, Dirk, Ickmans, Kelly, Clarys, Peter et al.·Disability and rehabilitation·2015

This study looked at how sleep problems and low activity levels are connected in people with ME/CFS. Researchers measured fitness capacity, sleep patterns, and daily activity in 42 women with ME/CFS and compared them to 24 healthy inactive women. People with ME/CFS slept more, spent more time in bed, had difficulty falling asleep and staying asleep, and were less physically active than the control group.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

The association between daytime napping and cognitive functioning in chronic fatigue syndrome.

Gotts, Zoe M, Ellis, Jason G, Deary, Vincent et al.·PloS one·2015

This study looked at how sleep patterns, especially daytime napping, affect fatigue, sleepiness, and thinking ability in people with ME/CFS. Researchers asked 118 patients to keep a sleep diary for two weeks and complete daily assessments of their symptoms. They found that afternoon napping was linked to worse cognitive problems and increased daytime sleepiness, suggesting that when and how much patients nap may influence how well they can think and function.

SleepCognitive Impairment
E2 ModeratePEM not requiredModerate confidenceObservationalEditor reviewed

The role of insomnia in the treatment of chronic fatigue.

Kallestad, Håvard, Jacobsen, Henrik B, Landrø, Nils Inge et al.·Journal of psychosomatic research·2015

This study examined whether improving sleep problems (insomnia) could help people with chronic fatigue feel less tired and recover better from stress. Researchers worked with 122 people who had chronic fatigue and received a 3.5-week rehabilitation program focused on acceptance and commitment therapy. They found that patients whose insomnia improved also experienced greater improvements in fatigue and had better stress recovery, suggesting that treating sleep problems may be an important part of treating chronic fatigue.

Sleep
E2 ModeratePEM unclearPreliminaryObservationalEditor reviewed

Multivitamin mineral supplementation in patients with chronic fatigue syndrome.

Maric, Daniela, Brkic, Snezana, Tomic, Slavica et al.·Medical science monitor : international medical journal of experimental and clinical research·2014

This study tested whether taking a multivitamin and mineral supplement could help women with ME/CFS feel better. Thirty-eight women took the supplement for 2 months, and researchers measured changes in fatigue, sleep, headaches, and other symptoms. Most symptoms improved notably, including less fatigue and better sleep, though overall quality of life scores did not change.

SleepAutonomic Nervous System
E2 ModeratePEM not requiredModerate confidenceLongitudinalEditor reviewed

The role of hypocortisolism in chronic fatigue syndrome.

Nijhof, Sanne L, Rutten, Juliette M T M, Uiterwaal, Cuno S P M et al.·Psychoneuroendocrinology·2014

This study looked at stress hormone levels (cortisol) in adolescents with ME/CFS by measuring saliva samples. Teenagers with ME/CFS had lower cortisol levels than healthy peers, and those who improved with treatment showed their cortisol levels normalize, while those who didn't recover showed little change. The findings suggest that restoration of normal cortisol production during treatment may be linked to better outcomes.

Sleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Heart rate variability during sleep and subsequent sleepiness in patients with chronic fatigue syndrome.

Togo, Fumiharu, Natelson, Benjamin H·Autonomic neuroscience : basic & clinical·2013

This study looked at how the heart's rhythm changes during sleep in ME/CFS patients compared to healthy people, and whether these changes relate to feeling more or less tired after sleep. Researchers found that some ME/CFS patients who woke up feeling sleepier had different heart rhythm patterns during deep sleep than healthy controls, even though standard sleep measurements looked normal. This suggests the nervous system's control of the heart during sleep might be disrupted in ME/CFS, which could contribute to unrefreshing sleep.

SleepAutonomic Nervous System
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Are there sleep-specific phenotypes in patients with chronic fatigue syndrome? A cross-sectional polysomnography analysis.

Gotts, Zoe M, Deary, Vincent, Newton, Julia et al.·BMJ open·2013

This study looked at sleep patterns in 343 people with chronic fatigue syndrome using overnight sleep monitoring machines. Researchers found that about 30% of patients had a separate sleep disorder, and the remaining patients fell into four different groups based on their sleep problems—some had trouble falling asleep, some had frequent sleep interruptions, some slept longer than average, and some had very short sleep with lots of waking. The findings suggest that people with ME/CFS have different types of sleep problems and may benefit from different sleep treatments based on their specific pattern.

Sleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Temporal organization of rest defined by actigraphy data in healthy and childhood chronic fatigue syndrome children.

Kawabata, Minako, Ueno, Taro, Tomita, Jun et al.·BMC psychiatry·2013

This study looked at sleep and rest patterns in healthy children and children with chronic fatigue syndrome (CFS) using wristband activity trackers. The researchers found that when they looked at the patterns of rest and sleep separately—distinguishing between time spent out of bed versus in bed—children with CFS had different patterns compared to healthy children. This suggests that how the body organizes rest and activity may be disrupted in CFS.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Subjective sleep quality and daytime sleepiness in a large sample of patients with chronic fatigue syndrome (CFS).

Mariman, A, Vogelaers, D, Hanoulle, I et al.·Acta clinica Belgica·2012

This study looked at sleep problems in 415 ME/CFS patients by asking them to complete questionnaires about sleep quality and daytime sleepiness. The researchers found that ME/CFS patients reported both poor sleep quality and high daytime sleepiness, but these two problems didn't always occur together—some patients had poor sleep quality without feeling sleepy during the day, and a smaller group resembled people with insomnia. The findings suggest that sleep problems in ME/CFS are complex and may affect different patients in different ways.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Long-term sickness absence among patients with chronic fatigue syndrome.

Knudsen, Ann Kristin, Henderson, Max, Harvey, Samuel B et al.·The British journal of psychiatry : the journal of mental science·2011

This study looked at ME/CFS patients who were on long-term sick leave from work and compared them to those still working. Patients taking sick leave had more severe physical fatigue and sleep problems than other patients. Interestingly, those on sick leave also tended to avoid situations they found embarrassing and rested more often as a coping strategy. The researchers suggest that helping patients manage embarrassment-related thoughts and avoidance behaviors might help them return to work.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Characteristics of chronic fatigue syndrome in a Japanese community population : chronic fatigue syndrome in Japan.

Hamaguchi, Masahide, Kawahito, Yutaka, Takeda, Noriyuki et al.·Clinical rheumatology·2011

This Japanese study looked at how many people have ME/CFS in the general population and what their daily habits are like. Researchers found that about 1 in 100 people in Japan have ME/CFS, and people with the condition slept significantly less (about 5.5 hours per night) compared to people without it (about 6.3 hours). The symptom of unrefreshing sleep was particularly useful for identifying who has ME/CFS.

Sleep
E2 ModeratePEM unclearPreliminaryObservationalEditor reviewed

Treatment of the narcoleptiform sleep disorder in chronic fatigue syndrome and fibromyalgia with sodium oxybate.

Spitzer, A Robert, Broadman, Melissa·Pain practice : the official journal of World Institute of Pain·2010

Researchers looked at 118 patients with ME/CFS or fibromyalgia who had sleep problems similar to narcolepsy. When these patients were treated with a medication called sodium oxybate, 75% reported significant improvement in fatigue and 60% reported significant improvement in pain. This suggests that fixing the underlying sleep disorder might help relieve both conditions.

Sleep
E2 ModeratePEM not requiredPreliminaryCase-ControlEditor reviewed

Adolescent offspring of mothers with chronic fatigue syndrome.

Smith, Mark S, Buchwald, Dedra S, Bogart, Andy et al.·The Journal of adolescent health : official publication of the Society for Adolescent Medicine·2010

This study looked at whether teenagers whose mothers have ME/CFS are more likely to develop ME/CFS themselves or experience fatigue and other related symptoms. Researchers compared 26 teenagers with mothers who had ME/CFS to 45 teenagers whose mothers were healthy. While teenagers with affected mothers showed higher rates of prolonged fatigue and ME/CFS diagnosis, the differences were small and not statistically proven.

Pain and SensitizationSleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Replication of an empirical approach to delineate the heterogeneity of chronic unexplained fatigue.

Aslakson, Eric, Vollmer-Conna, Uté, Reeves, William C et al.·Population health metrics·2009

This study looked at nearly 400 women from different parts of Georgia to understand why chronic fatigue affects people so differently. Instead of treating all chronic fatigue as one disease, researchers found that people fall into five distinct groups with different symptom patterns—some with sleep and mood problems, some with weight and metabolic issues, and some without significant fatigue at all. The findings suggest that chronic fatigue is not one-size-fits-all, and doctors may need personalized approaches for different patient groups.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

High slow-wave sleep and low-light sleep: chronic fatigue syndrome is not likely to be a primary sleep disorder.

Neu, Daniel, Cappeliez, Bernard, Hoffmann, Guy et al.·Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society·2009

This study compared sleep patterns between people with ME/CFS and people with a primary sleep disorder (sleep apnea) to see if ME/CFS might actually be a sleep problem in disguise. Researchers found that ME/CFS patients have distinctly different sleep patterns—more deep sleep and fewer light sleep stages—compared to people with actual sleep disorders. This suggests ME/CFS is not primarily a sleep disorder, even though both conditions cause people to feel unrefreshed.

Sleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Sleep apnea and psychological functioning in chronic fatigue syndrome.

Libman, Eva, Creti, Laura, Baltzan, Marcel et al.·Journal of health psychology·2009

This study looked at whether sleep apnea (a condition where breathing stops and starts during sleep) is common in people with ME/CFS and how it affects mood and psychological well-being. The researchers found that 68% of ME/CFS patients had sleep apnea, but those who did were not significantly more ill than those without it. Both the ME/CFS and sleep apnea groups showed more psychological difficulties than healthy controls, but the researchers suggest these emotional struggles are likely a natural response to living with a chronic illness rather than a separate psychiatric condition.

SleepDiagnostics
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Electroencephalographic correlates of Chronic Fatigue Syndrome.

Decker, Michael J, Tabassum, Humyra, Lin, Jin-Mann S et al.·Behavioral and brain functions : BBF·2009

This study looked at brain wave patterns during sleep in people with ME/CFS compared to healthy controls using a sleep study test. Researchers found that people with ME/CFS had abnormal brain wave activity during different sleep stages, particularly weaker delta waves during deep sleep and weaker alpha waves during REM sleep. These findings suggest that the problem in ME/CFS may not be the structure of sleep itself, but rather how the brain regulates and maintains restorative sleep.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Actigraphic assessment of sleep disorders in children with chronic fatigue syndrome.

Ohinata, Junko, Suzuki, Nao, Araki, Akiko et al.·Brain & development·2008

This study examined sleep patterns in 12 children with ME/CFS using a special watch-like device called an actigraph that tracks movement and sleep. Children with ME/CFS slept much longer than healthy children but had lower activity levels and disrupted sleep patterns. The researchers found two main types of sleep problems: some children had very irregular sleep schedules, while others had a delayed sleep phase (sleeping much later than normal).

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Dynamics of sleep stage transitions in healthy humans and patients with chronic fatigue syndrome.

Kishi, Akifumi, Struzik, Zbigniew R, Natelson, Benjamin H et al.·American journal of physiology. Regulatory, integrative and comparative physiology·2008

This study examined sleep patterns in people with ME/CFS compared to healthy people by recording brain activity during sleep. Researchers found that people with ME/CFS have disrupted transitions between different types of sleep, particularly trouble maintaining lighter sleep and REM sleep, and instead wake up more frequently. This suggests that the brain's sleep regulation mechanisms work differently in ME/CFS.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Sleep structure and sleepiness in chronic fatigue syndrome with or without coexisting fibromyalgia.

Togo, Fumiharu, Natelson, Benjamin H, Cherniack, Neil S et al.·Arthritis research & therapy·2008

This study looked at sleep patterns in people with ME/CFS, comparing those with and without fibromyalgia to healthy people. Researchers found that ME/CFS patients had worse sleep quality and felt more tired and sleepy after sleeping than healthy controls. The key finding was that some ME/CFS patients experienced frequent sleep interruptions—their sleep kept getting broken up—which made their sleep feel unrefreshing even though they didn't have diagnosable sleep disorders like sleep apnea.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Are patients with chronic fatigue syndrome just 'tired' or also 'sleepy'?

Neu, Daniel, Hoffmann, Guy, Moutrier, Robert et al.·Journal of sleep research·2008

This study asked whether ME/CFS patients experience daytime sleepiness (like wanting to nap) or mainly fatigue (exhaustion that doesn't improve with rest). Researchers tested 16 ME/CFS patients, 13 sleep apnea patients, and 12 healthy people using both objective sleep tests and questionnaires. They found that ME/CFS patients reported much higher fatigue than sleepiness, while sleep apnea patients showed the opposite pattern—suggesting fatigue and sleepiness are different problems.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Perception versus polysomnographic assessment of sleep in CFS and non-fatigued control subjects: results from a population-based study.

Majer, Matthias, Jones, James F, Unger, Elizabeth R et al.·BMC neurology·2007

People with ME/CFS commonly report that their sleep doesn't feel refreshing and that they have trouble sleeping, even though standard sleep tests don't always show obvious sleep problems. This study compared how 35 people with ME/CFS and 40 healthy people described their sleep quality against what their actual sleep looked like on overnight sleep monitoring. Interestingly, the sleep recordings looked similar between both groups, but ME/CFS patients were more accurate at noticing their actual sleep behavior, while healthy controls tended to overestimate how long it took them to fall asleep.

Sleep
E2 ModeratePEM not requiredModerate confidenceCase-ControlEditor reviewed

Higher heart rate and reduced heart rate variability persist during sleep in chronic fatigue syndrome: a population-based study.

Boneva, Roumiana S, Decker, Michael J, Maloney, Elizabeth M et al.·Autonomic neuroscience : basic & clinical·2007

This study found that people with ME/CFS have a faster heart rate and less heart rate variability (natural changes in heartbeat speed) during sleep compared to healthy people. These differences suggest that the nervous system in ME/CFS patients stays more activated even during sleep, which may be related to chemical imbalances in the body.

SleepAutonomic Nervous System
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Sleep quality perception in the chronic fatigue syndrome: correlations with sleep efficiency, affective symptoms and intensity of fatigue.

Neu, Daniel, Mairesse, Olivier, Hoffmann, Guy et al.·Neuropsychobiology·2007

ME/CFS patients often report feeling like they have poor sleep quality, even though doctors cannot always find obvious problems when measuring sleep objectively. This study compared how ME/CFS patients and healthy people rated their own sleep quality and found that ME/CFS patients consistently reported worse sleep, despite having similar sleep efficiency measurements. The poor sleep quality perception was somewhat linked to fatigue severity but not related to depression or anxiety symptoms.

Sleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

[Estimation of fatigue state in patient with CFS using actigraph and R-R interval power spectrum analysis].

