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Show Notes

Fibromyalgia sleep and ME/CFS sleep are full of problems. Getting to sleep, staying asleep, and experiencing refreshing sleep all elude patients. Dr Jacob Teitelbaum joins us again to share his experience and insights on sleep restoration in this episode of the Wisdom from the Other Side Podcast.

Dan Neuffer & Dr Teitelbaum discuss normal sleep vs sleep in fibromyalgia/ME/CFS/POTS and how to normalise fibromyalgia sleep disturbance to accelerate recovery progress. We peel back the layers of strategies for sleep normalisation, including neural retraining and also the psychological components of sleep disturbance. It's so easy into thinking that we have 'tried it all' in terms of fibromyalgia sleep remedies or ME/CFS sleep treatments, but what is needed is a structured building of strategies to improve sleep. We discuss fibromyalgia sleep problems like sleep apnea, fibromyalgia sleep medication (CFS sleep medication) and Upper Airways Resistance Syndrome in Fibromyalgia, ME/CFS and POTS.

Timestamps

Introduction0:00:00
Podcast Disclaimer0:01:08
Welcome0:01:52
What is normal sleep0:03:12
The impact of sleep and lack of sleep0:05:50
What is the ideal sleep0:07:08
First layer sleep strategies0:09:16
The psychological side of sleeplessness0:13:53
Another view on the cause of sleeplessness0:16:30
How Dr Teitelbaums layers the medicinal approach to sleep0:18:24
How to come off medications during ME/CFS/Fibromyalgia/POTS recovery0:24:38
More sleep distinctions0:27:15
Finding the "best" diet for sleep0:33:54
Sleep Apnea vs Upper Airways Resistance Syndrome in CFS/Fibromyalgia/POTS0:38:20
Treating Candida0:42:37
Dr Teitelbaum's ongoing research on serum peptide therapy0:44:16
How to treat Restless Leg Syndrome - (PLMD)0:48:41
The Magnesium / Iron connection0:50:15
The 'psychological' side of trying everything - a scientific approach0:52:15

Transcript

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Dan Neuffer: It was my pleasure to speak with Dr. Jacob Teitelbaum again. This time, our discussion centred around the challenges of sleep in fibromyalgia, MECFS, POTS, and related syndromes.

Whilst most of us instinctively know the importance of sleep to feel well, the research around the impact of sleeplessness in this group of illnesses is pretty clear, so it makes sense to give it plenty of attention.

But what is normal sleep? How can we restore sleep? Is it medication, herbs, or some other remedy?

We discuss the importance of a structured approach and peel back the layers, including the neurological training components of sleep restoration.

Those of you in the ANS Rewire program will already recognise many key insights, but hopefully this podcast will help you to work more effectively with your physician towards sleep normalisation to accelerate your recovery progress.


Let’s get into it.

Just a short but important message regarding the content of this podcast.

The ideas, concepts, and opinions expressed in this recording, website, and associated media and products are intended to be used for educational and information purposes only. Nothing presented is intended to replace your physician nor are they a substitute for medical diagnosis, advice, or treatment.

This podcast is provided with the understanding that the authors, guests., speakers, and publishers are not rendering medical advice of any kind.

Well, I am very excited to have Dr. Jacob Teitelbaum on Wisdom from the Other Side.

He certainly knows about wisdom from the other side because he has been on both sides of the ledger, including being a patient and recovering as well as being a physician and having been a patient himself.

He is, of course, the famous author of “From Fatigue to Fantastic” with a lovely, very attractive, new blue colour compared to the iconic yellow that he had for some decades. He is coming here today to speak about sleep.

Hi Jacob! Thanks for joining on Wisdom from the Other Side!

Dr. Jacob Teitelbaum: Dan, it’s a pleasure being with all of you today because sleep is a critical part of regenerating our bodies – whether it’s the biochemistry, whether it’s dealing with pain, or whether it’s anti-aging, all of these different things.

How to get a good night’s sleep? What is a good night’s sleep? Different tools. We’re going to talk about all of that today. You will be a sleep expert. But, more importantly, you’re going to finally know how you can get a good night’s sleep which, for those of us with CFS and fibro, can be a major challenge.

Shall we get to it? Let’s see how to have some nice sleep.

Dan: It’s funny. You know, nobody really thinks about sleep until they don’t have it anymore. It makes us think, “Well, what is normal?” We talk about the number of hours that people sleep which tends to reduce as people age, but there’s a lot of talk about how modern life has impacted sleep.

I was having a look at some research which suggested that we used to have different kinds of sleep patterns. People suggested that we used to have two sleeps a night instead of just one. Perhaps we didn’t have that many more hours than we do these days. I’m not so sure about that. That’s my response to it.

What are your thoughts on that? What do you think is normal?

Dr. Jacob: Looking at the medical anthropology, if you go back 150 years ago when Thomas Edison was inventing lightbulbs, the average night’s sleep in the United States was 9 hours a night. We had already been moving away from the biphasic sleep pattern.

The medical anthropologists say, if you go back 5,000 years ago before the modern era or industrial era, the average night’s sleep, the sun went down, and unless there was some celebration or festival, it was dark, boring, and dangerous outside. People went to bed. The sun came up, and people woke up.

The average night hours basically were 11 hours of sleep a night is what they estimated.

But what they found is that people at a village tended to have a two-hour block where they would wake up, and it would be different times of night. There would always be somebody naturally awake in case there was an attack or an emergency to sound the alarm. This time was used for meditation, prayer, sex, introspection, looking at dreams – quiet things like that.

The biphasic pattern is not unusual in humans. It’s pretty common, but even that took it down from 11 hours a night to 9 hours a night. We’re now down to 6 ¾ a night average because, again, since lightbulbs were invented – light, TV, radios, cellphones, Facebook, it goes on and on – we’re down to 6 ¾ hours. That’s a 30 percent pay cut to the body.

