I've been thinking about the sleep issue. First, if ME's unrefreshing sleep symptom was due to abnormal microarousal architecture, I would expect much more variation between individuals and for the individual, due to activity, diet, etc.
Second, if that symptom was due to inadequate sleep, shouldn't the severity increase during the day, being longer since actual sleep?
I'm not sure I'm following your points here, sorry. Would you mind elaborating?
Increased microarousals seems to be
one measurable differentiator between healthy people and pwME, that does not mean that it is the (or the only) cause for unrefreshing sleep. In fact, as mentioned before, it has also been seen in several trials that pwME apparently have significantly more SWS than healthy controls - but also seem to lack ultra slow delta waves during SWS.
I am not saying microarousals = reason for unrestful sleep. It seems to be a common denominator amongst pwME - but as of now that's it. It would make logical sense that it could influence restfulness.
Non-restful sleep is also not the same as excessive daytime sleepiness.
Some people report feeling worst upon waking, then getting a reprieve in the afternoon or evening.
I definitely have experienced that. I don't see how this would be an argument against sleep architecture disturbances though?
As for what the scans mean, the connection to sleep refreshment isn't clear. Questionnaires about such things as personal judgement of a symptom is far from reliable.
Correct. I am not aware of an objective measurement for feeling rested or not - I have not looked into it either. I do not think questionnaires are useless though.
From what I read, microarousals are a mechanism for creatures to switch between resting and checking whether it's safe to rest (Is that a predator I hear?).
That is one hypothesis, yes. Other hypotheses include an active role in glymphatic circulation for example, as discussed in the paper I linked you to previously. As of now, I don't think it is fully known.
The abnormalities could mean that PWME are more stressed due to worrying about triggering PEM, financial woes, etc. Perhaps microarousals are different in unhealthy or less active people in general. That's something the study could have checked. I'm sure there are many other possibilities.
I don't think you can see microarousals as a singular aspect. From what I read, the consistent findings in studies that measured are increased MAI, (paradoxically) increased SWS and reduced ultra slow delta power.
Stress for example is known to increase MAI but decrease SWS. This is not the same as what they have found in the trials I mentioned.
The perception of lack of sleep isn't caused by lack of sleep; it's caused by an accumulation of chemicals or cellular damage that hadn't been properly cleared by sleep, and that in turn alters other cells' functions, which affects other cells and organs, eventually leading to the perceptions.
Do you have any proof for this statement?