Tajima, Seiki, Kuratsune, Hirohiko, Yamaguti, Kouzi et al.·Nihon rinsho. Japanese journal of clinical medicine·2007

This study measured activity levels and sleep patterns in people with ME/CFS using wearable devices and heart rate analysis. Researchers found that ME/CFS patients had lower activity during waking hours, slept longer, experienced more frequent sleep disruptions, and showed abnormal nervous system activity during sleep compared to healthy people.

SleepAutonomic Nervous System
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Linear data mining the Wichita clinical matrix suggests sleep and allostatic load involvement in chronic fatigue syndrome.

Gurbaxani, Brian M, Jones, James F, Goertzel, Benjamin N et al.·Pharmacogenomics·2006

Researchers analyzed clinical data from 164 ME/CFS patients and controls to identify patterns that distinguish the condition from health. Using mathematical techniques to find which body measurements best separated the two groups, they found that sleep problems and markers of physical stress (allostatic load) were important—though no single measurement was strongly predictive on its own. The study suggests that ME/CFS may involve multiple interconnected biological changes rather than one simple cause.

Sleep
E2 ModeratePEM unclearPreliminaryCross-SectionalEditor reviewed

An empirical delineation of the heterogeneity of chronic unexplained fatigue in women.

Vollmer-Conna, Uté, Aslakson, Eric, White, Peter D·Pharmacogenomics·2006

This study looked at 159 women to understand why chronic fatigue affects people differently. Researchers used statistical analysis to group the women into distinct clusters based on their symptoms, sleep patterns, hormone levels, and stress responses. They found that chronic fatigue is not one single condition, but rather several different conditions with different underlying causes—some linked to sleep problems, others to depression, obesity, or hormonal changes.

Sleep
E2 ModeratePEM not requiredModerate confidenceCase-ControlEditor reviewed

Sleep characteristics of persons with chronic fatigue syndrome and non-fatigued controls: results from a population-based study.

Reeves, William C, Heim, Christine, Maloney, Elizabeth M et al.·BMC neurology·2006

This study compared sleep patterns in people with ME/CFS and healthy controls using overnight sleep monitoring tests. Researchers found that people with ME/CFS had slightly more breathing interruptions during sleep, but overall sleep architecture (the normal stages and patterns of sleep) was similar between the two groups. The results suggest that while sleep problems are common in ME/CFS, they may not be caused by the same underlying sleep abnormalities seen in other sleep disorders.

Sleep
E2 ModeratePEM not requiredModerate confidenceCase-ControlEditor reviewed

Subjective and objective sleepiness in monozygotic twins discordant for chronic fatigue syndrome.

Watson, Nathaniel F, Jacobsen, Clemma, Goldberg, Jack et al.·Sleep·2004

This study compared sleepiness in identical twins where one had ME/CFS and one did not. People with ME/CFS reported feeling much more sleepy on questionnaires, but when researchers measured how quickly they fell asleep in a lab test, both groups fell asleep at similar speeds. The researchers suggest that people with ME/CFS may be confusing their chronic exhaustion with sleepiness.

Sleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Chronic fatigue syndrome impairs circadian rhythm of activity level.

Tryon, Warren W, Jason, Lenny, Frankenberry, Erin et al.·Physiology & behavior·2004

This study looked at how people with ME/CFS move and rest throughout the day and night by using activity monitors worn on the waist. Researchers found that people with ME/CFS were less active during the day and had less predictable patterns of activity and rest compared to healthy people. These disrupted patterns may help explain why ME/CFS patients experience fatigue and other symptoms.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Sleep assessment in a population-based study of chronic fatigue syndrome.

Unger, Elizabeth R, Nisenbaum, Rosane, Moldofsky, Harvey et al.·BMC neurology·2004

This study looked at sleep problems in 339 people with ME/CFS from Kansas to understand how sleep issues relate to their fatigue. Researchers found that over 80% of ME/CFS patients had at least one sleep problem, with non-restorative sleep (sleep that doesn't feel refreshing) and restlessness being the most common. Interestingly, ME/CFS patients were not unusually sleepy during the day, which suggests their fatigue comes from a different mechanism than typical sleep deprivation.

Sleep
E2 ModeratePEM not requiredModerate confidenceCase-ControlEditor reviewed

Comparison of subjective and objective measures of insomnia in monozygotic twins discordant for chronic fatigue syndrome.

Watson, Nathaniel F, Kapur, Vishesh, Arguelles, Lester M et al.·Sleep·2003

People with ME/CFS report feeling like they sleep poorly and don't rest well, but when researchers measured their actual sleep using medical equipment, the sleep looked similar to their healthy identical twins. The main difference was that people with ME/CFS had more REM sleep (a specific sleep stage) and felt much less refreshed after sleeping, even though the equipment showed they were sleeping normally. This suggests that ME/CFS may involve a mismatch between how sleep actually is and how it feels.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

How significant are primary sleep disorders and sleepiness in the chronic fatigue syndrome?

Le Bon, O, Fischler, B, Hoffmann, G et al.·Sleep research online : SRO·2000

This study looked at whether sleep problems might explain ME/CFS symptoms in 46 patients. Researchers found that many CFS patients did have sleep disorders like sleep apnea, but these sleep problems were not connected to how severe their CFS was or their other symptoms. Importantly, over half of the CFS patients had no sleep disorders at all, suggesting that ME/CFS is a distinct condition separate from typical sleep problems.

Sleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

High nocturnal melatonin in adolescents with chronic fatigue syndrome.

Knook, L, Kavelaars, A, Sinnema, G et al.·The Journal of clinical endocrinology and metabolism·2000

Researchers measured melatonin (a natural hormone that helps control sleep) in saliva samples from 13 teenagers with ME/CFS and 15 healthy teenagers. They found that ME/CFS patients had significantly higher melatonin levels during the night, yet paradoxically, all the ME/CFS patients reported their sleep felt unrefreshing and unrestorative. Based on this finding, the researchers suggested that giving melatonin supplements to teenagers with ME/CFS may not be helpful.

Sleep
E2 ModeratePEM unclearModerate confidenceLongitudinalEditor reviewed

Prognostic factors for persons with idiopathic chronic fatigue.

Hartz, A J, Kuhn, E M, Bentler, S E et al.·Archives of family medicine·1999

This study followed 199 people with chronic fatigue for 2 years to understand which factors predicted who would improve. Researchers found that people who had clearer thinking, fewer additional symptoms, better sleep patterns, and were married tended to show the most improvement in fatigue. Interestingly, when patients improved in other symptoms like depression, muscle pain, or sleep problems, their fatigue also tended to improve together.

SleepCognitive Impairment
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Exploring the validity of the Chalder Fatigue scale in chronic fatigue syndrome.

Morriss, R K, Wearden, A J, Mullis, R·Journal of psychosomatic research·1998

This study tested whether the Chalder Fatigue Scale—a common questionnaire used to measure tiredness in ME/CFS patients—actually measures what it claims to measure. Researchers analyzed responses from 136 ME/CFS patients and found that fatigue has four distinct components: mental tiredness (linked to thinking problems), sleep difficulties, physical weakness (linked to low fitness), and depression. The results suggest the 11-item version of the scale works better than the original 14-item version for measuring fatigue in ME/CFS.

SleepCognitive Impairment
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Lack of seasonal variation of symptoms in patients with chronic fatigue syndrome.

García-Borreguero, D, Dale, J K, Rosenthal, N E et al.·Psychiatry research·1998

Many people experience changes in energy, mood, appetite, and sleep across different seasons, often feeling worse in winter. This study tested whether ME/CFS patients experience these same seasonal changes. The researchers found that ME/CFS patients actually show much less seasonal variation in their symptoms compared to healthy people, suggesting their fatigue and other symptoms stay relatively constant year-round rather than fluctuating with the seasons.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Sleep abnormalities demonstrated by home polysomnography in teenagers with chronic fatigue syndrome.

Stores, G, Fry, A, Crawford, C·Journal of psychosomatic research·1998

Researchers used home sleep monitoring equipment to measure sleep quality in 18 teenagers with ME/CFS compared to healthy teens of the same age and gender. They found that teenagers with ME/CFS woke up much more frequently during the night—both for brief moments and longer periods—compared to the healthy group. These frequent sleep disruptions could help explain why young people with ME/CFS feel so exhausted during the day.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Do patients with "pure" chronic fatigue syndrome (neurasthenia) have abnormal sleep?

Sharpley, A, Clements, A, Hawton, K et al.·Psychosomatic medicine·1997

This study compared sleep in 20 people with ME/CFS (who did not have depression, anxiety, or other sleep disorders) to 20 healthy people. Although ME/CFS patients reported feeling like they had poor, unrefreshing sleep and took daytime naps, objective sleep measurements showed surprisingly few differences—most patients actually slept a normal amount of time at night, though they spent longer lying awake after first falling asleep.

Sleep
E2 ModeratePEM not requiredPreliminaryObservationalEditor reviewed

An open study of the efficacy and adverse effects of moclobemide in patients with the chronic fatigue syndrome.

White, P D, Cleary, K J·International clinical psychopharmacology·1997

This study tested whether a medication called moclobemide could help people with ME/CFS. Researchers gave 49 patients the drug for 6 weeks and found small improvements in fatigue, depression, and anxiety. The medication worked better for patients who also had depression, with half of them feeling much better, compared to only about one-fifth of those without depression.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

The relation of sleep difficulties to fatigue, mood and disability in chronic fatigue syndrome.

Morriss, R K, Wearden, A J, Battersby, L·Journal of psychosomatic research·1997

This study looked at sleep problems in 69 people with ME/CFS who had no mental health conditions and 58 with ME/CFS plus depression or anxiety. Researchers found that sleep difficulties are common in ME/CFS but are usually caused by the illness itself rather than depression. People with ME/CFS often took naps and woke up from pain, and when their sleep got worse, their ME/CFS symptoms often worsened too.

Sleep
E2 ModeratePEM unclearModerate confidenceCross-SectionalEditor reviewed

Sleep anomalies in the chronic fatigue syndrome. A comorbidity study.

Fischler, B, Le Bon, O, Hoffmann, G et al.·Neuropsychobiology·1997

This study examined sleep patterns in 49 ME/CFS patients compared to 20 healthy people using overnight sleep monitoring. Patients with ME/CFS had difficulty falling asleep and staying asleep, and spent less time in deep, restorative stage 4 sleep. These sleep problems were distinctive enough that researchers could correctly identify who had ME/CFS based on sleep patterns alone.

Sleep
E2 ModeratePEM unclearPreliminaryCase-ControlEditor reviewed

Somatomedin C (insulin-like growth factor I) levels in patients with chronic fatigue syndrome.

Bennett, A L, Mayes, D M, Fagioli, L R et al.·Journal of psychiatric research·1997

Researchers measured levels of somatomedin C (a growth-related hormone) in 49 ME/CFS patients and compared them to 30 healthy people. They found that ME/CFS patients had higher levels of this hormone than healthy controls. This is interesting because a similar condition called fibromyalgia shows the opposite pattern—lower levels of this hormone.

Sleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Periodic K-alpha sleep EEG activity and periodic limb movements during sleep: comparisons of clinical features and sleep parameters.

MacFarlane, J G, Shahal, B, Mously, C et al.·Sleep·1996

This study examined a specific brain wave pattern during sleep called K-alpha activity and compared it to periodic leg movements during sleep. Researchers found that patients with K-alpha activity were predominantly women, younger, and more likely to have fibromyalgia and chronic fatigue syndrome, while also experiencing unrefreshing sleep, stomach problems, and muscle pain.

Sleep
E2 ModeratePEM not requiredModerate confidenceLongitudinalEditor reviewed

Neuraesthenia revisited: ICD-10 and DSM-III-R psychiatric syndromes in chronic fatigue patients and comparison subjects.

Farmer, A, Jones, I, Hillier, J et al.·The British journal of psychiatry : the journal of mental science·1995

This study examined psychiatric conditions in people with chronic fatigue syndrome (CFS) using standardized diagnostic interviews. Most CFS patients met criteria for a condition called neuraesthenia (an older term for nerve exhaustion) and had higher rates of depression, anxiety, and sleep problems compared to healthy people. Interestingly, when researchers followed patients over about 11 months without giving specific treatment, some psychiatric symptoms improved on their own, while the core fatigue condition remained.

SleepDiagnostics
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Dimensional assessment of chronic fatigue syndrome.

Vercoulen, J H, Swanink, C M, Fennis, J F et al.·Journal of psychosomatic research·1994

This study asked 298 people with ME/CFS to fill out detailed questionnaires about how the illness affected them. Researchers found that ME/CFS affects people in nine different ways: mood and emotional health, ability to do daily activities, sleep quality, physical avoidance, thinking and memory problems, beliefs about what caused their illness, relationships and social life, confidence in their own abilities, and overall life satisfaction. Understanding these separate aspects could help doctors better assess and treat ME/CFS in individual patients.

SleepCognitive Impairment
E2 ModeratePEM not requiredModerate confidenceObservationalEditor reviewed

Sleep disorders in patients with chronic fatigue.

Buchwald, D, Pascualy, R, Bombardier, C et al.·Clinical infectious diseases : an official publication of the Infectious Diseases Society of America·1994

This study looked at sleep problems in 59 people with chronic fatigue, most of whom had ME/CFS. Researchers found that 81% had at least one sleep disorder—most commonly sleep apnea—that might be treatable. Importantly, these sleep problems occurred whether or not people met the full criteria for ME/CFS, suggesting they are a separate issue worth investigating and treating.

Sleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Alpha-delta sleep in patients with a chief complaint of chronic fatigue.

Manu, P, Lane, T J, Matthews, D A et al.·Southern medical journal·1994

This study looked at sleep patterns in 30 patients with chronic fatigue to understand what might be causing their exhaustion. Researchers found that a specific type of abnormal sleep pattern called 'alpha-delta sleep' appeared in about 26% of patients, but it was not clearly linked to ME/CFS or fibromyalgia. The study also found that one-third of the patients had other primary sleep disorders like sleep apnea that may have been contributing to their fatigue.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Sleep disturbance in chronic fatigue syndrome.

Krupp, L B, Jandorf, L, Coyle, P K et al.·Journal of psychosomatic research·1993

This study looked at sleep problems in 72 people with ME/CFS, comparing them to people with multiple sclerosis and healthy volunteers. People with ME/CFS reported much worse sleep and fatigue than the other groups. When researchers used sleep monitoring equipment on some ME/CFS patients, they found that over half had treatable sleep disorders like sleep apnea or periodic leg movements during sleep.

Sleep
E2 ModeratePEM unclearPreliminaryCross-SectionalEditor reviewed

Sleep, Epstein-Barr virus infection, musculoskeletal pain, and depressive symptoms in chronic fatigue syndrome.