That’s one of the major reasons we’re seeing chronic pain affecting one-third of the population, obesity, as well as fatigue and chronic fatigue syndrome. In most of the population, they have poor sleep because they don’t make the time. In our population, it’s because the sleep is not working.

Dan: Yes, I think a lot of people are being robbed by late night entertainment as well. I have to say, it’s interesting. Obviously, I remember the first night of good sleep that I had as I had been recovering. I remember waking up bewildered at what had happened. How did I get to sleep to the other day and the way it feels for my body?

Certainly, since I’ve been recovered, I’ve enjoyed good health for many years. I did have a period where I had sleep issues due to another medical issue where I had appendicitis and abdominal pain for a period of some months. I have to say, even as a well person, as soon as you take off a few of those hours, the level of vitality that you have plummets dramatically with sleep, doesn’t it?

Dr. Jacob: Sleep is critical to avoid being in pain. We get normal little micro tears in our muscles from normal use. The growth hormones repair those tissues. Research shows, if you take somebody, every time they’d go into deep sleep, they’d shake them out of deep sleep for 24 to 36 hours, and they would develop widespread pain. 

Dan: Do you think there is a difference in terms of when we go to sleep? There’s a lot of talk about getting sleep before midnight and whether we sleep late in the day. I guess I haven’t been necessarily convinced by this. I was curious what your take was on it.

Dr. Jacob: What size shoe is the best size for everybody? This is not a one-size-fits-all thing.

It’s like there’s no one diet that’s best for everybody. There’s no one shoe size that fits everybody. Sleep is not one-size-fits-all either. There are some people who are night owls. There are some who are early to bed, early to rise. It depends.

For most of my life, I’ve been a night owl. In fact, in med school, they called me The Ghost because at 2:00 in the morning, you’d find me in the medical stacks in the library going through and just pulling journals off and reading them. I was a card-carrying certified geek, and I still am.

I had my 70th birthday two weeks ago. I’ve been shifting since I moved to Hawaii a little more to being in bed by 9:00 or 10:00 pm instead of 2:00 to 3:00 in the morning, and it varies.

How much time per night? The average night’s sleep that I think is optimal is 8 to 9 hours, but for some people, they can get 4 hours of sleep, and they feel fine. Others need 10.

Again, when people say, “Well, this is the way you should do it,” tell them, “Thank you. Yes, that’s way you should do it.” Notice what feels the best to you because what works the best for you is how I recommend you do it.

But, first, let’s give you the tools so you can do what feels best.

Dan: That’s my sentiment exactly, Jacob. People often ask me about all kinds of things. I often give them more wishy-washy answers. I say, “Listen, at the end of the day, someone’s opinion or experience is nice, but what really counts is what works and what really, really counts is what works for you.” I love your approach.

Let’s talk about what are the key strategies. I guess the first question is why is sleep disrupted? What are the first things we should be looking at? Some people want to throw a book at it right away, but I think it makes sense to approach it in layers.

Dr. Jacob: Layer one – for those of you who have kids, you know the importance of a good sleep routine for your children to be able to go to sleep.

You don’t have them running like crazy people and then watch them have the story of the Headless Horseman riding around or whatever and say, “Okay! In bed now, honey!” while they’re still like this. You say, “Which princess do you want to watch tonight?” and watch the show. Even if it’s a little scary, it’s not really for the kids because they’re familiar enough with it.

They have their routine that is signalling their psyche that it’s time to shift from the adrenaline part of the nervous system – sympathetic – over to what’s called the “old man after dinner” or the parasympathetic part of the nervous system that supports sleep.

When it comes to sleep, we are just big kids. You want a bedtime routine that signals that it’s time for calm. You don’t want to watch CNN or Fox. The main mantra of these organisations is “Truth – Who gives a damn? Just scare them to death and make them hate each other.”

God bless them. They’re all nice people. I’m on both of them. I’ve never met one of them who wasn’t loved, but it’s like the old story of the newspaper editor of a hundred years ago where the new cub reporters come in and say, “The dog bit a man on the way over to the studio. Can I write about it?” The old editor says, “Dog bites man? Boy, that’s not news. Got a man who bites the dog? That’s news!”

Looking at the news, you would think that men are running all over the place biting dogs. Most of the stuff on the news is a fiction meant to scare you to death and make you hate each other at the fulfilment needs of their advertisers and owners. I don’t mind fiction. I’m a science fiction fantasy geek and buff, but I like my fiction to be labelled fiction.

How did Mark Twain say it? “If you don’t read the news, you’re uninformed. But if you do read the news, you’re misinformed.” Jefferson – who is one of the founders of the country – basically said he stopped reading the news and he had not found that he’s missing anything. I don’t think it’s gotten any better since then.

I’d recommend, for most of the stuff, turn it off. With the Ukraine thing, I’ve been watching to see how the propaganda works in each country and what the responses are. I’m a political science major in my old incarnation. But turn all that stuff off. Don’t be paying bills right before bedtime.

You want a calming bedtime routine – calming music, a calming book, an old TV show like FRIENDS or something that you’ve seen a hundred times before – something where you know what it’s going to be, you can say what the next lines are because it’s an old familiar blankie thing that will soothe you and ease you off to sleep. Create that setting of a bedtime routine.

You also want to keep your room dark. Another study came out this month showing that – actually, we’ll be parting on this in my newsletter that’s going out tomorrow – if there’s even enough light that you can’t read by like a night light, it forces your brain into the sympathetic system staying awake and alert which is what keeps you from going into deep sleep. If you are on sympathetic drive because of the night-time, you’re going to find that deep sleep suffers that’s restored of sleep.

