[Poll] How does exertion affect sleep? (Read instructions in first post)

[mango]

I ticked "Other changes is sleep" for complete day-night sleep reversal. For milder pem it can sometimes be more of a delayed sleep–wake phase. (It's not just that same night, but usually for the duration of the PEM.)

 

[forestglip]

I noticed something that might be ambiguous. I'm not sure how people are marking these other ones if they mark "I cannot sleep at all", so to make a consistent rule, please use this:

If you select "I cannot sleep at all":

• Also select "My total sleep time is decreased"
• Do not select "I fall asleep later"

 

[JemPD]

I dont know how to vote, sometimes its sleep much much later wired & awake till 8am or so when i eventally drop off, sometimes its drop off at (eg) 4 but only for a couple of hours. The more i over exert the worse it is - so if i done a little over i will sleep later, if alot i wont sleep at all.
so which should i answer?

 

[forestglip]

I dont know how to vote, sometimes its sleep much much later wired & awake till 8am or so when i eventally drop off, sometimes its drop off at (eg) 4 but only for a couple of hours. The more i over exert the worse it is - so if i done a little over i will sleep later, if alot i wont sleep at all.
so which should i answer?

I don't think it matters too much, but just go with what happens with more intense exertion (no sleep).

 

[forestglip]

Okay, 35 people voted at the time of this post.

I didn't give clear instructions for the option "I fall asleep later" at first. I think some people who don't sleep at all understandably also marked this and some didn't (I later added to the instructions not to). So it's not clear what that number is showing, other than at least about 48% either fall asleep later or don't sleep at all.

The rest of the options are more straightforward.

There's a large skewing towards less sleep after exertion (54.3%) vs more sleep (14.3%), and a little less than half of those with less sleep can't sleep at all.

This somewhat agrees with the two studies done on sleep changes after exercise in ME/CFS (1, 2): Healthy controls fell asleep faster, while ME/CFS participants time to fall asleep didn't change at all. Since the criteria in these studies did not require PEM, it's plausible that the part of the ME/CFS cohort without PEM fell asleep faster like the controls, the ones with PEM fell asleep slower, and it averaged out to no change. In any case, the direction of the effect in the studies and here points to increased trouble sleeping in ME/CFS after exercise.

About half in this poll have changes in temperature regulation.

About three quarters experience increased amounts of the "wired but tired" feeling, so that may be the most universal symptom here.

No one said exertion has no effect on their sleep. I'm wondering if selection bias might have something to do with that.

1. The effects of exercise on dynamic sleep morphology in healthy controls and patients with chronic fatigue syndrome, 2013, Kishi et al

2. Sleep is not disrupted by exercise in patients with chronic fatigue syndrome, 2010, Togo et al

 

[Evergreen]

Regarding the tired-and-wired experience, a BBC article about sleep caught my eye recently https://www.bbc.com/future/article/20250131-how-the-brains-blue-dot-regulates-your-sleep.

It's about a little part of the brain called the locus coeruleus, which the NIH is interested in in ME/CFS, for better or worse (see symposium, Nicholas Madian's section on the EEfRT results, starts at about 2:21:20, https://videocast.nih.gov/watch=54675).

In the BBC article, this quote stuck out:

If you force yourself to keep going when you are tired, your brain copes by cranking its gear up to provide maximum horsepower for its struggling machinery – so much so that it almost 'gets stuck' at a high setting – Mithu Storoni

That certainly echoes my experience. I think it happens to normal people occasionally, eg when they have to work much later than usual to finish a presentation/paper/project. But I feel like that a lot after overexertion. I've been revved up and left there, and because it's happened so many times, like @Trish said, I know what's coming - a crash.

It also makes me think of when young children are overtired and can't settle to sleep.

The "other changes in sleep" that I endorsed are frequent waking, eg after a half hour or after each sleep cycle (about one and a half hours), if I'm lucky enough to sleep that long at a stretch.

Really interesting topic, @forestglip.

And thanks for making me laugh out loud @Sasha . Everyone's sheepish responses very funny too.

 

[forestglip]

It's about a little part of the brain called the locus coeruleus

Interesting. I did a search and found these:

S4ME thread: Differential Effects of Exercise on fMRI of the Midbrain Ascending Arousal Network Nuclei in ME/CFS and GWI in a Model of PEM, 2021, Baraniuk et al

Postexercise ME/CFS had greater activation than [gulf war illness] for midline periaqueductal gray, dorsal and median raphe, and right midbrain reticular formation, parabrachial complex and locus coeruleus.

S4ME thread: Cognitive decline and brainstem hypometabolism in long COVID: A case series, 2022, Jacques Hugon et al

We report here 3 cases of brain fog with major hypometabolic areas of the pons revealed by the cerebral FDG PET. [...] The dysfunction of the locus coeruleus in these patients could partly explain the cognitive disorders observed.

S4ME thread: A hypoarousal model of neurological post-COVID syndrome: the relation between mental fatigue, the level of central nervous activation and cognitive processing speed, 2023, Martin et al

We cannot directly infer the underlying pathomechanisms of arousal dysfunction in post-COVID patients in our study. However, our results point towards possible neurostructures and -modulators. As tonic alertness regulation depends on input from wakefulness-promoting monoaminergic systems including the noradrenergic locus coeruleus system, post-infectious brainstem alterations might lead to decreased cortical activation resulting in slowed information processing speed and feeling of fatigue.

 

[Evergreen]

S4ME thread: Differential Effects of Exercise on fMRI of the Midbrain Ascending Arousal Network Nuclei in ME/CFS and GWI in a Model of PEM, 2021, Baraniuk et al

I had a look at this. I wish they'd spelled out what the results could mean for patients' symptoms. Would greater activation mean that ME/CFS patients temporarily feel better/worse/worse in a different way/what way than GWI patients after exercise?

Very interesting to see how similar the ME/CFS and GWI patients were, except in terms of pain and mental health, which were worse in GWI.

 

[Mij]

This somewhat agrees with the two studies done on sleep changes after exercise in ME/CFS (1, 2): Healthy controls fell asleep faster, while ME/CFS participants time to fall asleep didn't change at all. Since the criteria in these studies did not require PEM, it's plausible that the part of the ME/CFS cohort without PEM fell asleep faster like the controls, the ones with PEM fell asleep slower, and it averaged out to no change. In any case, the direction of the effect in the studies and here points to increased trouble sleeping in ME/CFS after exercise.

I don't equivalate exertion with what I describe as PEM.

In general I sleep well post exercise and I 'work out' in the evenings. In general I don't sleep well or at all when I over exert cognitively, interacting with people, talking and being out for a couple of hours. My adrenaline feels out of whack. I couldn't sleep for 2 days when I got stuck on a elevator years ago. I was so exhausted/weak limbs when I got off.