Whelton, C L, Salit, I, Moldofsky, H·The Journal of rheumatology·1992

This study compared sleep patterns, virus exposure, and symptoms in 14 ME/CFS patients versus 12 healthy people. Patients reported sleep that didn't feel refreshing and had unusual brain wave patterns during sleep, but didn't show excessive daytime sleepiness. The study found no evidence that a chronic Epstein-Barr virus infection was causing the illness, but patients did have more widespread pain, tender points, and depression symptoms.

Pain and SensitizationSleep
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Fatigue after COVID-19 in non-hospitalized patients according to sex.

Mazurkiewicz, Iwona, Chatys-Bogacka, Zaneta, Slowik, Joanna et al.·Brain and behavior·2023

This study looked at whether men and women experience post-COVID fatigue differently after a mild COVID-19 infection. Researchers asked 303 people (mostly women) about fatigue symptoms before COVID-19 and at different time points afterward. Women reported more persistent tiredness that didn't improve with rest, sleep problems, and sore throats compared to men, especially in the weeks right after infection.

Sleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Somatic symptom disorder in patients with post-COVID-19 neurological symptoms: a preliminary report from the somatic study (Somatic Symptom Disorder Triggered by COVID-19).

Kachaner, Alexandra, Lemogne, Cédric, Dave, Julie et al.·Journal of neurology, neurosurgery, and psychiatry·2022

This study examined whether patients with long-lasting neurological symptoms after COVID-19 meet diagnostic criteria for somatic symptom disorder (SSD), a condition where psychological distress can amplify physical symptoms. Researchers evaluated 50 patients and found that about two-thirds met SSD criteria, though brain imaging and standard neurological tests were mostly normal. Most patients also had fatigue meeting chronic fatigue syndrome criteria, sleep problems, and significant work loss.

Sleep
E2 ModeratePEM not requiredModerate confidenceObservationalEditor reviewed

Transitional Changes in Fatigue-Related Symptoms Due to Long COVID: A Single-Center Retrospective Observational Study in Japan.

Nakano, Yasuhiro, Otsuka, Yuki, Honda, Hiroyuki et al.·Medicina (Kaunas, Lithuania)·2022

This study compared long COVID symptoms in patients infected with different COVID-19 variants (Delta vs. Omicron) in Japan. Patients infected with Omicron had milder initial illness but were more likely to experience fatigue, sleep problems, and ongoing cough. Those infected with Delta were more likely to lose their sense of taste or smell and experience hair loss.

Sleep
E2 ModeratePEM not requiredModerate confidenceObservationalEditor reviewed

Characteristics of Sleep Disturbance in Patients with Long COVID: A Retrospective Observational Study in Japan.

Sunada, Naruhiko, Nakano, Yasuhiro, Otsuka, Yuki et al.·Journal of clinical medicine·2022

This study looked at sleep problems in 363 long COVID patients in Japan and found that about 16.5% had significant sleep disturbance. People infected during the Omicron wave were twice as likely to have sleep problems compared to those infected during the Delta wave. Patients with sleep disturbance also reported more fatigue, brain fog, headaches, and anxiety, and had abnormal stress hormone levels suggesting their bodies were under persistent stress.

SleepCognitive Impairment
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Post-Covid-19 Syndrome: Improvements in Health-Related Quality of Life Following Psychology-Led Interdisciplinary Virtual Rehabilitation.

Harenwall, Sari, Heywood-Everett, Suzanne, Henderson, Rebecca et al.·Journal of primary care & community health·2021

Researchers created a 7-week online rehabilitation program for people recovering from long COVID, led by psychologists and a team of other health professionals. The program covered topics like managing fatigue, improving sleep, nutrition, stress management, and activity pacing. Among 76 participants who completed the program and filled out quality-of-life surveys, people reported significant improvements in their ability to move around, care for themselves, do daily activities, and manage pain and mood.

Sleep
E2 ModeratePEM unclearPreliminaryLongitudinalEditor reviewed

Characterization of Post-Viral Infection Behaviors Among Patients With Long COVID: Prospective, Observational, Longitudinal Cohort Analyses of Fitbit Data and Patient-Reported Outcomes.

Zhang, Tianmai M, Sharp, Sydney P, Scott, John D et al.·JMIR formative research·2025

Researchers gave 82 people with long COVID or ME/CFS Fitbit devices to track their physical activity, heart rate, and sleep for up to a year, while also asking them to report how they felt. They found that people who were less physically active reported worse fatigue, breathing problems, and physical function, and their symptoms worsened over time compared to those who remained more active. This suggests that activity levels may be related to symptom severity in long COVID, though the study couldn't prove that low activity causes worse symptoms.

Sleep
E2 ModeratePEM not requiredModerate confidenceObservationalEditor reviewed

Identifying commonalities and differences between EHR representations of PASC and ME/CFS in the RECOVER EHR cohort.

Powers, John P, McIntee, Tomas J, Bhatia, Abhishek et al.·Communications medicine·2025

Researchers compared medical records from millions of patients to see how Long COVID (PASC) and ME/CFS are similar and different. They found that both conditions share common symptoms like fatigue, breathing difficulties, and trouble concentrating, but Long COVID tends to have more heart and lung problems, while ME/CFS more often involves pain and sleep issues. These similarities suggest that some treatment approaches might help both conditions.

Pain and SensitizationSleepCognitive Impairment
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Long-COVID in children and their parents: A prospective cohort study.

Iijima, Hiroyuki, Funaki, Takanori, Kubota, Mitsuru·Pediatrics international : official journal of the Japan Pediatric Society·2025

This study followed Japanese children hospitalized with COVID-19 and their parents to see how many developed long-COVID symptoms. About 45% of children had lingering symptoms one month after infection, dropping to 23% by six months. The most common symptoms were cough, tiredness, and sleep problems, with sleep issues being most strongly linked to a reduced quality of life.

Sleep
E2 ModeratePEM unclearModerate confidenceCross-SectionalEditor reviewed

Overlapping conditions in Long COVID at a multisite academic center.

Grach, Stephanie L, Dudenkov, Daniel V, Pollack, Beth et al.·Frontiers in neurology·2024

This study looked at 247 patients with Long COVID who visited Mayo Clinic to see what new health problems developed after their COVID-19 infection. Researchers compared them to 40 people who had COVID-19 but recovered normally. The results showed that Long COVID patients experienced much higher rates of pain, neurological symptoms, sleep problems, and other issues. Importantly, 58% of Long COVID patients screened positive for ME/CFS—a serious fatigue and post-exertional symptom condition—compared to none of the control group.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Insomnia and sleep characteristics in post COVID-19 fatigue: A cross-sectional case-controlled study.

Rauwerda, Nynke L, Kuut, Tanja A, Braamse, Annemarie M J et al.·Journal of psychosomatic research·2024

This study looked at sleep problems in people with long COVID fatigue and compared them to people with ME/CFS. Researchers found that 64% of long COVID patients had clinically significant insomnia, and their sleep problems were closely linked to depression and age. While long COVID patients slept slightly less than ME/CFS patients on average, both groups struggled significantly with sleep quality and nighttime insomnia.

Sleep
E2 ModeratePEM requiredPreliminaryCross-SectionalEditor reviewed

Pediatric Post-Acute Sequelae of SARS-CoV-2 Infection.

Jason, Leonard A, Johnson, Madeline, Torres, Chelsea·Fatigue : biomedicine, health & behavior·2023

This study compared young people recovering from long COVID (PASC) with young people who have ME/CFS to understand how their symptoms differ. Researchers asked 19 parents about their child's symptoms during initial COVID infection and again later, then compared these to 19 young people with ME/CFS. Most PASC symptoms improved over time, but fatigue and sleep problems stayed high—similar to what ME/CFS patients experience.

SleepPost-Exertional Malaise
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Physical Activity Effects on Muscle Fatigue in Sport in Active Adults with Long COVID-19: An Observational Study.

Coscia, Francesco, Mancinelli, Rosa, Gigliotti, Paola Virginia et al.·Diagnostics (Basel, Switzerland)·2023

This study looked at how physical activity affected fatigue and other symptoms in people with Long COVID-19. Researchers compared people who stayed active with those who were sedentary and tracked their symptoms over 6 to 12 months. They found that people who remained physically active experienced a larger drop in fatigue over time compared to those who were inactive, though both groups still had muscle weakness and sleep problems.

SleepCognitive Impairment
E2 ModeratePEM unclearPreliminaryCross-SectionalEditor reviewed

Urine Metabolite Analysis to Identify Pathomechanisms of Long COVID: A Pilot Study.

Taenzer, Maja, Löffler-Ragg, Judith, Schroll, Andrea et al.·International journal of tryptophan research : IJTR·2023

This study examined urine samples from people with Long COVID and ME/CFS to look for chemical imbalances that might explain their symptoms. Researchers found that both groups had lower levels of certain amino acids and neurotransmitters (brain chemicals) compared to healthy people, particularly affecting energy production, mood, and sleep. These chemical signatures could potentially be used as simple urine tests to help doctors understand what is happening in patients and create personalized treatments.

SleepAutonomic Nervous SystemCognitive Impairment
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The Fatigue-Related Symptoms Post-Acute SARS-CoV-2: A Preliminary Comparative Study.

Thomas, Marie·International journal of environmental research and public health·2022

This study compared fatigue and related symptoms in 26 people experiencing Long COVID with two groups: people without fatigue and people with ME/CFS. The Long COVID group reported severe fatigue, brain fog, sleep problems, and difficulty concentrating—similar to what people with ME/CFS experience. The findings suggest Long COVID and ME/CFS may share some common features.

SleepCognitive Impairment
E2 ModeratePEM unclearPreliminaryCross-SectionalEditor reviewed

Chronic fatigue syndrome (CFS)/Myalgic Encephalomyelitis (ME) and Fibromyalgia (FM): the foundation of a relationship.

Mckay, Pamela G, Martin, Colin R, Walker, Helen et al.·British journal of pain·2021

This study compared people with ME/CFS and fibromyalgia (FM) to see if these two conditions share similar symptoms and severity. Researchers asked 208 participants from each group to complete questionnaires about their pain, fatigue, sleep quality, mood, and how much these symptoms affected their daily lives. The study found that both groups experienced similarly debilitating symptoms and poor quality of life, suggesting these conditions may be connected in important ways.

Pain and SensitizationSleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Long COVID and chronic fatigue syndrome: A survey of elderly female survivors in Egypt.

Aly, Menna A E G, Saber, Heba G·International journal of clinical practice·2021

This study looked at 115 elderly women in Egypt who had recovered from COVID-19 to see if their lingering symptoms might lead to chronic fatigue syndrome (ME/CFS). Most women reported problems like fatigue, muscle pain, and sleep trouble after COVID, and the study found that stress, sadness, and poor sleep were most strongly linked to developing CFS-like symptoms. Only one person in the study actually met full criteria for probable CFS, but the researchers suggest doctors should watch for these warning signs in long COVID patients.

SleepCognitive Impairment
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The presence of overlapping quality of life symptoms in primary antibody deficiency (PAD) and chronic fatigue syndrome (CFS).

Bansal, Rhea A, Tadros, Susan, Bansal, Amolak S·Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology·2020

This study looked at whether people with primary antibody deficiency (PAD)—a condition where the immune system doesn't make enough protective proteins—also experience ME/CFS-like symptoms. Researchers sent questionnaires to over 680 PAD patients and found that about 16% of those who responded had symptoms matching ME/CFS criteria, which is much higher than the general population. The study also found that sleep problems, fatigue, anxiety, and low mood were very common in PAD patients.

Sleep
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Health Conditions and Psychotic Experiences: Cross-Sectional Findings From the American Life Panel.

Oh, Hans, Smith, Lee, Koyanagi, Ai·Frontiers in psychiatry·2020

This study looked at whether people who experience psychotic symptoms (like unusual beliefs or perceptions) also tend to have more physical health problems. Researchers surveyed a representative group of American adults and found that people reporting lifetime psychotic experiences were more likely to have conditions like chronic fatigue syndrome, chronic pain, sleep disorders, migraines, and gastrointestinal problems. The more health conditions someone had, the stronger the association with psychotic experiences.

Pain and SensitizationSleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Physical Activity and Sleep in Chronic Fatigue Syndrome and Fibromyalgia Syndrome: Associations with Symptom Severity in the General Population Cohort LifeLines.

Joustra, Monica L, Zijlema, Wilma L, Rosmalen, Judith G M et al.·Pain research & management·2018

This study looked at how physical activity and sleep relate to symptom severity in ME/CFS and fibromyalgia by comparing nearly 91,000 people from a large population study. Patients with ME/CFS and fibromyalgia were less active and slept longer than healthy controls. Interestingly, both too little and too much physical activity or sleep were linked to worse symptoms, suggesting that finding the right balance is important for managing these conditions.

Sleep
E2 ModeratePEM unclearModerate confidenceCross-SectionalEditor reviewed

Prevalence of and risk factors for severe cognitive and sleep symptoms in ME/CFS and MS.

Jain, Vageesh, Arunkumar, Amit, Kingdon, Caroline et al.·BMC neurology·2017

This study compared cognitive problems (like trouble concentrating and memory issues) and sleep difficulties in people with ME/CFS and people with MS. Researchers found that cognitive and sleep problems were much more common in ME/CFS patients—98% reported trouble concentrating, and 55% reported severe unrefreshing sleep. The study also identified that ME/CFS patients who were older, current smokers, or had lower incomes were more likely to experience severe symptoms.

SleepCognitive Impairment
E2 ModeratePEM not requiredModerate confidenceObservationalEditor reviewed

Dry Eye Syndrome Risks in Patients With Fibromyalgia: A National Retrospective Cohort Study.

Chen, Chao-Hsien, Yang, Tse-Yen, Lin, Cheng-Li et al.·Medicine·2016

This study found that people with fibromyalgia are more likely to develop dry eye syndrome than people without fibromyalgia. Younger fibromyalgia patients (under 50) and those with sleep problems or other conditions like irritable bowel syndrome had even higher risks of developing dry eyes. The researchers used health insurance records from Taiwan to track over 25,000 fibromyalgia patients and compare them to over 100,000 people without fibromyalgia.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Chronic fatigue syndrome and fibromyalgia in diagnosed sleep disorders: a further test of the 'unitary' hypothesis.

Pejovic, Slobodanka, Natelson, Benjamin H, Basta, Maria et al.·BMC neurology·2015

This study looked at whether ME/CFS and fibromyalgia are actually the same condition or different disorders. Researchers compared patients with sleep-breathing problems, sleep insomnia, and healthy controls, measuring how often each group had ME/CFS, fibromyalgia, or both. They found that while both conditions occurred in sleep disorder patients, fibromyalgia was much more common in insomnia patients, whereas ME/CFS appeared in both groups equally—suggesting these may be separate conditions with different causes.

Sleep
E2 ModeratePEM not requiredModerate confidenceLongitudinalEditor reviewed

Obstructive sleep apnea increases the risk of bladder pain syndrome/interstitial cystitis: a population-based matched-cohort study.