Using a little night mask that will keep the light out will improve sleep quality. Also, what the study showed is that it causes weight loss because it triggers the sympathy insulin resistance when you have the light on during the night. Keep it dark in the room. Keep the temperature optimal for you – for what feels best for you.

Obvious little things are simply setting the context for a good night’s sleep.

Dan: It’s very interesting. People talk about there being a physiological reason why we struggle with sleep when we have CFS and fibromyalgia. We don’t tend to talk that much about the psychological side because we get so bashed over the head by people suggesting that we’re not really ill and saying it’s psychological. But I have to say, when it comes to sleep, there is a really significant psychological side.

As you were talking about this bedtime routine and getting that feeling, relaxing, and nothing to stimulate, I think for many of us, once we have a problem with sleep, and once we have an experience with insomnia, sleep becomes an issue.

As we move towards our bedtime routine, there’s often a racing of anxiety. “Oh! We’re going to go to sleep. I have to sleep! We’re going to sleep tonight!” Of course, that is the very thing that’s going to stop you sleeping.

Dr. Jacob: Right.

Dan: It’s a little bit of a “chicken or the egg?” thing, isn’t it?

Dr. Jacob: Yes, old patterns, and breaking those patterns is a big part of what you’re about. You’re teaching plasticity and using that for new patterns. It makes a major difference.

Looking at behavioural patterns, it’s like when you take medications and supplements. You’ve taken so many things that make you react, you have a pill in your hand, and you wonder, “What’s this going to do?” and you’re already breaking out in a rash or something and shaking. It’s called the “uh oh!” response. It’s like the Pavlov conditioning response.

It’s about doing things to break that pattern and creating a new routine of success for sleep – things like what ANS Rewire will be teaching – would be a major thing. But it’s important to realise, this is not only pattern and it’s not only the context and environment.

The hypothalamic dysfunction, the hypothalamus is the sleep centre. The hypothalamus is all about regulating temperature. It’s what keeps your temperature at the optimal level. It controls the hormones that regulate the thyroid. Your temperature has to drop to be able to sleep, so the sleep centre is wrapped in the hypothalamus. All of this is in that circuit that goes offline.

Because of that, I have no problem at all. In addition, the sleep hygiene and the brain retraining, adding herbals and natural things and medications to get the sleep that’s needed. And then, also retraining the brain and weaning off of the things.

But let me give you a concept that may be foreign but is critical. Low energy equals poor sleep.

You’re going to think, “No, energy is stimulating. It’s going to keep you awake. It’s going to keep you from sleeping.” But it’s quite the opposite. The hypothalamic control centre is the circuit breaker in the brain. It’s about an almond-sized area, part of the limbic system.

When energy level drops, this is the first area to malfunction. The hypothalamus uses more energy for its size than any other area in the body. That’s why it acts like a circuit breaker. That’s why, if energy drops, that centre and sleep centre drops, and the ability to sleep drops.

Things that improve energy without being stimulating that are basically healthy energy instead of energy loan sharks improve sleep. For example, there are four studies in the last 2.5 years testing different natural compounds that increase energy production. Each of them showed that the increase in sleep was in the order of about 45 percent improvement in sleep by improving energy from any number of directions.

The whole shine protocol that we use in the placebo-controlled, double-blind published research showed that, in fibromyalgia, CFS, and ME, 91 percent improved with an average of 90 percent increase in quality of life, improving energy production.

Don’t forget the importance of that. We’ll talk about that more as we go on about the studies, things that you can do naturally to optimise energy – not necessarily only by sedating yourself but by energising the system that controls sleep.

Dan: Look, it really resonates, Jacob. It’s this requirement for a multilateral approach.

Personally, I’ve had – in doing my recovery – great success with some ortho molecular approaches, specifically around serotonin and melatonin and the use of 5-HTP.

In fact, I remember – within a short period of time of taking 5-HTP – that was when I had that sleep. In the morning, when I woke up, I went, “What happened?” It wasn’t done in isolation, but nonetheless, I felt very sure that it had an impact.

Tell me, how do you like to layer it? Is it an herbal approach first? Then, ortho molecular? Then, medications? Is that how you approach it?

Dr. Jacob: I like to begin with melatonin. I like a mix – immediate and sustained release melatonin. Or even predominantly the EP120 sustained-release melatonin. That’s very good. That’s 10 milligrams. I’ve been going with higher dosing because, initially, I would give 0.3 milligrams. But as we now have over 30 years’ experience under our belts using it, the higher doses seem quite safe and quite helpful.

I will go ahead and use herbals – valerian, passionflower, hops. There’s a reason beer helps people to sleep.

There’s 5-HTP – 200 to 400 milligrams. If you’re taking an antidepressant, that raises serotonin, so I keep it to 200 milligrams or even don’t use it if it’s a high dose of antidepressant. It takes about six weeks to see the full effect. That was one of the first things studied in double-blind study to help fibro. That’s the 5-HTP.

I’ll tend to use essential oils – lavender, ravensara, and different things along those lines.

In the US, there are two products – one is called Revitalizing Sleep Formula, the other is Terrific Zzzz – but, again, for the rest of the world, I think it’s easier to know components.

Dan: Ingredients.

Dr. Jacob: I tend to start with those things. Magnesium at bedtime – about 200 milligrams of magnesium – helps settle restless leg, helps relax the muscle. This is the order that I’ll start with.

I have no problem combining them all pretty quickly. I’ll give each thing a day or two to see what it’s going to do even though the 5-HTP takes six weeks to see the full effect. You’ll see some effects the same day – same with the magnesium. The others show on the same day.

Then, specifically for sleep, I’m going to tend to use the Z medication. There’s a couple of key parts to sleep – one is initiating sleep or falling asleep, and that’s a very different thing than maintaining sleep. I will tend to go with medications.

