A: There are a few critical sleep therapy concepts to know before we start to discuss specific treatments in depth:

1. It is better to take a low dose of several treatments than a high dose of one. If you take enough of a single treatment to keep you out all night, it is likely to stay in the body for another five to six hours after you wake up and keep you hung over. By taking low doses of several things, each one gets out of the body quicker so you are not hung over the next day. The effect during sleep is additive, however, so it will keep you out all night.
2. It is critical to get eight to nine hours of quality sleep a night if your pain is to go away and your immune system is to heal. This is also needed for adequate growth hormone production (the other alternative is to take growth hormone shots at $12,000 a year).
3. You need to take as much sleep support as it takes to get eight to nine hours sleep a night and you need to take it for as long as you need it -- even if this is for ever! Otherwise it would be like taking somebody with high blood pressure, leaving them with high blood pressure if it is not controlled after the first pill, and telling them they have to be off the medicine after two weeks! This would be ludicrous and medical malpractice. Unfortunately it seems this is how most of you have had your sleep disorder treated.
4. Everyone is different. It is helpful to try many different combinations of sleep therapies until you find the one that makes you feel the best. This actually is not very different than trying on shoes to find one that is best for YOU!
5. If during treatment you find that the quality and length of your sleep is starting to decrease, this generally does not mean that you’re developing tolerance or addiction to the treatments. It usually means that there is a new or worsening stress in your life that is further "blowing your circuit breaker", and worsening your sleep. If your sleep quality and length goes down, adjust the sleep treatments to get your eight to nine hours a night. You can then lower the dose four to six weeks after the stress passes.
6. Do not even try to lower the dose of your sleep medication below what is needed to get eight to nine hours of sleep a night until you're feeling well for six months. During this time, it is much more important that you get optimum sleep than it is to come off of or to lower sleep medications. Although you may think six hours a sleep is heaven compared to what you have been getting, if you don't get the eight to nine hours a night that your body needs, your sleep center will not heal and you will not be able to come off of the pills. Take whatever it takes to get eight to nine hours a night of sleep so you're feeling better for at least six months. At that time, your sleep center will turn back on, and you'll be able to safely lower the dose of the sleep treatments. Even after you're well, I recommend you stay on something for sleep long-term (e.g. 1 to 2 capsules of the herbal sleep formula below or 25 to 50 milligrams of Desyrel). Do this even if you are able to sleep without them. Otherwise, patients are prone to have their sleep suffer during periods of stress and this can throw them back into the illness. Taking sleep treatments long-term in a low dose is like having insurance to protect against this.
7. If you frequently wake up to urinate during the night, do not drink a lot of fluids near bedtime. Most patients with CFIDS/FMS have frequent waking during the night. Like most people, their bladders are full at night. Because of a full bladder, they think they are waking up because they have to urinate. This is not the case. They are waking up because of their CFIDS/FMS.

   If you were to wake up your spouse when you woke up and asked, "Honey, is your bladder full?" He or she would moan, "Uh-huh," and roll over and go back to sleep. Unfortunately, most people have learned to get up and go to the bathroom when they wake up at night. The bladder is kind of like a baby—if you teach the baby to wake up to play in the middle of the night (that is, if you go to the bathroom frequently), pretty soon it will wake you up to play at night. There is a simple way to remedy this problem. If and when you wake up during the night and you notice your bladder is full, just talk to it (in your mind, so your spouse doesn’t think you’re nuts) and tell it, "Nighttime is for sleeping. We will go to the bathroom in the morning when it is time to wake up." Then roll over and go back to sleep. If you still have to urinate five minutes later, then you can go to the bathroom. Most of you will find that your bladder will happily go back to sleep, and when you wake up in the morning, you won’t even have to urinate as badly as you did when you woke up in the middle of the night.

   Because of the bladder muscle spasticity that is common in fibromyalgia, you may be afraid that you will wet yourself if you don’t get up to urinate. The large majority of people with CFIDS/FMS will not experience incontinence. If this concerns you, the first couple of nights you may want to use an incontinence protection product such as a Depend undergarment just so you don’t worry about wetting yourself. After a few nights, you will be comfortable sleeping without protection. Although this sounds like a very low-tech approach to treating sleep, you will be amazed at how beneficial it is. Try it and see!

   Put the bedroom clock out of arm’s reach and facing away from you so you can't see it. Looking at the clock frequently aggravates sleep problems and is frustrating.