Chung, Shiu-Dong, Lin, Ching-Chun, Liu, Shih-Ping et al.·Neurourology and urodynamics·2014

This study found that people with obstructive sleep apnea (OSA)—a condition where breathing stops repeatedly during sleep—are nearly 4 times more likely to develop bladder pain syndrome/interstitial cystitis (BPS/IC) compared to people without OSA. Researchers followed over 32,000 people in Taiwan for 3 years and tracked who developed BPS/IC. The findings suggest that sleep problems and bladder pain may be connected, and doctors should ask patients with sleep apnea about urinary symptoms.

Sleep
E2 ModeratePEM unclearModerate confidenceCross-SectionalEditor reviewed

[Impact of the fibromyalgia in the chronic fatigue syndrome].

Faro, Mónica, Sáez-Francàs, Naia, Castro-Marrero, Jesús et al.·Medicina clinica·2014

This study looked at nearly 1,000 ME/CFS patients to see how many also had fibromyalgia (a condition causing widespread pain and fatigue), and whether having both conditions made symptoms worse. They found that about half of the ME/CFS patients also had fibromyalgia, and those patients experienced higher levels of fatigue, pain, sleep problems, and cognitive difficulties. People with both conditions reported a much greater impact on their quality of life compared to those with ME/CFS alone.

SleepAutonomic Nervous SystemCognitive Impairment
E2 ModeratePEM unclearModerate confidenceCross-SectionalEditor reviewed

Sleep-stage dynamics in patients with chronic fatigue syndrome with or without fibromyalgia.

Kishi, Akifumi, Natelson, Benjamin H, Togo, Fumiharu et al.·Sleep·2011

This study looked at sleep patterns in women with ME/CFS, comparing those with ME/CFS alone to those who also have fibromyalgia (FM). Researchers found that people with ME/CFS alone had trouble staying asleep and waking up too often from REM sleep, while those with both conditions showed different sleep problems including difficulty maintaining deeper sleep stages. These findings suggest that ME/CFS and fibromyalgia may involve different types of sleep disturbances.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Interstitial cystitis/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome.

Nickel, J Curtis, Tripp, Dean A, Pontari, Michel et al.·The Journal of urology·2010

This study looked at how often bladder pain syndrome occurs alongside other conditions like irritable bowel syndrome, fibromyalgia, and ME/CFS. Researchers found that people with bladder pain syndrome were much more likely to have these other conditions compared to healthy controls. Importantly, people who had multiple overlapping conditions experienced worse pain, sleep problems, depression, and lower quality of life than those with just one condition.

Pain and SensitizationSleep
E2 ModeratePEM unclearModerate confidenceObservationalEditor reviewed

A retrospective review of the sleep characteristics in patients with chronic fatigue syndrome and fibromyalgia.

Spitzer, A Robert, Broadman, Melissa·Pain practice : the official journal of World Institute of Pain·2010

Researchers studied sleep patterns in 118 patients with ME/CFS and fibromyalgia using objective sleep tests. They found that most patients had abnormal sleep studies showing excessive daytime sleepiness, and some had sleep features similar to narcolepsy. A genetic marker (HLA DQB1*0602) associated with narcolepsy was found in 43% of patients, much higher than in the general population.

Sleep
E2 ModeratePEM not requiredModerate confidenceCase-ControlEditor reviewed

Health and functional status of twins with chronic regional and widespread pain.

Aaron, Leslie A, Arguelles, Lester M, Ashton, Suzanne et al.·The Journal of rheumatology·2002

This study looked at twins where one had chronic pain (either in one area or widespread) and the other did not, to understand how pain affects health and function independent of ME/CFS. Researchers found that chronic pain significantly worsens general health perception, physical functioning, and sleep quality, effects that remain even after accounting for ME/CFS. However, the mental health impact of pain appears closely linked to having ME/CFS symptoms together.

Pain and SensitizationSleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder.

Aaron, L A, Burke, M M, Buchwald, D·Archives of internal medicine·2000

This study found that ME/CFS, fibromyalgia, and temporomandibular disorder (TMD) often occur together in the same patients and share similar symptoms like pain, fatigue, and sleep problems. The researchers also discovered that patients with these conditions frequently experience other illnesses like irritable bowel syndrome and headaches—much more often than healthy people do. The study suggests these conditions may be connected in some way we don't yet fully understand.

Pain and SensitizationSleepCognitive Impairment
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Melatonin levels in women with fibromyalgia and chronic fatigue syndrome.

Korszun, A, Sackett-Lundeen, L, Papadopoulos, E et al.·The Journal of rheumatology·1999

This study looked at melatonin—a hormone that helps control sleep and daily rhythms—in women with fibromyalgia and chronic fatigue syndrome. Researchers collected blood samples every 10 minutes over 24 hours and found that women with fibromyalgia had higher melatonin levels at night compared to healthy controls, but women with chronic fatigue syndrome did not. The authors concluded there is no evidence that taking melatonin supplements would help these patients.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Chronic fatigue syndrome and seasonal affective disorder: comorbidity, diagnostic overlap, and implications for treatment.

Terman, M, Levine, S M, Terman, J S et al.·The American journal of medicine·1998

This study looked at whether ME/CFS symptoms get worse during winter months, similar to seasonal depression. Researchers asked 110 ME/CFS patients about their symptoms in summer and winter, and found that about one-third showed a seasonal pattern with winter worsening. This suggests that some ME/CFS patients might benefit from light therapy, a treatment commonly used for seasonal depression.

Sleep
E2 ModeratePEM unclearPreliminaryCross-SectionalEditor reviewed

Insulin-like growth factor-I (somatomedin C) levels in chronic fatigue syndrome and fibromyalgia.

Buchwald, D, Umali, J, Stene, M·The Journal of rheumatology·1996

Researchers tested whether people with ME/CFS have lower levels of a growth hormone called IGF-I, which had previously been found to be low in fibromyalgia patients. They measured IGF-I levels in 15 people with ME/CFS, 15 with both ME/CFS and fibromyalgia, 27 with fibromyalgia alone, and 15 healthy volunteers. The study found no significant differences in IGF-I levels between any of the patient groups and healthy controls, suggesting that low IGF-I may not be a key feature of ME/CFS.

Sleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Sleep disturbances and fatigue in women with fibromyalgia and chronic fatigue syndrome.

Schaefer, K M·Journal of obstetric, gynecologic, and neonatal nursing : JOGNN·1995

This study looked at sleep problems in women with fibromyalgia and chronic fatigue syndrome (CFS). Researchers found that both groups had significant sleep difficulties, and that trouble staying asleep was the most common sleep problem reported. There was a clear link between poor sleep and fatigue—women who slept poorly felt more tired.

Sleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Primary juvenile fibromyalgia syndrome and chronic fatigue syndrome in adolescents.

Bell, D S, Bell, K M, Cheney, P R·Clinical infectious diseases : an official publication of the Infectious Diseases Society of America·1994

This study looked at whether children diagnosed with chronic fatigue syndrome (CFS) also had fibromyalgia, a condition involving widespread muscle pain and tender points. Researchers found that about 30% of children with CFS met the criteria for fibromyalgia, and these children experienced more muscle pain, sleep problems, and neurological symptoms than those without fibromyalgia. The study suggests that CFS and fibromyalgia in children may be closely related or even the same condition.

Pain and SensitizationSleep
E2 ModeratePEM not requiredPreliminaryObservationalEditor reviewed

"Chronic Epstein-Barr virus infection" syndrome and polymyalgia rheumatica.

Buchwald, D, Sullivan, J L, Leddy, S et al.·The Journal of rheumatology·1988

This study looked at 23 patients with polymyalgia rheumatica (PMR), a condition causing muscle pain and stiffness, and noticed many also experienced severe fatigue, sleep problems, and recurring sore throats—symptoms similar to ME/CFS. Even after treatment improved their muscle pain, these fatigue-related symptoms continued for months. However, blood tests showed their Epstein-Barr virus antibody levels were normal and similar to healthy people their age, suggesting the virus wasn't the primary cause.

Sleep
E2 ModeratePEM not requiredModerate confidenceLongitudinalEditor reviewed

Fatigue in Epstein-Barr virus infected adolescents and healthy controls: A prospective multifactorial association study.

Pedersen, Maria, Asprusten, Tarjei Tørre, Godang, Kristin et al.·Journal of psychosomatic research·2019

This study followed teenagers with acute Epstein-Barr virus (EBV) infection and compared them to healthy teenagers to understand what causes fatigue. Researchers measured 148 different factors including symptoms, quality of life, sleep, emotions, immune markers, and heart rate control at the start of infection and again six months later. They found that fatigue was consistently linked to sleep problems, negative emotions, and poor quality of life, but surprisingly, markers of active infection were not associated with how tired people felt.

SleepAutonomic Nervous System
E2 ModeratePEM not requiredPreliminaryCase-ControlEditor reviewed

Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study.

Moldofsky, Harvey, Patcai, John·BMC neurology·2011

This study looked at people who had severe SARS infection and were unable to return to work for over a year afterward. These patients experienced long-lasting fatigue, widespread muscle pain, weakness, depression, and poor sleep quality. Researchers found that their sleep patterns and symptoms were very similar to those seen in fibromyalgia and chronic fatigue syndrome.

Pain and SensitizationSleep
E2 ModeratePEM not requiredPreliminaryCase-ControlEditor reviewed

Sleep and symptoms in fibrositis syndrome after a febrile illness.

Moldofsky, H, Saskin, P, Lue, F A·The Journal of rheumatology·1988

This study looked at sleep patterns in people with fibromyalgia (a condition causing widespread pain and fatigue) who developed the condition after a fever, compared to people with fibromyalgia without a clear trigger and healthy volunteers. All fibromyalgia patients showed abnormal brain wave patterns during sleep that prevented their sleep from being truly restful, and they experienced similar muscle pain and tender points. This suggests that post-illness fibromyalgia shares the same sleep problems as other forms of fibromyalgia.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Adverse effects of obesity on overall health, quality of life, and related physical health metrics: A cross-sectional and longitudinal study from the All of Us Research Program.

Yao, Zhiqi, Tchang, Beverly G, Chae, Kacey et al.·Journal of internal medicine·2025

This study looked at over 323,000 people in the United States to understand how obesity affects overall health and quality of life. Researchers found that people with higher body weight reported worse health, more pain, more fatigue, and greater difficulty with physical activity compared to people of normal weight. The effects were strongest in people with the most severe obesity, who were nearly 4 times more likely to report poor health and severe pain.

Pain and SensitizationSleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

The relationship between fatigue, sleep quality, and sleep deprivation.

Ayas, Fahriye Yonca, Özcebe, Lütfiye Hilal·Sleep & breathing = Schlaf & Atmung·2025

This study looked at how fatigue, sleep quality, and daytime sleepiness are connected in workplace employees. Researchers found that when people have poor sleep quality or don't sleep enough hours, they tend to experience more fatigue and daytime sleepiness—and these problems appear to affect each other in a cycle. The study suggests that addressing sleep problems may be important for reducing fatigue and improving workplace safety.

Sleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Chronic fatigue syndrome in caregivers of children with cerebral palsy and affecting factors.

Pasin, Tugce, Karatekin, Bilinc Dogruoz, Pasin, Ozge·Northern clinics of Istanbul·2023

This study looked at mothers caring for children with cerebral palsy to see how many developed ME/CFS and what factors affected them. The researchers found that about 80% of the mothers met the clinical criteria for ME/CFS, with mothers who stayed home having more severe fatigue than those who worked full-time. The child's hand and arm function appeared to be an important factor in how severe the mother's fatigue became.

Sleep
E2 ModeratePEM not requiredModerate confidenceCase-ControlEditor reviewed

The Impact of Micro RNA-320a Serum Level on Severity of Symptoms and Cerebral Processing of Pain in Patients with Fibromyalgia.

Hussein, Mona, Fathy, Wael, Abdelaleem, Enas A et al.·Pain medicine (Malden, Mass.)·2022

Researchers measured a molecule called miR-320a in the blood of people with fibromyalgia and compared it to healthy people. They found that fibromyalgia patients had higher levels of this molecule, and those with higher levels tended to have worse symptoms like pain, fatigue, sleep problems, and depression. However, this molecule did not appear to affect how the brain processes pain signals.

Pain and SensitizationSleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Fatigue-Related Cognitive-Behavioral Factors in Survivors of Childhood Cancer: Comparison with Chronic Fatigue Syndrome and Survivors of Adult-Onset Cancer.

van Deuren, Sylvia, van Dulmen-den Broeder, Eline, Boonstra, Amilie et al.·Journal of adolescent and young adult oncology·2021

This study compared how fatigue affects three groups: people who had cancer as children, people with ME/CFS, and people who had cancer as adults. Researchers looked at thinking patterns and behaviors that might keep fatigue going, like how people cope, sleep habits, and beliefs about their illness. They found many similarities between the groups, but some differences in how people explained their fatigue and how much support they had.

Sleep
E2 ModeratePEM not requiredModerate confidenceRegistry-ResourceEditor reviewed

Sarcoidosis among US Hispanics in a Nationwide Registry.

Innabi, Ayoub, Alzghoul, Bashar N, Kalra, Saminder et al.·Respiratory medicine·2021

This study looked at how sarcoidosis (a disease that causes inflammation in the body) affects Hispanic patients in the United States compared to non-Hispanic patients. Researchers surveyed nearly 3,835 people and found that Hispanic patients with sarcoidosis experience more depression, chronic pain, sleep problems, and job loss than non-Hispanic patients. The findings suggest that doctors may need to approach treatment differently for Hispanic patients with this condition.

Pain and SensitizationSleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

The Epidemiology of Insomnia and Sleep Duration Across Mental and Physical Health: The SHoT Study.

Sivertsen, Børge, Hysing, Mari, Harvey, Allison G et al.·Frontiers in psychology·2021

This study looked at sleep problems in over 50,000 Norwegian college students and found that insomnia (difficulty sleeping) is much more common in people with both mental and physical health conditions. Students with ME/CFS had particularly high rates of insomnia—about 65% of women and an unspecified percentage of men experienced insomnia when they also had ME/CFS. The study also found that people with these conditions slept shorter amounts overall.

Sleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Hematological and Psychophysiological Correlates of Anomalous Information Reception in Mediums: A Preliminary Exploration.

Beischel, Julie, Tassone, Shawn, Boccuzzi, Mark·Explore (New York, N.Y.)·2019

This study looked at whether people who identify as mediums (those who report communicating with deceased individuals) experience more health problems than people who don't. Researchers found that mediums reported significantly more autoimmune diseases, sleep problems, gastrointestinal issues, and other symptoms compared to non-mediums. However, blood tests and heart rate measurements taken during mediumship sessions showed no unusual changes.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

[Sleep disturbances - an important factor in combination 'minor' symptoms of multiple sclerosis].