I know Zolpidem and Zopiclone have their problems, but for initiating sleep, the Z drug I find to be very helpful in this disease, and I’m quite comfortable using them in people who need them and are not able to adequately fall asleep with the others.

We don’t see addictive issues unless people are going over 12 milligrams a day of Zolpidem. What you do see is rebound insomnia. You don’t stop, but suddenly, if you’ve been on it for months, you’re not going to sleep for 10 days. You have to decrease about 2.5 milligrams every two months, and it’s not hard weaning.

Trazodone – 25 to 50 milligrams with usual doses 300 to 450. Cyclobenzaprine – 2.5 to 5 milligrams; instead of the usual 10 three times a day, just one at bedtime. Gabapentin is being attacked now because they find drug addicts use it. Why? Because it helps their pain and it does make the other drugs more effective that they’re taking, but it is much safer than the Ibuprofen.

You have two studies in the British Medical Journal that showed that arthritis Ibuprofen-related medications are pretty useless in fibro. It caused over 50,000 US deaths per year. On the news media, you didn’t hear a peep about it because they’re major advertisers. It was an odd thing.

I still can’t get a report or two except the two studies in the British Medical Journal. Gabapentin, unless it’s being taken with high-dose narcotics, there are usually zero deaths when taking on proper dosing. I find that very helpful for sleep.

I begin in terms of setting the context, setting the sleep routine, setting the sleep hygiene, adding the herbal things, then adding in the medications.

Here’s a critical concept. What I find is, if I give you a high enough dose of natural or prescription to keep you asleep all night because of the severity of the sleep disorder, you will be hungover until 4:00 in the afternoon because you take something, here’s how high in the blood it goes, and then it clears out of the body over a certain amount of time – called a half-life.

But, if I give you enough to let this out of the body by morning, it’s not high enough to keep you asleep, and you won’t be hungover. But, if I give you a low dose of five things, each of these is cleared out of the body on its own timetable. That’s what’s called half-life.

It’s not affected usually by the other medication. Each one is clear. But, if you get a blood level here of one, and here of another, and here of a third, and here of another, the effect is all out just to keep out all night, but it’s all out of the body by morning, so you’re not hungover.

It’s like you go to a Chinese apothecary. They don’t think, “Here’s a big bag of this herb.” They have 50 little drawers behind them. They pull out all these drawers, take a pinch of this, a pinch of this, a tiny bit of this, a tiny bit of that, and they put it all together. That approach works better in my experience with people who have CFS and fibromyalgia.

I will add one thing, too. As long as it’s comfortable, at a safe dose, and adjusted to get the 8 hours of sleep at night. Meanwhile, while you’re working at resetting the limbic system – the ANS Rewire – then, as that starts coming back online – Dan, you can talk about timing of that – now your own sleep centre is working again then in the reverse order we just gave.

Dan: Yes, absolutely.

Look, many people don’t like medications, and I understand that. They want to come off medications. There are all kinds of medications. Just about every medication seems to be prescribed to people with CFS and fibro, right?

One of the things that can happen is that, when they withdraw too early in their recovery, it can trigger them again. I always say, “Look, wait until you get to 80 or 90 percent recovered, then go very slowly – under supervision with your doctor and which one you do first – and take your time.”

I think people often do it too quickly. Mind you, I have seen people do it and actually be okay, but I think it’s reckless and I think you need to nurture your recovery.

Dr. Jacob: The way that I recommend – because you want your body to learn that healthy is the new normal for you – I tell people, “Look, take everything you need.” When you’re feeling healthy and back to yourself for 9 months, I pop the question which is “Are you ready to come off stuff?”

It’s funny. It’s almost 50-50. About half the people say, “When can we start to get rid of?” and then we start. Every two weeks, we drop a half a pill or a pill of something. “You feel any worse? You don’t need it? Good? Ready to do the next one.” Then, they can wean down.

I recommend long-term they stay on a multivitamin and something for sleep – even if it’s diphenhydramine or something – because that will put them at less risk of a stress pushing them over the edge of the cliff. I do keep those two things.

The other half of people, when I ask, “Are you ready to come off stuff?” they say, “The only way you’re getting any of this stuff away from me is out of my cold dead fingers.” Okay. There’s nothing I’m giving that can’t be used long term. When the person is ready and it feels good to do so, that’s the time. There’s no hurry in weaning.

Dan: Yes, you can’t push someone into it. They have to feel comfortable because we don’t want to increase anxiety in any way, do we?

An anecdote of 5-HTP, one of the things that seemed important is when to take the 5-HTP and what else to take it with. I’m not sure what your thoughts are on this, but at the time, I remember being under the impression that having an insulin response at the same time that you’re taking 5-HTP seemed beneficial, so I would take the 5-HTP with a little nip of juice or something like that.

Is this the case with any of the medications or supplements or herbals – the timing of when you take it or what you take it with becomes important?

Dr. Jacob: Not so much, but the thing is taking a little nip of something can be healthy.

Let’s go through waking up at 2:00 in the morning. We talked about initiating sleep, but how do you maintain sleep? In terms of whether the change in the insulin would affect this conversion from 5-HTP to serotonin, one could make an argument, and they’re probably right with it.

But I could also make the argument that giving something sweet late at night will trigger their blood sugar to drop about an hour later and wake them up.

Dan: That’s right. I totally agree with you. That’s always my incentive.

Dr. Jacob: Yes, that’s where I was going with that. With most medications, it’s more this – except for the Z medications – Zopiclone, Zolpidem, those kinds of things. But you take them 20 minutes before bedtime or right at bedtime. The other things that usually help people take less than 60 minutes before bedtime – even 90 if they need, whatever it takes – to be kicking in around that time.