Yakupov, E Z, Troshina, Yu V·Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova·2017

This study looked at sleep problems in 54 people with multiple sclerosis (MS) compared to 54 healthy people. Researchers found that people with MS had much more trouble sleeping, and that poor sleep was connected to anxiety, depression, and fatigue. The study suggests that sleep disturbances may play an important role in how MS affects quality of life and fatigue symptoms.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Fatigue and psychosocial variables in autoimmune rheumatic disease and chronic fatigue syndrome: A cross-sectional comparison.

Ali, Sheila, Matcham, Faith, Irving, Katherine et al.·Journal of psychosomatic research·2017

This study compared how people with ME/CFS and people with autoimmune rheumatic diseases (like rheumatoid arthritis) experience fatigue and cope with their symptoms. The researchers found that people with ME/CFS were more fatigued, had worse sleep, and were more likely to avoid activities and struggle with accepting their illness, while people with rheumatic diseases were more likely to worry about damage to their bodies. This suggests that fatigue in these different conditions may need different treatment approaches.

Sleep
E2 ModeratePEM not requiredPreliminaryObservationalEditor reviewed

The pre-interventional psychiatric history - an underestimated confounder in benign intracranial lesions studies.

Wenz, H, Wenz, R, Groden, C et al.·Clinical neurology and neurosurgery·2015

This study looked at 103 patients who had surgery for benign brain tumors or aneurysms and were physically recovered afterward. Researchers found that patients with a history of psychiatric conditions before surgery reported worse quality of life, more sleep problems, more fatigue symptoms, and more PTSD symptoms after surgery compared to those without prior psychiatric history—even though both groups had similar physical recovery.

Sleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

The Preinterventional Psychiatric History as a Major Predictor for a Reduced Quality of Life After Treatment of Unruptured Intracranial Aneurysms.

Fontana, Johann, Wenz, Ralf, Groden, Christoph et al.·World neurosurgery·2015

This study looked at patients who had surgery for unruptured brain aneurysms (weak blood vessel spots in the brain that hadn't bled yet) and compared them to patients who had surgery for brain tumors. The researchers found that patients with a history of psychiatric conditions before surgery reported worse quality of life and more chronic fatigue symptoms after surgery, but when they removed those patients from the analysis, the differences went away. This suggests that pre-existing mental health conditions, not the aneurysm or surgery itself, may explain poor outcomes.

Sleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Altered resting brain connectivity in persistent cancer related fatigue.

Hampson, Johnson P, Zick, Suzanna M, Khabir, Tohfa et al.·NeuroImage. Clinical·2015

This study used brain imaging to compare how the brains of breast cancer survivors with fatigue differ from those without fatigue. Researchers found that people experiencing persistent cancer-related fatigue showed different patterns of communication between brain regions, particularly involving areas linked to thinking about oneself and regulating sleep. These brain connectivity differences were associated with worse physical fatigue and poor sleep quality.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Non-REM sleep EEG power distribution in fatigue and sleepiness.

Neu, Daniel, Mairesse, Olivier, Verbanck, Paul et al.·Journal of psychosomatic research·2014

This study compared brain wave patterns during sleep between people with ME/CFS, people with sleep apnea, and healthy controls. Researchers found that ME/CFS patients show a different pattern of brain activity during sleep compared to those with sleep apnea, which may help explain why ME/CFS fatigue doesn't improve with rest like normal sleepiness does.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Predictors and consequences of fatigue in prevalent kidney transplant recipients.

Chan, Winnie, Bosch, Jos A, Jones, David et al.·Transplantation·2013

This study looked at tiredness in people who have received kidney transplants and are doing well medically. Researchers found that nearly 6 out of 10 kidney transplant patients experience significant fatigue that affects their daily life and quality of life, yet most doctors weren't documenting this problem in their medical records. The fatigue levels were similar to those seen in chronic fatigue syndrome, and it was linked to factors like inflammation, kidney function decline, poor sleep, anxiety, and depression.

Sleep
E2 ModeratePEM not requiredModerate confidenceCase-ControlEditor reviewed

Cognitive impairment in fatigue and sleepiness associated conditions.

Neu, Daniel, Kajosch, Hendrik, Peigneux, Philippe et al.·Psychiatry research·2011

This study compared how fatigue and sleepiness affect thinking and memory. Researchers tested 15 people with ME/CFS, 15 people with sleep apnea, and 16 healthy controls using memory tests, attention tasks, and brain wave measurements. Both patient groups showed cognitive problems, though people with sleep apnea had slightly more difficulty with certain thinking tasks and movement speed.

SleepCognitive Impairment
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Physical and psychosocial correlates of severe fatigue in rheumatoid arthritis.

van Hoogmoed, Dewy, Fransen, Jaap, Bleijenberg, Gijs et al.·Rheumatology (Oxford, England)·2010

This study looked at severe fatigue in people with rheumatoid arthritis (RA), a condition that causes joint inflammation. Researchers found that 42% of RA patients experienced severe fatigue that felt frustrating and exhausting. Importantly, this severe fatigue was more closely linked to pain, mood, sleep quality, and how patients thought about their fatigue—rather than to inflammation markers alone.

Pain and SensitizationSleep
E2 ModeratePEM not requiredPreliminaryCross-SectionalEditor reviewed

Fatigue status in relation to lifestyle in healthy Japanese adolescents.

Zou, Ning, Kubota, Masaru, Kuruma, Eriko et al.·International journal of pediatrics·2010

This study looked at fatigue in over 1,200 healthy Japanese teenagers aged 11–16 to see how common different types of fatigue were and whether lifestyle habits made a difference. Researchers found that girls reported higher fatigue scores related to ME/CFS-type symptoms than boys, and fatigue increased as teenagers got older. Sleep, exercise, diet quality, and sugary drinks were all linked to how tired teenagers felt.

Sleep
E2 ModeratePEM not requiredModerate confidenceLongitudinalEditor reviewed

Predictors of persistent and new-onset fatigue in adolescent girls.

ter Wolbeek, Maike, van Doornen, Lorenz J P, Kavelaars, Annemieke et al.·Pediatrics·2008

This study followed 653 teenage girls over one year to understand why some develop long-lasting fatigue while others recover. Researchers found that about 26% of girls who were severely fatigued at the start remained fatigued throughout the year. Depression, anxiety, low physical activity, and poor sleep were linked to persistent or new fatigue, suggesting that emotional health and lifestyle habits play important roles in fatigue development.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Severe fatigue in adolescents: a common phenomenon?

ter Wolbeek, Maike, van Doornen, Lorenz J P, Kavelaars, Annemieke et al.·Pediatrics·2006

This study looked at how common severe tiredness is in teenagers and whether it's connected to depression, anxiety, and other symptoms seen in ME/CFS patients. Researchers surveyed over 3,400 teenagers about their fatigue, mood, sleep, and daily habits. They found that severe fatigue is quite common in adolescents—especially in girls—and that it often clusters with depression, anxiety, and ME/CFS-like symptoms.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Sleep and chronic pain: challenges to the alpha-EEG sleep pattern as a pain specific sleep anomaly.

Rains, Jeanetta C, Penzien, Donald B·Journal of psychosomatic research·2003

Researchers looked at a brain wave pattern during sleep called alpha-EEG, which has been thought to be linked to chronic pain conditions like fibromyalgia and ME/CFS. They found that this sleep pattern was uncommon (only 5% of patients) and occurred in people with chronic pain, psychiatric conditions, and other medical problems. Surprisingly, less than 40% of people with this sleep pattern actually had chronic pain, suggesting the pattern alone does not cause pain.

Sleep
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Fatigue after breast cancer and in chronic fatigue syndrome: similarities and differences.

Servaes, Petra, Prins, Judith, Verhagen, Stans et al.·Journal of psychosomatic research·2002

This study compared 57 women with ME/CFS to 57 women who had breast cancer and were experiencing severe fatigue after treatment. Researchers measured fatigue, physical activity, mood, sleep, and concentration using questionnaires, tests, and activity monitors worn for 12 days. While both groups experienced significant fatigue, ME/CFS patients generally had more severe symptoms overall, though some breast cancer survivors reported similar problems with sleep and concentration.

SleepCognitive Impairment
E2 ModeratePEM not requiredModerate confidenceCross-SectionalEditor reviewed

Correlations among Epworth Sleepiness Scale scores, multiple sleep latency tests and psychological symptoms.

Olson, L G, Cole, M F, Ambrogetti, A·Journal of sleep research·1998

This study looked at whether a simple questionnaire about daytime sleepiness (the Epworth Sleepiness Scale) actually measures the same thing as a more complex sleep test that measures how quickly people fall asleep. The researchers found that these two tests don't measure the same thing—the questionnaire is influenced by mood and psychological symptoms, while the objective sleep test is not.

Sleep
E3 PreliminaryPEM requiredPreliminaryEditor reviewed

Glymphatic System Dysregulation as a Key Contributor to Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

Nemat-Gorgani, Mohsen, Jensen, Michael Anthony, Davis, Ronald Wayne·International journal of molecular sciences·2025

Your brain has a cleaning system called the glymphatic system that removes toxic waste buildup, especially during sleep. This review suggests that this cleaning system may not be working properly in ME/CFS, which could explain symptoms like fatigue and brain fog. If the glymphatic system is involved in ME/CFS, new treatments designed to fix this cleaning process might help patients feel better.

SleepPost-Exertional Malaise
E3 PreliminaryPEM not requiredPreliminaryCase-ControlEditor reviewed

Sleep state misperception: is there a CNS structural source?

Truzzi, Giselle de Martin, Teixeira, Igor de Lima, do Prado, Lucila Bizari Fernandes et al.·Sleep science (Sao Paulo, Brazil)·2021

This case report describes one patient with AIDS who experienced sleep state misperception—feeling like she wasn't sleeping even though she actually was sleeping—and had a brain lesion in a specific region called the left nucleocapsular area. Sleep tests confirmed she was sleeping normally, but her brain wasn't perceiving it correctly. The researchers suggest that damage to certain brain structures might explain why some people feel unrefreshed despite actually sleeping.

Sleep
E3 PreliminaryPEM unclearPreliminaryCross-SectionalEditor reviewed

Intra brainstem connectivity is impaired in chronic fatigue syndrome.

Barnden, Leighton R, Shan, Zack Y, Staines, Donald R et al.·NeuroImage. Clinical·2019

This study used brain imaging (fMRI) to compare how different parts of the brainstem communicate in people with ME/CFS versus healthy people. The brainstem is a critical control center that regulates automatic body functions like heart rate, breathing, and sleep. Researchers found that in ME/CFS patients, certain communication pathways between brainstem regions were weaker or missing, which could explain many ME/CFS symptoms like fatigue, cognitive problems, and autonomic dysfunction.

Sleep
E3 PreliminaryPEM unclearPreliminaryObservationalEditor reviewed

Open-label pilot for treatment targeting gut dysbiosis in myalgic encephalomyelitis/chronic fatigue syndrome: neuropsychological symptoms and sex comparisons.

Wallis, Amy, Ball, Michelle, Butt, Henry et al.·Journal of translational medicine·2018

This study tested whether treating an overgrowth of Streptococcus bacteria in the gut could help ME/CFS patients, particularly those with brain fog and sleep problems. Forty-four patients received alternating weeks of an antibiotic and a probiotic for 4 weeks. The treatment reduced the problematic bacteria and improved several symptoms including sleep quality, attention, and memory, though it did not significantly affect fatigue or mood.

SleepCognitive Impairment
E3 PreliminaryPEM not requiredPreliminaryCross-SectionalEditor reviewed

The experience of sleep in chronic fatigue syndrome: A qualitative interview study with patients.

Gotts, Zoe M, Newton, Julia L, Ellis, Jason G et al.·British journal of health psychology·2016

This study asked 11 people with ME/CFS to describe their sleep problems in detail through interviews. The researchers found that sleep is extremely important to everyone with ME/CFS—all participants felt their sleep was somehow 'broken' and spent a lot of energy trying to manage it. Everyone agreed that poor sleep made their daytime symptoms worse, though each person experienced sleep problems in their own unique way.

Sleep
E3 PreliminaryPEM not requiredModerate confidenceReview-NarrativeEditor reviewed

Chronic fatigue syndrome and sleep disorders: clinical associations and diagnostic difficulties.

Ferré, A·Neurologia·2016

This review looked at the connection between ME/CFS and sleep problems. Many people with ME/CFS experience non-restorative sleep (where sleep doesn't feel refreshing) and fatigue, but these same symptoms can happen with other sleep disorders. The key finding is that doctors need to carefully check whether patients have a separate sleep disorder before or alongside an ME/CFS diagnosis, because treating the sleep problem might help improve overall quality of life.

SleepDiagnostics
E3 PreliminaryPEM not requiredWeak / uncertainEditorialEditor reviewed

[The theorotical basis for chronic fatigue syndrome from bladder meridian of foot-taiyang].

Yao, Fei, Zhao, Yi, Jiang, Shichao et al.·Zhongguo zhen jiu = Chinese acupuncture & moxibustion·2015

This study explores traditional Chinese medicine (acupuncture) theory to understand chronic fatigue syndrome. The researchers examined how the bladder meridian—a pathway used in acupuncture treatment—may relate to fatigue, sleep problems, and organ function. They propose that treating this meridian might help reduce both physical and mental exhaustion in ME/CFS patients.

Sleep
E3 PreliminaryPEM not requiredPreliminaryObservationalEditor reviewed

Sleep quality and the treatment of intestinal microbiota imbalance in Chronic Fatigue Syndrome: A pilot study.

Jackson, Melinda L, Butt, Henry, Ball, Michelle et al.·Sleep science (Sao Paulo, Brazil)·2015

This small study tested whether reducing certain bacteria in the gut could improve sleep in people with ME/CFS. Researchers gave 21 participants a short course of antibiotics and measured changes in their gut bacteria and sleep. Seven participants showed significant reduction in a type of bacteria called Streptococcus, and these people did sleep better after treatment. However, most participants' gut bacteria returned to their original state, suggesting the antibiotic effects didn't last.

Sleep
E3 PreliminaryPEM unclearPreliminaryObservationalEditor reviewed

Targeting mitochondrial dysfunction in the treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) - a clinical audit.

Myhill, Sarah, Booth, Norman E, McLaren-Howard, John·International journal of clinical and experimental medicine·2013

This study looked at 138 ME/CFS patients and found that all of them had problems with their mitochondria—the parts of cells that produce energy. Patients received personalized treatment based on diet, sleep, supplements, and rest-activity balance, adjusted according to their specific mitochondrial problems. Those who followed the full treatment plan improved their mitochondrial function by about four times on average.

Sleep
E3 PreliminaryPEM not requiredModerate confidenceCross-SectionalEditor reviewed

Validation of the three-factor model of the PSQI in a large sample of chronic fatigue syndrome (CFS) patients.

Mariman, An, Vogelaers, Dirk, Hanoulle, Ignace et al.·Journal of psychosomatic research·2012

This study tested whether a sleep questionnaire commonly used in research works properly for people with ME/CFS. Researchers asked 413 patients with ME/CFS to fill out the Pittsburgh Sleep Quality Index (PSQI), which measures sleep problems. They found that the questionnaire best divides sleep issues into three separate categories: sleep efficiency (how much time you actually sleep), perceived sleep quality (how good your sleep feels), and daily disturbances (how tiredness affects daytime functioning).

Sleep
E3 PreliminaryPEM unclearModerate confidenceMethods-PaperEditor reviewed

Validation of ECG-derived sleep architecture and ventilation in sleep apnea and chronic fatigue syndrome.

Decker, Michael J, Eyal, Shulamit, Shinar, Zvika et al.·Sleep & breathing = Schlaf & Atmung·2010

Researchers tested a new computer method that analyzes heart rate patterns to measure sleep quality and breathing problems during sleep, comparing it to the traditional gold-standard method of manually reviewing sleep recordings. The new method worked very well for measuring overall sleep time, wake time, and most sleep stages, though it was less accurate at distinguishing between deep and light sleep. This could eventually allow easier and cheaper sleep testing for patients with ME/CFS who often have sleep problems.

Sleep
E3 PreliminaryPEM not requiredPreliminaryObservationalEditor reviewed

Power spectral analysis of sleep EEG in twins discordant for chronic fatigue syndrome.

Armitage, Roseanne, Landis, Carol, Hoffmann, Robert et al.·Journal of psychosomatic research·2009

Researchers compared brain wave patterns during sleep between identical twins where one had ME/CFS and one did not. They found no significant differences in the electrical activity of the brain during sleep between the sick and healthy twins, even though those with ME/CFS reported more sleep problems. This suggests that genetic factors may influence sleep patterns more strongly than the illness itself.

Sleep
E3 PreliminaryPEM unclearPreliminaryReview-NarrativeEditor reviewed

[Fibromyalgia and chronic fatigue syndrome in children and adolescents].

Galanopoulos, Ng, Kampakis, Gp, Ladopoulou, Kf·Psychiatrike = Psychiatriki·2007

This review discusses fibromyalgia and chronic fatigue syndrome (ME/CFS) in children and teenagers, noting that both conditions are fairly common in this age group. Patients with these conditions experience widespread muscle pain, exhaustion, depression, headaches, and sleep problems that can significantly impact school, family life, and overall development. The authors emphasize that early diagnosis and treatment combining medication, physical therapy, and psychological support are important for helping young people manage these conditions.

Pain and SensitizationSleep
E3 PreliminaryPEM not requiredModerate confidenceCase-ControlEditor reviewed

The impact of a 4-hour sleep delay on slow wave activity in twins discordant for chronic fatigue syndrome.

Armitage, Roseanne, Landis, Carol, Hoffmann, Robert et al.·Sleep·2007

This study looked at how the brain's sleep patterns differ between people with ME/CFS and their healthy twins. Researchers kept twins awake 4 hours later than usual and then let them sleep normally. They found that people with ME/CFS showed weaker deep sleep activity when recovering from the sleep delay, suggesting their bodies may have trouble responding normally to sleep pressure.

Sleep
E3 PreliminaryPEM not requiredPreliminaryObservationalEditor reviewed

[Sleep disturbance in chronic fatigue syndrome].

Kumano-go, Takayuki, Adachi, Hiroyoshi, Sugita, Yoshiro·Nihon rinsho. Japanese journal of clinical medicine·2007

This study looked at sleep problems in ME/CFS patients using a special laser device to measure blood flow patterns during sleep. The researchers found that different ME/CFS patients showed different types of abnormal sleep patterns, suggesting that ME/CFS may actually be several different conditions rather than one single illness. Sleep disturbances like insomnia, oversleeping, and irregular sleep-wake cycles are common in ME/CFS.

Sleep
E3 PreliminaryPEM not requiredPreliminaryMethods-PaperEditor reviewed

The challenge of integrating disparate high-content data: epidemiological, clinical and laboratory data collected during an in-hospital study of chronic fatigue syndrome.

Vernon, Suzanne D, Reeves, William C·Pharmacogenomics·2006

Researchers invited people with ME/CFS, people with other unexplained fatigue illnesses, and healthy controls to stay in a hospital for 2 days. During the visit, they measured brain chemicals, nervous system function, immune markers, and gene activity. A team of 20 scientists from different fields worked together to find new ways to understand all this information and look for biological markers that might explain ME/CFS.

Sleep
E3 PreliminaryPEM unclearPreliminaryCase-ControlEditor reviewed

Efficacy of neurotropin in chronic fatigue syndrome: a case report.

Toda, Katsuhiro, Kimura, Hiroaki·Hiroshima journal of medical sciences·2006

This case report describes one 28-year-old man with ME/CFS who was treated with a medication called Neurotropin (four tablets daily). His fatigue and widespread pain began improving within a week, and his sleep, focus, and memory improved within two weeks. He stopped taking the medication after 11 weeks and remained symptom-free for at least 5 months afterward.

Pain and SensitizationSleepCognitive Impairment
E3 PreliminaryPEM not requiredPreliminaryEditor reviewed

Working under daylight intensity lamp: an occupational risk for developing circadian rhythm sleep disorder?

Doljansky, J T, Kannety, H, Dagan, Y·Chronobiology international·2005

A 47-year-old man with chronic fatigue syndrome developed a severely disrupted sleep-wake cycle after 20 years of working under very bright lights (used for diamond grading) often late into the night. When he switched to treatment combining melatonin at bedtime, bright light therapy in the morning, and avoiding bright light at night, his sleep pattern stabilized and his daytime tiredness improved significantly within one week.

Sleep
E3 PreliminaryPEM not requiredPreliminaryCase-ControlEditor reviewed

The effects of repeated thermal therapy for two patients with chronic fatigue syndrome.

Masuda, Akinori, Kihara, Takashi, Fukudome, Tsuyoshi et al.·Journal of psychosomatic research·2005

This study followed two ME/CFS patients who tried a type of heat therapy called far-infrared sauna (heated to 60°C) combined with warming afterward. After about 15-25 sessions, both patients reported major improvements in fatigue, pain, sleep problems, and fever. They continued the therapy once or twice a week for a year and did not get worse, even after stopping their previous medication.

Pain and SensitizationSleep
E3 PreliminaryPEM not requiredPreliminaryObservationalEditor reviewed

Learning and memorization impairment in childhood chronic fatigue syndrome manifesting as school phobia in Japan.

Miike, Teruhisa, Tomoda, Akemi, Jhodoi, Takako et al.·Brain & development·2004

This study followed children with chronic fatigue syndrome (CFS) in Japan over 15 years to understand why they experience severe tiredness and difficulty learning and remembering information. The researchers found that these children had problems with their autonomic nervous system (the automatic system controlling heart rate, temperature, and digestion), disrupted sleep-wake cycles similar to jet lag, and reduced blood flow to certain brain areas. Understanding these patterns may help explain why learning becomes so difficult for children with CFS.

SleepCognitive Impairment
E3 PreliminaryPEM unclearPreliminaryReview-NarrativeEditor reviewed

Biorhythms and possible central regulation of magnesium status, phototherapy, darkness therapy and chronopathological forms of magnesium depletion.

Durlach, Jean, Pagès, Nicole, Bac, Pierre et al.·Magnesium research·2002

This paper proposes that magnesium deficiency may be linked to disrupted circadian rhythms (biological clocks) and could contribute to several conditions including ME/CFS, fibromyalgia, and sleep problems. The authors suggest that light therapy, dark therapy, and magnesium supplementation may help by affecting the body's internal clock and natural sleep hormone production.

Sleep
E3 PreliminaryPEM unclearPreliminaryEditorialEditor reviewed

Chronopathological forms of magnesium depletion with hypofunction or with hyperfunction of the biological clock.

Durlach, J, Pagès, N, Bac, P et al.·Magnesium research·2002

This paper suggests that low magnesium levels may disrupt the body's internal clock (circadian rhythm) in two opposite ways. In one pattern, the clock runs too fast, causing depression, nighttime headaches, and fatigue—similar to symptoms in ME/CFS and fibromyalgia. In the other pattern, the clock runs too slow, causing anxiety, migraines, and sleep problems. The authors propose that measuring melatonin levels could help distinguish between these two patterns and guide treatment.

Sleep
E3 PreliminaryPEM not requiredModerate confidenceMechanisticEditor reviewed

Decreased tryptophan availability but normal post-synaptic 5-HT2c receptor sensitivity in chronic fatigue syndrome.

Vassallo, C M, Feldman, E, Peto, T et al.·Psychological medicine·2001

This study examined whether people with ME/CFS have oversensitive serotonin receptors in the brain, which could explain some of their symptoms. Researchers gave patients and healthy people a drug that directly activates serotonin receptors and measured the response. They found that both groups responded similarly, suggesting the problem in ME/CFS is not overly sensitive receptors but rather increased serotonin activity from nerve cells themselves. Interestingly, people with ME/CFS had lower levels of tryptophan (a building block for serotonin) in their blood.

Sleep
E3 PreliminaryPEM not requiredPreliminaryCase-ControlEditor reviewed

Nefazodone for patients with chronic fatigue syndrome.

Hickie, I·The Australian and New Zealand journal of psychiatry·1999

This small study looked at whether a medication called nefazodone could help ME/CFS patients feel better. Ten patients took the drug and also received advice about sleep and behavioral strategies. Most patients reported some improvement in tiredness, sleep problems, and mood, and half were able to return to work or their normal activities.

Sleep
E3 PreliminaryPEM unclearPreliminaryEditorialEditor reviewed

Fibromyalgia and chronic fatigue syndrome: an update for athletic trainers.

Cramer, C R·Journal of athletic training·1998

This article reviews what we know about ME/CFS and fibromyalgia, two conditions that cause severe fatigue, muscle pain, and sleep problems. The authors looked at medical research and government health information to summarize how these conditions affect people, especially athletes. They discuss various treatments being tested, including exercise, relaxation therapy, and medications, and emphasize the importance of careful medical evaluation and psychological support during diagnosis and treatment.

Pain and SensitizationSleep
E3 PreliminaryPEM not requiredPreliminaryReview-NarrativeEditor reviewed

[Chronic fatigue syndrome--psychiatric aspects].

Lemke, M R·Fortschritte der Neurologie-Psychiatrie·1996

This editorial discusses how ME/CFS involves both physical symptoms and mental health aspects that need to be understood together. The authors explain that while doctors have focused heavily on physical symptoms, psychiatric factors—such as stress, sleep problems, and how the body's stress system works—play an important role in the syndrome. An effective approach to ME/CFS requires doctors from different specialties to work together.

SleepImmune System
E3 PreliminaryPEM not requiredWeak / uncertainReview-NarrativeEditor reviewed

[Chronic fatigue syndrome. Definition, diagnostic measures and therapeutic possibilities].

Lieb, K, Dammann, G, Berger, M et al.·Der Nervenarzt·1996

ME/CFS is a disorder that causes persistent tiredness, but doctors cannot diagnose it with a simple blood test or scan. Instead, doctors use specific clinical criteria to identify the condition, while carefully ruling out other illnesses like depression or sleep problems that can look similar. Currently, there is no cure for ME/CFS, so treatment focuses on managing individual symptoms like poor sleep, pain, and mood changes with a combination of medical care and psychological support.

Pain and SensitizationSleepDiagnostics
E3 PreliminaryPEM not requiredPreliminaryMethods-PaperEditor reviewed

Determination of observer-rated alpha activity during sleep.

Flanigan, M J, Morehouse, R L, Shapiro, C M·Sleep·1995

Many ME/CFS patients have been reported to show a particular brain wave pattern called 'alpha intrusion' during sleep, which may contribute to poor sleep quality. This study examined whether the way researchers measure brain waves during sleep affects whether they can detect this pattern. The researchers found that the type of electrode placement and reference point used significantly influenced whether alpha waves were observed, suggesting that previous findings about alpha intrusion in ME/CFS patients may depend heavily on the measurement method used.

Sleep
E3 PreliminaryPEM not requiredWeak / uncertainReview-NarrativeEditor reviewed

[Chronic fatigue syndrome].

Sternon, J, Decaux, G, Hoffmann, G·Revue medicale de Bruxelles·1994

This paper describes how doctors can diagnose ME/CFS using specific criteria and discusses what might cause the condition. The authors note that viral infections may trigger ME/CFS, and that anxiety or depression can make symptoms worse. Importantly, they found that some patients improve on their own after a few years, though most don't respond well to available treatments.

SleepDiagnostics
E3 PreliminaryPEM not requiredPreliminaryReview-NarrativeEditor reviewed

Pharmacological approaches to the therapy of chronic fatigue syndrome.

McCluskey, D R·Ciba Foundation symposium·1993

This study examined various medications used to treat ME/CFS and found that none completely resolved symptoms. The researchers suggest that ME/CFS may be caused by a sleep regulation problem in the brain, which leads to not only extreme tiredness but also pain sensitivity, temperature control issues, and mood problems. They propose that medications affecting brain chemicals, especially serotonin, might help and should be tested in larger clinical trials.

Sleep
E3 PreliminaryPEM unclearPreliminaryReview-NarrativeEditor reviewed

[Neuro-psychiatric aspects of chronic fatigue syndrome].

Shimizu, T·Nihon rinsho. Japanese journal of clinical medicine·1992

This review examines the differences between ME/CFS and other conditions that can look similar, particularly fibromyalgia and depression. The authors explain that ME/CFS is not a psychological disorder and that sleep disturbances may play a central role in the condition. They suggest that brain imaging technology could help doctors more accurately identify ME/CFS in the future.

Sleep
E3 PreliminaryPEM unclearPreliminaryEditor reviewed

Inspiratory muscle training improves autonomic function in myalgic encephalomyelitis/chronic fatigue syndrome and post-acute sequelae of SARS-CoV-2: A pilot study.

Edgell, Heather, Pereira, Tania J, Kerr, Kathleen et al.·Respiratory physiology & neurobiology·2025

This study tested whether a simple breathing exercise program could help people with ME/CFS and Long COVID feel better. For 8 weeks, participants practiced strengthening their breathing muscles. People in all groups—including those with ME/CFS and Long COVID—showed improvements in how far they could walk, their heart rate, sleep quality, and how their nervous system functioned. Those with ME/CFS also noticed less pain and better blood vessel function.

SleepAutonomic Nervous System
E3 PreliminaryPEM unclearPreliminaryReview-NarrativeEditor reviewed

Nutrition and Chronobiology as Key Components of Multidisciplinary Therapeutic Interventions for Fibromyalgia and Associated Chronic Fatigue Syndrome: A Narrative and Critical Review.