For those who find that their mind is wide awake and racing at bedtime, that’s usually tired all day. They get irritable when hungry – or hangry – from low blood sugar during the day. At night-time, they’ve been tired all day. “Now, it’s 10:00. I’m ready for bed, and my mind is wide awake and racing.” That’s adrenal fatigue. The adrenal stress hormone is low during the day.

At night, it needs to drop from a normal level of 18 – or I guess the European unit has to be about 680 during the day and need to drop under 40 at night. If it doesn’t, you’re going to feel racy at night. In those people, I would give phosphatidylserine. That’s a supplement. I think it’s probably over the counter in the UK and in Australia, too.

I will go ahead and make 100 milligrams, 90 minutes before bedtime for one or two nights to see how that does. Then, 200 and then 300 milligrams to see what feels best. You’ll find that, if that’s the case, you’ll know pretty quickly. It’ll stop that racing and facilitate going to sleep. If it doesn’t help in the first few days, then don’t bother with it. But that’s 90 minutes before bedtime.

The Z medications are either 20 minutes before bedtime or when you climb into bed. That’s the timing of things.

What you’re going to see is that 2:00 waking is like a universal alarm clock only heard by people with fibromyalgia, ME, and CFS that goes off at 2:00 to 4:00 in the morning. Bing! Wide awake.

Dan: It’s like a startle response for some people, isn’t it? They wake up with a racing heart. Some people don’t just wake up. Some people wake up and they’re like—

Dr. Jacob: Exactly. It’s an adrenaline response in many people.

Dan: Yes.

Dr. Jacob: In part, the sleep stuff may be waking up, but especially if you have night sweats with it. There are a couple of key things that are triggering. One is the blood sugar. Remember we talked about cortisol that’s normal and not being 18 in the morning. It should be 14 to 12. In most people with fibro, it’s too low that they get irritable when hungry. It goes down at night and needs to drop under one, but they’re hovering two, so they get a racy heart. But then, in the middle of the night, they sleep, and their blood sugar plummets, and they wake up wide awake because of adrenaline release with blood sugar.

The cheapest test – have a one- to two-ounce protein snack. Have a hard-boiled egg right at bedtime. That will help maintain the blood sugar – not completely but being more stable throughout the night – and may help. You’ll know quickly if that’s helping. It doesn’t hurt if you have two hard-boiled eggs.

Number two would be perimenopause – you’re waking up in a sweat, especially if you’re a woman in her 40s and 50s, and the estrogen is going; and especially with fibro, CFS, and ME. I’m going to use fibro, CFS, and ME interchangeably – yes, they’re all different, but for the purposes of today, the overlap is enough that we can do that.

If you find that your symptoms of fatigue, brain fog, and insomnia are worse around your menses, that is diagnostic of low estrogen and progesterone, regardless of the blood tests, and regardless of your period still being fine. It’s contributing to the illness and using bio-identical hormones would be worth considering – to help in supporting sleep.

Progesterone, even if you’ve had a hysterectomy and ovaries are out, progesterone is critical for sleep – not the synthetic poison, but the bio-identical. The synthetic estrogens were made for a very, very, very important purpose. It’s because they’re patentable. Therefore, they were profitable.

But as far as your body is concerned, it’s like, “I want what my body makes. I don’t want this synthetic thing because it’s not the same molecule. I don’t want that pregnant horse urine estrogen.” That’s what they’re giving because it’s patentable. I will use bio-identical with the exception of things like birth control pills. There are some things that the synthetics play a role.

If there’s an infection and you’re breaking out in sweats in the middle of the night, again, candida where you have chronic nasal congestions, sinusitis, gas bloating, diarrhea, constipation. Those are markers of candida overgrowth. The sweats will wake you up at night. You need to treat the candida for the fibromyalgia to go away. There is no test that is reliable for that.

You’ll see these different things that will trigger a middle-of-the-night adrenaline release. Infections do that. A cold or flu will. Addressing these things then can help the sleep quality.

Sorry if I got a little long-winded there.

Dan: No, I appreciate that. In fact, you answered a couple of questions I was going to ask.

In the ANS Rewire program, we speak about the role of hypoglycaemia and how it triggers the autonomic nervous system as one of several physical triggers and why it’s important to improve our insulin resistance – well, I should say improve our insulin sensitivity.

Obviously, diet is a part of that. Activity as we start to recover and are able to increase our activity can play a role in that. Like yourself, I talk about the importance of having something to eat late in the evening.

Dr. Jacob: Protein.

Dan: Like a protein snack. Like an egg. Obviously, when we’re sleeping, were supposed to primarily be burning fat as opposed to when you’re inactive.

Dr. Jacob: It doesn’t maintain your sugars as well though.

Dan: But it doesn’t maintain your blood sugar. That’s exactly right.

The issue with many people is, as they make this change in their diet and they make sure they have a protein snack late at night, waking at 2:00 or 3:00 in the morning – these startle responses – seem to disappear. But some folk still have the issue.

You were mentioning infections and things. That makes sense. But I do wonder about fine tuning the diet side of things. People often become very anti-carbohydrates. I can understand why that might be the case, but I do think they can still play an important role when we have an unbalanced hyperreactive system. There’s a lot to be said about dampening it by giving a balance of nutrition.

Whilst I still talk about the late protein snack, at dinnertime, I still encourage people to have a reasonable amount of carbs, and nothing too sugary. I just wondered what your thoughts were on how to balance this.

Dr. Jacob: There’s no one diet that’s best for everybody. Otherwise, there would be one plant or animal that would grow on the planet, and we wouldn’t need all the rest – from a humancentric point of view, anyway. Everybody has different things. We’re all different.

I know in my lifetime, there are times that I’m vegetarian, and there are times that I’m meat-a-holic, depending on the type of work I’m doing and how much grounding I need with work. When I’m traveling around the world lecturing and I’m trying to go on a low-protein diet, I’m in trouble.

Basically, low sugar, high salt – those two are your friends.

Most people find a high-protein diet works best for them, especially if they have adrenal fatigue, but some people on the low-carb diet will go depressed. Some people will thrive on a vegan diet, and others get sick as death.

Again, how do you tell the best diet for you? How is that working out for you? How does it feel? You try different things. Again, you’ll say, “Well, when I drink a 46-ounce soda with 39 spoons of sugar in it, I feel great!” Yes, but how about a day later?

How does it feel? How is it working out for you? Do what feels best for you.

We have this bizarre thing. It’s funny. The United States was populated by people who were so puritan that they were such a pain in the ass. People at shotgun-point said, “Get on the boats and go.” They said, “We’re going to fall off the end of the earth.” “Well, if you don’t go, we’re shooting you now.”

They were so annoying, telling people that however the universe is created – whether God, or evolution, or whatever it was – whoever did it was such a maniac that everything that felt good to us is evil and bad. Who would do something like that? Evolutionarily, no sense at all. A loving God?

Dan: The opposite, right?

Dr. Jacob: Generally, the things that feel good to us are good – with the exception of some things that have addictive issues like sugar or heroine or stuff like that. But, overall, bacon, butter, eggs, coffee – these are all healthy food until the food processors get a hold of them, then they try to fool the tastebuds.

See what feels the best for you. See what leaves you then feeling the best. Let that be your guide for what diet is best.

Dan: Yes, personal experimentation is absolutely essential. I totally agree.

There are other issues around sleep. You mentioned obviously some of the infections and things like that that can be part of the startling combination with the hypoglycaemia. But, like I said, there are a number of other illnesses that some people will find themselves experiencing. I find that comes surprisingly more than you would think because it’s not just with folks who are overweight but also other folks with sleep apnoea.

Dr. Jacob: About a third of people will have sleep apnoea.

Within sleep apnoea, you have two main types.

One is the person who has the nickname “refrigerator” because their shirt collar size in America is 16.5 inches or more, and they’re 280 pounds, and the tissues are thickening. You have fat put elsewhere on the body. The fat is filling the neck and it compresses the airways like a balloon.

They have a little neck. You blow up the balloon and those lungs. You have a little neck that the air goes in and out of. If that neck compresses, they stop breathing. It’s as if you’re suffocating them. If they get in a position with all fat, it’s obstructive sleep apnoea. The hallmark is that they are snoring and then they stop breathing and gasp.

The other hallmark is not fatigue during the day but fall asleep easily at the wheel or watching the telly during the day. Falling asleep easily during the day in somebody with a big neck size who snores and maybe has hypertension.

Dan: It’s usually a car accident that leads to a diagnosis, isn’t it?

Dr. Jacob: It’s going to be one thing. They fall asleep at the wheel. It’s like, “Oh, that.”

Dan: I’ve seen it so often where people fall asleep at the wheel. Boom. They get diagnosed with sleep apnoea. Until then, they’re completely oblivious.

Dr. Jacob: Yes, a lot of times – until their wife gets taken in for spousal abuse because they keep elbowing them in the middle of the night. They roll over on the side and they’re all black and blue.

But here’s the thing – ask your spouse or your bed mate if you tend to snore loud in the middle of the night. Notice if it’s on your back. You can videotape yourself. See if the snoring is mostly on your back.

If so, then wear a tight night shirt, pyjama shirt, or T-shirt, and take a tennis ball. Put it in a little plastic bag and pin it to the small of the back of the night shirt. This way, when you lie down on your back, you’re lying on the tennis ball. That’s not comfortable. You will automatically roll on your side.

You will most likely not, but some people do have apnoea on their side, but that may take care of it. You’ll know because you’ll get less elbows in the side from your wife all night.

Simple things like that. Unfortunately, even though a lot of people have sleep apnoea, there’s a very small percent who actually found that they feel better with the sleep apnoea machine from the fibromyalgia.

If you have somebody who is the low weight, then you want to look at two other conditions. One is called central sleep apnoea where the signalling in the brain is not working. This is more common in high altitude, but those people won’t snore. They’re just got breathing. The sleep ap helps a little bit. Sometimes, it’ll be significant.

But here’s the other thing. The third is very, very common because you’re talking about people with sleep apnoea being big, but how about those little skinny beanpoles that instead of high blood pressure have low blood pressure?

Now, you’re looking at something called upper airway resistance syndrome where the hallmark is thin, low blood pressure, orthostatic intolerance, and the nasal congestion. As they try to breathe through the nose, they can’t.

When I treat the candida using fluconazole for six to eight weeks, a compounded prescription nose spray, and things like that that knock out the candida, then the upper airway resistance goes away, and the upper airway resistance syndrome. In those beanpole people, ask them, “Pinch it. Can you breathe through your nostril?” If it’s blocked up on both sides, have them treated for candida – unless it’s known allergies to dust. That’s how that breaks apart.

Dan: How do you treat the candida? What did you say you use?

Dr. Jacob: There’s a medication – fluconazole. It’s discussed in the book in detail, but the bottom line is cut back the sugar because yeast grows by fermenting sugar. You can use artificial sweeteners. They don’t ferment those. Use a good probiotic. Kaffir and things like that can be very good. Go ahead and use whatever natural antifungals are available. There are many. Do a search online.

Those by themselves don’t quite do it. The medication – you’re going to need a holistic doctor to get this – is fluconazole. It’s Diflucan in the United States. 200 milligrams a day for six to eight. It’s about week five that people notice their gut and sinus stuff improve.