Carrasco-Querol, Noèlia, Cabricano-Canga, Lorena, Bueno Hernández, Nerea et al.·Nutrients·2024

This review examines how diet and body rhythms (sleep-wake cycles) affect fibromyalgia and chronic fatigue syndrome. The authors found that what you eat, nutrient levels, gut bacteria, and your natural circadian rhythm all play important roles in these conditions. They conclude that treating FM/CFS effectively requires paying attention to nutrition and sleep timing alongside other therapies.

Sleep
E3 PreliminaryPEM unclearPreliminaryReview-NarrativeEditor reviewed

Possible Application of Melatonin in Long COVID.

Cardinali, Daniel P, Brown, Gregory M, Pandi-Perumal, Seithikurippu R·Biomolecules·2022

This review examines whether melatonin, a natural hormone that regulates sleep, might help people with long COVID who experience symptoms similar to ME/CFS—such as brain fog, fatigue, and muscle pain. Melatonin has several properties that could potentially help: it reduces inflammation, fights harmful molecules in the body, supports immune function, and protects nerve cells. The authors suggest melatonin might be worth studying further as a treatment for the lingering cognitive and pain symptoms some long COVID patients experience.

Pain and SensitizationSleepCognitive Impairment
E3 PreliminaryPEM not requiredModerate confidenceReview-NarrativeEditor reviewed

Central sensitivity and fibromyalgia.

Mezhov, Veronica, Guymer, Emma, Littlejohn, Geoffrey·Internal medicine journal·2021

Fibromyalgia and ME/CFS are conditions where the nervous system becomes oversensitive, causing widespread pain, fatigue, sleep problems, and brain fog. These conditions often occur together and share similar underlying problems with how the brain and spinal cord process pain and other signals. This review explains what causes these conditions and how doctors can recognize and treat them using a combination of education, exercise, stress management, and medications.

SleepCognitive Impairment
E3 PreliminaryPEM unclearPreliminaryReview-NarrativeEditor reviewed

Fibromyalgia and Associated Disorders: From Pain to Chronic Suffering, From Subjective Hypersensitivity to Hypersensitivity Syndrome.

Maugars, Yves, Berthelot, Jean-Marie, Le Goff, Benoit et al.·Frontiers in medicine·2021

This article reviews what scientists know about fibromyalgia as of 2020, including how it's diagnosed and why it happens. The authors explain that fibromyalgia involves the brain processing pain signals too intensely, and that people with fibromyalgia often experience many other symptoms like fatigue, sleep problems, and sensitivity to sounds, lights, and touch. They also discuss how fibromyalgia shares common features with other conditions like ME/CFS, all involving a heightened sensitivity to stimuli controlled by the central nervous system.

Sleep
E3 PreliminaryPEM unclearPreliminaryObservationalEditor reviewed

An Open-Label, Pilot Trial of HRG80™ Red Ginseng in Chronic Fatigue Syndrome, Fibromyalgia, and Post-Viral Fatigue.

Teitelbaum, Jacob, Goudie, Sarah·Pharmaceuticals (Basel, Switzerland)·2021

This study tested a special form of red ginseng called HRG80 in people with ME/CFS, fibromyalgia, and post-COVID fatigue. Over one month, 188 patients took daily ginseng supplements and reported their symptoms. About 60% of participants felt better, with improvements in energy, mental clarity, sleep, and stamina.

Pain and SensitizationSleepCognitive Impairment
E3 PreliminaryPEM not requiredModerate confidenceReview-NarrativeEditor reviewed

Chronic fatigue in Ehlers-Danlos syndrome-Hypermobile type.

Hakim, Alan, De Wandele, Inge, O'Callaghan, Chris et al.·American journal of medical genetics. Part C, Seminars in medical genetics·2017

Chronic fatigue is common in people with Ehlers-Danlos syndrome (EDS), a connective tissue disorder, and can significantly reduce quality of life. This review explains that EDS and ME/CFS share similar symptoms, and some people diagnosed with ME/CFS may actually have undiagnosed EDS. Treatment requires ruling out common causes of fatigue like anemia and thyroid problems, then addressing EDS-specific issues like sleep problems, pain, heart rhythm problems, and physical deconditioning through a combination of symptom management, physical therapy, and supportive care.

Sleep
E3 PreliminaryPEM not requiredPreliminaryCross-SectionalEditor reviewed

Linking disease symptoms and subtypes with personalized systems-based phenotypes: a proof of concept study.

Aschbacher, Kirstin, Adam, Emma K, Crofford, Leslie J et al.·Brain, behavior, and immunity·2012

This study examined how the body's stress-response system (the HPA axis) works differently in people with ME/CFS and fibromyalgia compared to healthy people. Researchers measured stress hormones (cortisol and ACTH) every 10 minutes for 24 hours and used computer modeling to understand each person's unique hormone patterns. They found that nighttime hormone patterns were different in patients versus healthy controls, and these patterns were linked to symptoms like pain, fatigue, and poor sleep.

Sleep
E3 PreliminaryPEM unclearPreliminaryEditorialEditor reviewed

Fatigue and disrupted sleep-wake patterns in patients with cancer: a shared mechanism.

Wu, Horng-Shiuann, Davis, Jean E, Natavio, Teofanes·Clinical journal of oncology nursing·2012

Cancer patients often experience severe tiredness and sleep problems at the same time, suggesting they may share a common cause. This paper proposes that stress hormones—particularly those controlled by a system called the HPA axis—may be disrupted in ways that trigger both fatigue and poor sleep. Because ME/CFS patients have similar symptoms and similar HPA axis problems, studying cancer-related fatigue might help us understand ME/CFS better.

Sleep
E3 PreliminaryPEM not requiredModerate confidenceReview-NarrativeEditor reviewed

Fibromyalgia syndrome: a discussion of the syndrome and pharmacotherapy.

Smith, Howard S, Barkin, Robert L·American journal of therapeutics·2010

Fibromyalgia is a condition that causes widespread pain throughout the body, along with fatigue, sleep problems, brain fog, and mood changes. This article explains that fibromyalgia may share common features with ME/CFS and other conditions involving heightened pain sensitivity. While there is no cure, doctors can help manage symptoms through exercise, therapy, patient education, and specific medications.

Pain and SensitizationSleepCognitive Impairment
E3 PreliminaryPEM unclearPreliminaryReview-NarrativeEditor reviewed

Violence, stress, and somatic syndromes.

Crofford, Leslie J·Trauma, violence & abuse·2007

This review article examines how experiences of violence and stress may trigger or worsen conditions like ME/CFS, fibromyalgia, and irritable bowel syndrome—illnesses that involve pain, exhaustion, mood changes, memory problems, and sleep issues. The authors explain that stress affects the brain and body's hormone and nervous system function, which may make people more vulnerable to developing these conditions. Understanding this connection could help us recognize how violence exposure affects long-term health.

Pain and SensitizationSleepCognitive Impairment
E3 PreliminaryPEM unclearPreliminaryReview-NarrativeEditor reviewed

Cranial electrotherapy stimulation and fibromyalgia.

Gilula, Marshall F·Expert review of medical devices·2007

This review examines cranial electrotherapy stimulation (CES), a treatment that uses mild electrical stimulation applied to the head to help manage fibromyalgia pain and related symptoms. While CES is not a cure-all, research suggests it may help some fibromyalgia patients feel better. The review also discusses how fibromyalgia often occurs alongside other conditions like anxiety, depression, sleep problems, and fatigue—symptoms that overlap with ME/CFS.

Pain and SensitizationSleep
E3 PreliminaryPEM unclearPreliminaryEditorialEditor reviewed

Magnesium depletion with hypo- or hyper- function of the biological clock may be involved in chronopathological forms of asthma.

Durlach, J, Pagès, N, Bac, P et al.·Magnesium research·2005

This paper proposes that low magnesium levels combined with disrupted biological clocks (your body's natural 24-hour rhythm) may contribute to asthma that gets worse at night. The authors suggest that magnesium depletion is different from simple magnesium deficiency—it involves a deeper dysregulation that cannot be fixed by supplements alone. They propose two subtypes based on whether the biological clock is overactive (linked to nighttime asthma) or underactive (linked to daytime symptoms).

Sleep
E3 PreliminaryPEM not requiredPreliminaryReview-NarrativeEditor reviewed

Fibromyalgia: a stress disorder? Piecing the biopsychosocial puzzle together.

Van Houdenhove, Boudewijn, Egle, Ulrich T·Psychotherapy and psychosomatics·2004

This review article explores whether stress might be a root cause of fibromyalgia, a condition with widespread pain and fatigue that overlaps significantly with chronic fatigue syndrome. The authors examine how the body's stress response system works and how stress-related changes might lead to abnormal pain sensitivity and other fibromyalgia symptoms. They propose that fibromyalgia could be understood as a stress-related disorder involving both physical and psychological factors.

Sleep
E3 PreliminaryPEM not requiredPreliminaryReview-NarrativeEditor reviewed

Sleep and circadian rhythm disorders in fibromyalgia.

Korszun, A·Current rheumatology reports·2000

Fibromyalgia is a condition causing widespread muscle pain along with sleep problems and extreme tiredness. This review examines how broken sleep patterns and disrupted body clocks (which control things like stress hormones) play a role in fibromyalgia. The authors suggest that treating sleep disorders, depression, and improving sleep habits—along with careful use of medications—may help relieve symptoms.

Sleep
E3 PreliminaryPEM unclearWeak / uncertainEditorialEditor reviewed

[Fibromyalgia syndrome].

Matsumoto, Y·Nihon rinsho. Japanese journal of clinical medicine·1999

This paper discusses fibromyalgia syndrome (FMS), a condition characterized by widespread pain, fatigue, sleep problems, and mood changes without visible inflammation or damage on tests. The author explains that while fibromyalgia is recognized as real, some doctors still debate whether it is truly distinct from other conditions. Many people with ME/CFS also meet the criteria for fibromyalgia, but there are some differences between the two conditions—such as signs of viral triggers and low blood chemical levels found in ME/CFS but not usually in fibromyalgia.

Pain and SensitizationSleep
E3 PreliminaryPEM not requiredPreliminaryEditorialEditor reviewed

Periodic limb movements of sleep and the restless legs syndrome.

Williams, D C·Virginia medical quarterly : VMQ·1996

This article examines periodic limb movements during sleep and restless legs syndrome, which are not diseases themselves but signs that something is disturbing the nervous system. The author suggests these conditions may be related to ME/CFS and other disorders, and that they arise from problems in a brainstem region that controls smooth sleep and wakefulness. Various treatments can help reduce symptoms and improve sleep quality.

Sleep
E3 PreliminaryPEM unclearPreliminaryReview-NarrativeEditor reviewed

The pathogenesis of chronic pain and fatigue syndromes, with special reference to fibromyalgia.

Clauw, D J·Medical hypotheses·1995

This paper reviews what doctors and researchers knew in 1995 about fibromyalgia and similar conditions that cause chronic pain and tiredness. The authors noticed that fibromyalgia overlaps significantly with chronic fatigue syndrome, migraines, irritable bowel syndrome, and mood disorders, suggesting these conditions may share common underlying causes rather than being completely separate diseases.

SleepAutonomic Nervous System
E3 PreliminaryPEM unclearPreliminaryEditorialEditor reviewed

Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome.

Goldenberg, D L·Current opinion in rheumatology·1991

This review examines three related conditions—fibromyalgia, chronic fatigue syndrome, and myofascial pain—that often occur together and cause pain, tiredness, and sleep problems. Researchers are discovering that these conditions may share common biological causes involving how the body senses pain, hormone imbalances, and problems with muscle function. Unfortunately, the new treatments being tested at that time were not particularly effective.

Pain and SensitizationSleepDiagnostics
E3 PreliminaryPEM not requiredPreliminaryEditor reviewed

Could Modafinil Be an Option in the Treatment of Sexual Dysfunctions Due to Antidepressant Use in Women? Two Case Reports.

Yilbaş, Barış·Turk psikiyatri dergisi = Turkish journal of psychiatry·2022

Some antidepressant medications can cause sexual side effects like loss of desire and difficulty with arousal. This report describes two women whose sexual problems improved when modafinil (a medication used for sleep disorders and fatigue) was added to their antidepressant treatment. One woman saw significant improvement at 100 mg daily, while the other needed 200 mg daily to see meaningful improvement.

Sleep
E3 PreliminaryPEM not requiredPreliminaryMechanisticEditor reviewed

Study on the active components and mechanism of Suanzaoren decoction in improving cognitive impairment caused by sleep deprivation.

Cheng, Li, Wang, Fei, Li, Zi-Heng et al.·Journal of ethnopharmacology·2022

This study examined how an ancient Chinese herbal remedy called Suanzaoren Decoction (SZRD) might help improve thinking and memory problems caused by poor sleep. Researchers used computer analysis and laboratory experiments to identify the active ingredients in the herbs and understand how they work in the body, finding that the remedy may work through pathways related to estrogen in the brain.

SleepCognitive Impairment
E3 PreliminaryPEM not requiredPreliminaryEditor reviewed

Building-related illness (BRI) in all family members caused by mold infestation after dampness damage of the building.

Kramer, Axel, Wichelhaus, Thomas A, Kempf, Volkhard et al.·GMS hygiene and infection control·2021

A family of five living in a house with severe mold damage all developed health problems. The mother developed symptoms very similar to ME/CFS, including extreme fatigue, cognitive problems, sleep issues, and respiratory complaints. After the family moved out, symptoms improved gradually—the father recovered in 2 weeks, the children in 6 months, and the mother took 18 months to fully recover.

SleepCognitive Impairment
E3 PreliminaryPEM not requiredPreliminaryCase-ControlEditor reviewed

Not what it seems to be: Depression versus periodic limb movement disorder.

Gupta, Ravi, Kundu, Kaustuv, Khayyam, Khwaja et al.·Indian journal of psychiatry·2020

This case report describes a patient who was initially diagnosed with depression and wasn't getting better with antidepressant medications. Doctors later realized he actually had a sleep disorder called periodic limb movement disorder (PLMD), where the legs move involuntarily during sleep. When treated with a medication called ropinirole, his symptoms improved significantly. This story highlights how sleep problems can look like depression or chronic fatigue, and getting the right diagnosis matters.

Sleep
E3 PreliminaryPEM not requiredPreliminaryRCTEditor reviewed

Treatment for Gulf War Illness (GWI) with KPAX002 (methylphenidate hydrochloride + GWI nutrient formula) in subjects meeting the Kansas case definition: A prospective, open-label trial.

Holodniy, Mark, Kaiser, Jon D·Journal of psychiatric research·2019

Researchers tested a combination treatment called KPAX002—containing a stimulant medication (methylphenidate) plus vitamins and nutrients meant to support energy production in cells—in 17 people with Gulf War Illness. After 12 weeks, patients reported about 25% improvement in their overall symptoms, including better fatigue, brain fog, sleep, and pain. The treatment was generally safe and well-tolerated, though a larger, more rigorous study is needed to confirm these results.