Again, in the US, ITC Pharmacy makes the prescription compounded nose spray that’s very, very good. If you have a compounding pharmacy where you are, you can email me at fatiguedoc@gmail.com and I can send you a recipe for your local compounding pharmacy to make the sinusitis nose spray. It’ll need to be by prescription though.

I can also send information sheets on orthostatic intolerance. If you’d like, I can send copies of the studies that we completed and even the data for the fourth study. We may want to talk about that in a moment because these are the things that have been really lifechanging for people.

Dan: Yes, that was on my list to ask you about that because you are continuously doing research and finding new ways. I really appreciate your dedication. Tell us about these studies and these treatments.

Dr. Jacob: Remember how we talked at the beginning about optimising energy production is critical for the hypothalamic sleep centre to work? We looked at several things that we had found to be helpful, but also there was a new compound that came out of Europe.

Some of you may have heard about peptide therapy. Most holistic doctors are using it intravenously. They’re about 800 bucks a pop. They’re quite expensive, but they’re radically beneficial.

There was a fellow who was working with starving people in Africa where they had hospitals had dealing with malnutrition. They found that they could make a peptide – an animal serum peptide. What they were finding was that not just were these people recovering dramatically and more quickly nutritionally but all these different conditions – the fibromyalgia is going away, the rheumatoid arthritis was improving, all these different health conditions.

There’s a colleague who’s a friend of mine in Canada that I have a lot of respect for. He said he had tried it as this person had sent it to him. He said he has the fibromyalgia centre at the hospital. He was seeing dramatic results, so we went ahead, and I tried it in some of my folk. It was turning people’s lives around.

It’s called Recovery Factors. It’s not available in the United States. The United States has a lot of regulation. It’s available everywhere in the world except the United States. For the UK, because of Brexit, you can’t effectively ship less than four bottles without having to pay $50.00 to go through the regulatory thing for each of them, so they have a minimum of four bottles. For the rest of Europe and Australia, it’s the one bottle. One bottle will be enough to tell you.

In this study, we gave basically 8 tablets a day. It’s a nutritional support thing. The side effects were near nothing. We saw 60 percent of people improved with 79 percent average increase in energy. It was remarkable.

When the United States said you can’t ship it in anymore, I’ve had people who went from crippled to being healthy, and now they’re having to wait. They’re doing what they can. It’ll probably be about another four to six months before it’s available in the US.

God bless the US. I love the country, but the regulatory system is nuts. In Europe, Australia, and the UK even, because of the four-bottle minimum in the UK, you might want to get a friend or two to order it with. But the website is recoveryfactors.com.

If you’re in the US, leave your email address. The company will let you know when it’s available in the US or even in the UK if you’re not able to do the four bottles at once. After one bottle, that’s when we saw the 79 percent increase in energy, 84 percent increase in overall well-being, 45.7 percent improvement in sleep, cognition improved 52 percent, the anxiety went down 35 percent, gut symptoms improved. This was received with a number of things.

Recovery Factors is really a leap forward. I’m excited and looking forward to when I can get it for my patients again, but God bless America anyway. I’d recommend that for everybody with this condition. Order one bottle. See how it goes. It’s lifechanging for many people.

Dan: Is it available for folk who live in Canada and in mainland Europe?

Dr. Jacob: Yes, everywhere but the United States.

Dan: There you go.

Dr. Jacob: I know.

Dan: Look, I guess in some other conditions, there’s restless leg syndrome.

Dr. Jacob: Here’s the thing. For restless leg syndrome, low magnesium is a critical player. It’s a dopamine deficiency is what that is. You’ll see during the day that restless leg syndrome has this rhythmic moving thing. It’s technically called PLMD – periodic leg movement disorder. It happens at night-time.

The standard dopamine medications, I’d avoid for people. The studies have shown that your ferratin – which is the measure for iron – is considered normal if it’s over 12. Researchers are a quiet, low-key, understated kind of group. What they said is the normal range is “insane.”

The studies show that, if the ferratin level is under 60, giving iron will settle down the restless leg syndrome. Once it’s over 60, you’ll see all the benefit you’re going to see. Taking magnesium at bedtime will help restless leg syndrome or PLMD.

Gabapentin – a very good sleep medication for pelvic pain syndrome for fibromyalgia – helps restless leg syndrome. The Z medications like Zolpidem also help restless leg syndrome.

As mentioned, about a third of people with fibro have restless leg syndrome. In those cases, I simply will tailor the rest of the treatments that we’re giving that they need anyway. That knocks out the restless leg syndrome.

Dan: It’s interesting. I think there’s a very strong connection between ferratin and magnesium. When you look at a chlorophyll molecule and you look at a haemoglobin molecule, it’s this huge complex molecule, and they’re virtually identical – except the difference is one has iron in the middle, and one has magnesium.

When a family member of mine was very young, we had an iron deficiency. All we wanted to do was pour in iron. It’s what the doctors wanted to do, and it didn’t make a difference. I started looking into it. When I saw those two molecules, it made me wonder. Sure enough, once we started supplementing with magnesium, the iron deficiency went away.

Dr. Jacob: Funny, isn’t it?

The magnesium deficiency is arguably the most important nutritional deficiency in the Western diet. The average diet does have 600 milligrams before food processing and only 245 milligrams a day after food processing. The blood tests are not reliable because it’s intracellular so you don’t see it in the blood so much.

The easiest thing, and the form is important, I use the multivitamin. In the US, there’s the vitamin powder called the Energy Revitalisation System. If you don’t like powder, there are tablets called Clinical Essentials. These are readily available on Amazon, and maybe even overseas. It’s a very good multi. The tablets have 150 milligrams of magnesium. Put two tablets in the powder, that’s 200 magnesium along with 50 other key nutrients.

You don’t need to be taking separate pills for this and that and the other. If you have a good multi – and most are not, but – the Energy Revitalisation System or Clinical Essentials are excellent. It’s easy to be getting these things. I don’t supplement iron though unless the ferratin is under 60 because then it becomes toxic.