Pain and SensitizationSleepCognitive Impairment
E3 PreliminaryPEM not requiredModerate confidenceReview-NarrativeEditor reviewed

[Narcolepsy and Other 'Central Disorders of Hypersomnolence'].

Mathis, Johannes·Praxis·2018

This article discusses how doctors can tell the difference between several sleep-related conditions that cause excessive daytime sleepiness or fatigue. The authors explain that complaints like tiredness and fatigue are common, but they can have many different causes. Careful diagnosis using sleep studies and other tests is needed to distinguish narcolepsy, idiopathic hypersomnia, and chronic fatigue syndrome from one another, since each condition requires different treatments.

Sleep
E3 PreliminaryPEM not requiredPreliminaryRegistry-ResourceEditor reviewed

Supplementation with Robuvit® in post-traumatic stress disorders associated to high oxidative stress.

Belcaro, Gianni, Luzzi, Roberta, Hosoi, Morio et al.·Minerva medica·2018

This study looked at whether a plant-based supplement called Robuvit® could help people with PTSD (post-traumatic stress disorder) recover faster alongside standard therapy. Over 4 weeks, people who took Robuvit® along with therapy showed greater improvements in symptoms like intrusive memories, nightmares, flashbacks, sleep problems, and fatigue compared to those who received therapy alone.

Sleep
E3 PreliminaryPEM not requiredWeak / uncertainReview-NarrativeEditor reviewed

Fibromyalgia: A Critical and Comprehensive Review.

Borchers, Andrea T, Gershwin, M Eric·Clinical reviews in allergy & immunology·2015

Fibromyalgia is a condition that causes widespread pain, fatigue, and sleep problems, and it shares many symptoms with other conditions that are hard to diagnose. This review explains that while some people think fibromyalgia might be caused by infection, inflammation, or injury, there is not strong evidence supporting these ideas. The authors recommend that treatment should focus on education, exercise, physical therapy, and approved medications rather than opioids.

Pain and SensitizationSleepDiagnostics
E3 PreliminaryPEM unclearPreliminaryReview-NarrativeEditor reviewed

The role of antipsychotics in the management of fibromyalgia.

Calandre, Elena P, Rico-Villademoros, Fernando·CNS drugs·2012

This review examines whether antipsychotic medications—drugs typically used to treat psychiatric conditions—might also help people with fibromyalgia manage pain, sleep problems, fatigue, and mood disturbances. The authors found that some antipsychotics, particularly quetiapine, have shown promise in small studies and case reports, though most research is preliminary and more rigorous testing is needed.

Pain and SensitizationSleep
E3 PreliminaryPEM not requiredPreliminaryReview-NarrativeEditor reviewed

Sleep disorders, medical conditions, and road accident risk.

Smolensky, Michael H, Di Milia, Lee, Ohayon, Maurice M et al.·Accident; analysis and prevention·2011

This review examined how sleep disorders and medical conditions—including ME/CFS, sleep apnea, insomnia, and others—may increase the risk of car accidents caused by drowsiness and fatigue. The authors found that while these conditions clearly cause tiredness and poor sleep, very few studies have actually looked at whether they make people more likely to have driving accidents. They call for better research to understand this connection and test whether treating these conditions reduces crash risk.

Sleep
E3 PreliminaryPEM not requiredWeak / uncertainReview-NarrativeEditor reviewed

The tired teen: A review of the assessment and management of the adolescent with sleepiness and fatigue.

Findlay, Sheri M·Paediatrics & child health·2008

This review examines why teenagers feel tired and sleepy, and how doctors can help. Many teens experience sleepiness or fatigue, but the authors found that most cases are caused by not getting enough sleep rather than serious medical conditions. The review emphasizes that doctors need to thoroughly evaluate each teen's situation, as underlying medical problems are rarely discovered.

Sleep
E3 PreliminaryPEM not requiredPreliminaryReview-NarrativeEditor reviewed

Possible links between behavioral and physiological indices of tiredness, fatigue, and exhaustion in advanced cancer.

Olson, Karin, Turner, A Robert, Courneya, Kerry S et al.·Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer·2008

This paper proposes a new framework for understanding tiredness and fatigue in advanced cancer patients. The researchers suggest that cancer and its treatments stress the body, which then affects four key systems: thinking ability, sleep quality, nutrition, and muscle strength. They propose that problems in all four of these areas together—not just one alone—are what cause severe fatigue, and that studying how these systems interact could lead to better treatments.

SleepCognitive Impairment
E3 PreliminaryPEM unclearPreliminaryReview-NarrativeEditor reviewed

Possible mechanisms of the formation of chronic fatigue syndrome in the clinical picture of multiple sclerosis.

Kasatkin, D S, Spirin, N N·Neuroscience and behavioral physiology·2007

This study examined why people with multiple sclerosis (MS) often experience severe fatigue. The researchers identified different types of fatigue—exhaustion at rest, excessive tiredness after activity, and worsening fatigue during MS flare-ups—and explored how brain chemistry, hormones, immune system problems, and sleep issues might all contribute to this fatigue.

Sleep
E3 PreliminaryPEM not requiredModerate confidenceMethods-PaperEditor reviewed

Brief and distinct empirical sleepiness and fatigue scales.

Bailes, Sally, Libman, Eva, Baltzan, Marc et al.·Journal of psychosomatic research·2006

Doctors and patients often use the words 'sleepiness' and 'fatigue' interchangeably, but they actually describe different experiences. This study created two short, separate questionnaires—one to measure sleepiness (the urge to sleep) and one to measure fatigue (overall exhaustion)—by pulling items from existing popular fatigue and sleepiness scales. Testing these new scales on people with ME/CFS, narcolepsy, and healthy controls showed they measure distinct conditions that may respond to different treatments.

SleepDiagnostics
E3 PreliminaryPEM not requiredWeak / uncertainReview-NarrativeEditor reviewed

[Fibromyalgia syndrome].

Siegmeth, Walter·Wiener medizinische Wochenschrift (1946)·2003

Fibromyalgia syndrome (FMS) is a real medical condition that causes widespread pain and should be diagnosed using clear, established criteria. Research suggests it may involve problems with the nervous system, hormonal systems, and pain control pathways in the brain. Treatment works best when it combines information and education, physical therapy, and sometimes medication, rather than relying on drugs alone.

Sleep
E3 PreliminaryPEM not requiredWeak / uncertainObservationalEditor reviewed

[Use of local negative pressure in combination with electric sleep or Charcot's douche for treatment of erectile dysfunctions].

Karpukhin, I V·Voprosy kurortologii, fizioterapii, i lechebnoi fizicheskoi kultury·2001

This study looked at 43 men with erectile dysfunction linked to stress, anxiety, and chronic fatigue. Researchers combined three treatments: a device that uses negative pressure, electric sleep therapy, and a water treatment called Charcot's douche. The combination appeared to help improve sexual function in men whose problems were caused by psychological stress rather than physical causes.

Sleep
E3 PreliminaryPEM not requiredPreliminaryCase-ControlEditor reviewed

[Genioglossal advancement in the surgical treatment of obstructive sleep apnea syndrome in adults].

Foltán, R, Sonka, K·Sbornik lekarsky·2000

This case report describes a 68-year-old woman with severe sleep apnea (a condition where breathing repeatedly stops during sleep) who also had symptoms of chronic fatigue, daytime sleepiness, and morning headaches. Because she couldn't tolerate the standard breathing mask treatment due to anxiety, she had surgery to widen her airway. After surgery, her sleep apnea improved significantly and her fatigue and other symptoms improved.

Sleep
E3 PreliminaryPEM not requiredWeak / uncertainReview-NarrativeEditor reviewed

[Fibromyalgia. A critical review].

Cathébras, P, Lauwers, A, Rousset, H·Annales de medecine interne·1998

Fibromyalgia is a chronic pain condition that affects about 2% of the general population, with symptoms including widespread pain, fatigue, and sleep problems. This review examines how fibromyalgia overlaps with other conditions like ME/CFS and depression, and discusses why current treatments like antidepressants and therapy have limited effectiveness. The authors suggest that fibromyalgia may develop through interconnected factors rather than a single cause.

SleepDiagnostics
E3 PreliminaryPEM not requiredPreliminaryObservationalEditor reviewed

Short-term night-shift working mimics the pituitary-adrenocortical dysfunction in chronic fatigue syndrome.

Leese, G, Chattington, P, Fraser, W et al.·The Journal of clinical endocrinology and metabolism·1996

This study found that nurses who worked night shifts for just 5 days showed abnormal stress hormone patterns similar to those seen in ME/CFS patients. Specifically, their bodies produced high levels of one stress hormone (ACTH) but low levels of another (cortisol) during night shifts. This suggests that disrupted sleep and routine alone may be enough to trigger the hormone imbalances characteristic of ME/CFS.

Sleep
E3 PreliminaryPEM not requiredWeak / uncertainReview-NarrativeEditor reviewed

Fibromyalgia syndrome: a review.

Reiffenberger, D H, Amundson, L H·American family physician·1996

Fibromyalgia syndrome is a chronic condition characterized by widespread pain, stiffness, and tender points in muscles and soft tissues, often accompanied by fatigue and sleep problems. It affects women more than men, typically starting around age 49. Treatment combines medication (like certain antidepressants), education, reassurance, and exercise to help manage symptoms.

Pain and SensitizationSleep
E3 PreliminaryPEM not requiredPreliminaryCase-ControlEditor reviewed

Consideration of narcolepsy in the differential diagnosis of chronic fatigue syndrome.

Ambrogetti, A, Olson, L G·The Medical journal of Australia·1994

This study describes four patients who were initially diagnosed with chronic fatigue syndrome (CFS) but actually had a different condition called narcolepsy, which causes extreme daytime sleepiness. When these patients were properly diagnosed with narcolepsy and treated with a medication called methylphenidate, their symptoms improved significantly or resolved completely. The authors suggest that doctors should carefully check for narcolepsy in patients with CFS who report severe daytime sleepiness.

Sleep
E0 ConsensusPEM unclearModerate confidenceReview-NarrativeMachine-drafted

Sleep, pain, fibromyalgia, and chronic fatigue syndrome.

Landis, Carol A·Handbook of clinical neurology·2011

This review examined the connections between sleep problems, pain, fibromyalgia, and chronic fatigue syndrome (ME/CFS). The author looked at existing research to understand how poor sleep and pain symptoms often occur together in these conditions and how they may be related to each other.

Pain and SensitizationSleep
E0 ConsensusPEM not requiredModerate confidenceMeta-AnalysisMachine-drafted

[Efficacy and safety of fonturacetam in asthenia: a systematic review and meta-analysis].

Devlikamova, F I, Safina, D R·Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova·2025

This review combined results from 11 studies testing a medication called fonturacetam (also known as Actitropil) in people with asthenia—a medical term for persistent exhaustion and lack of energy. After one month of treatment at 200 mg daily, patients reported significantly less fatigue, with improvements also seen in sleep, mood, thinking ability, and overall quality of life. About 5.5% of patients experienced mild, temporary side effects that went away within a week.

SleepCognitive Impairment
E2 ModeratePEM not requiredModerate confidenceObservationalMachine-drafted

Sleep education in primary school prevents future school refusal behavior.

Maeda, Tsutomu, Oniki, Kentaro, Miike, Teruhisa·Pediatrics international : official journal of the Japan Pediatric Society·2019

This study tested whether teaching primary school children about healthy sleep habits could prevent school refusal (persistent avoidance of attending school) later on. Researchers in Japan had students track their sleep for 2 weeks, gave them feedback, and taught them and their parents about the importance of regular sleep schedules. After the program started, school refusal rates dropped dramatically—from 10% of graduates in 2007 to 0% by 2012.

Sleep
E3 PreliminaryPEM unclearWeak / uncertainMachine-drafted

Auricular acupuncture for insomnia of chronic fatigue syndrome: a case report.

Zhang, Feng, Shen, Yifeng, Li, Jie et al.·Acupuncture in medicine : journal of the British Medical Acupuncture Society·2020

This study looked at whether auricular acupuncture (tiny needles placed in specific points on the ear) could help improve sleep in one patient with ME/CFS. The patient received acupuncture treatment and reported improvements in their insomnia symptoms. However, this is just one person's experience, so we cannot yet say whether this treatment would work for other ME/CFS patients.

Sleep
E3 PreliminaryPEM unclearPreliminaryMachine-drafted

[Moxibustion at Yongquan (KI 1) for sleep disorders of chronic fatigue syndrome].

Chen, Xiao-Qin, Gang, Zhi-Xiu, Xu, Zhi-Peng·Zhongguo zhen jiu = Chinese acupuncture & moxibustion·2013

This study explored whether moxibustion—a traditional Chinese medicine technique involving burning herbs near the skin—might help improve sleep problems in people with ME/CFS. The treatment focused on a specific acupuncture point on the sole of the foot called Yongquan (KI 1). While the study suggests this approach may have helped some patients sleep better, the research quality is limited and more rigorous testing is needed.

Sleep
E3 PreliminaryPEM unclearPreliminaryReview-NarrativeMachine-drafted

Chronic fatigue syndrome. 2: Treatment and future research.

Kantrowitz, F G, Farrar, D J, Locke, S E·Behavioral medicine (Washington, D.C.)·1995

This review article examines different ways to treat ME/CFS and outlines important directions for future research. The authors discuss various treatment approaches that have been studied and identify gaps in our current understanding of the condition. The paper emphasizes that while treatment options exist, more research is needed to find more effective therapies.

Sleep
E3 PreliminaryPEM unclearWeak / uncertainReview-NarrativeMachine-drafted

[Chronic fatigue syndrome. Clinical, social psychological problems and management].

Wessely, S·L'Encephale·1994

This review examines ME/CFS by comparing it to an older condition called neurasthenia and explores what causes the illness. The authors suggest that ME/CFS likely involves multiple factors including brain chemistry changes, difficulty perceiving effort, mood problems, and reduced physical activity—rather than being purely psychological or a muscle problem. They recommend cognitive-behavioral therapy (gradual activity increase) and antidepressants as the main treatments, while warning that too much rest can actually make the condition worse long-term.

Sleep
E3 PreliminaryPEM not requiredPreliminaryMachine-drafted

[Clinical efficacy of neurometabolic therapy of dissomical disorders in asthenic syndrome].

Esipov, A V, Ivolgin, A F, Khritinin, D F et al.·Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova·2019

This study tested whether a medication called cytoflavin, which helps cells produce energy, could help 100 patients with fatigue and sleep problems. Patients received cytoflavin as an infusion, either alone or combined with melatonin or another sleep medication. By day 14, 97% of patients reported significant improvement in fatigue and sleep quality.

Sleep

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