Dan: Yes, absolutely.

I guess we move towards finishing up here. We spoke about the psychological side of sleep as well as the physiological side. I want to point out that I think, from a psychological point of view, it’s not just about these psychological factors stopping you with sleeping, but it’s also how able we are to actually engage in strategies.

Sometimes, I’ll speak to folks, and they say, “I’ve tried it all. I’ve tried everything. Nothing’s worked.” I think becomes so easy to feel overwhelmed. We need to really be systematic about it. We need to actually say, “Am I actually doing that? Am I actually making those dietary changes consistently? Am I taking these herbs? Have I tried to add one and see if that helped? Have I kept on and added another layer?”

Often, people look for that magic bullet. I think they hop from one strategy to the other as opposed to building them. Has that been your experience as well?

Dr. Jacob: Yes, and it’s funny. I lecture all over the world. If I had a dollar for every time somebody came and said, “Well, I’ve tried everything,” and I say, “Well, have you tried this one?” “No.” “And that?” “No.” “This?” “No.” “Have you tried anything?”

It feels like you’ve tried everything. You’ve been through all the stuff. But once you organise it – and that’s part of what the book does – here’s how you do it. This is not for everything. Get the systems working. They’re like crutches. When you’re feeling well for 9 months, you can start tossing the crutches.

Do the ANS Rewire. That’s a critical part of the system that needs to be reset because, if the circuit breaker is not working and you’re taking 20 medications and supplements to take care of what the circuit is doing, you turn the circuit back on – duh!

ANS Rewire is a critical part in resetting the system.

There are two other supplements that we studied. One is called HRG80 Red Ginseng, but that one also 67 percent average increase in energy and 46 percent in sleep. Just one chewable tablet a day, but most ginsengs don’t work. It’s called HRG80 Red Ginseng. The other thing is called the Smart Energy System.

These two are just available in the United States though, but the Smart Energy System you can find on Amazon. You can find most of these – except Recovery Factors – at endfatigue.com. We do ship overseas, but it's pricy.

Dan: Yes, you mentioned your wonderful book which has been around for a long time and keeps getting updated. I’ve got to say, the book is great, but if you don’t have pen and paper alongside with it in your strategy, you might find yourself in trouble because you’ve got to be systematic.

“I’m taking this. I’m trying this. What’s happening with my sleep?” To look in your book and go, “There’s one thing. I’ll try that!” It’s not going to do it. You’ve got to follow the system of the book. If you’re not using pen and paper, I think you’re in trouble.

Dr. Jacob: That’s why we have the brain fog friendly summaries in the beginning of each book.

It gives the key things in half a page. You can go through all of that in maybe an hour and it’s organised and there’s the free energy analysis program. Basically, we hold our US patent for computerised doctor that we made for people with fibro.

We told people, “Well, it’s $400 to do it, but if you come forward, it’s free.” 80 percent of people wrote back, “I’m impoverished from fibromyalgia.” My wife and I made it free for everybody, but it’s EnergyAnalysisProgram.com.

It’s a 15-minute quiz. It’ll analyse your symptoms, even your blood tests, if you have the blood tests that are pertinent. It says, “Here are the key things draining your energy. Here are the prioritised key things to restoring energy.”

There are all kinds of ways to organise it, but organising it is critical or you’re going to get back to feeling like you tried everything when you’ve tried nothing effectively.

Dan: Yes, you’ve got to away from that shutdown approach and be methodical.

Many are working with wonderful physicians. That’s great because they’ll do that for you, but a lot of people need to take control of this themselves.

Dr. Jacob: They don’t have an option.

Dan: Jacob, thank you so much for your wisdom and sharing your experience today. Sleep is central. I’m sure there’s a good reason why the shine protocol starts with it. I appreciate you sharing all your knowledge. I look forward to having you back another time on Wisdom from the Other Side.

Dr. Jacob: Always a pleasure. Be well, everybody!

Dan: Thanks for tuning into this episode of the podcast! We hope you felt supported by it.

If you have any questions, feel free to reach out to us via cfsunravelled.com and make sure that you subscribe to the podcast on iTunes or wherever you listen to it. You can leave a comment and a four- or five-star review if you feel so inclined.

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Check out some of our other podcasts. I hope you’ll join us again soon.

Links

Dr Jacob Teitelbaum has released the fourth edition of his book "From Fatigue to Fantastic" - it's the blue edition, check it out in all good bookstores including https://www.amazon.com/dp/0593421507

Dr Jacob Teitelbaum's website:  https://www.vitality101.com/

Other Resources

Paperback & eBook

CFS Unravelled is the book that started it all, outlining the explanation for the pathogenesis of ME/CFS, Fibromyalgia, POTS, MCS and related syndromes and explaining how recovery is possible.

Learn more HERE.

All my email subscribers receive additional FREE resources like my book Discover Hope.  So consider subscribing and reading the book to rediscover hope.

Discover Hope Bookcover

To learn how other people recover, listen to the recovery interviews!

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If you would like to learn more about the ANS REWIRE program, check out the 4 free intro lessons or visit the ANS REWIRE website.

Check out some other recent episodes

Episode 4: Dr Jacob Teitelbaum, world leading MECFS Fibromyalgia POTS physician, shares his research and experience
Episode 13: Snippet – Should you change program, coach or practitioner to help you recover from CFS/Fibromyalgia/POTS/MCS?
Episode 1: How to cope and deal with the injustice of invisible illness including chronic illness like Fibromyalgia, ME/CFS, POTS and MCS
Episode 6: What we learned from 100s of conversations with people who recovered from MECFS Fibromyalgia & POTS

You can see the full list of episodes HERE.

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