Brain Damage in Chronic Fatigue Syndrome and Sleep Apnea

There are a lot of controversial theories about the origins of chronic fatigue syndrome (CFS), and even more recommendations on how it can be treated. One particular explanation is that people with CFS have some sort of brain dysfunction, which disrupts how it regulates the body’s nervous, metabolic, and hormonal systems. A recent study confirmed that white matter and grey matter volume was diminished in various parts of the brain and brainstem.

These findings are very similar to numerous studies showing that untreated obstructive sleep apnea can lead to brain volume loss or lower tissue density in various parts of the brain, including areas that control memory, executive function, and especially autonomic control. This brings up the classic chicken or the egg question: Did brain damage come first and CFS afterwards, or does CFS cause brain damage? Knowing how common sleep-breathing problems are at any age, and knowing how even mild levels of breathing difficulty during sleep can significantly affect brain functioning, perhaps brain damage from suddenly worsened sleep apnea could be a more logical reason for most (but not all) cases of CFS.

Many patients with CFS will have documented obstructive sleep apnea, but not all. However, the upper airway anatomy in most CFS patients are more like people who have upper airway resistance syndrome. Their upper airways are so narrow that their nervous system become overly sensitive to any degree of airway obstruction. As I’ve stated before, UARS patients wake up to a light stage of sleep, even with very subtle degrees of breathing obstruction. These pauses are not long enough to be called apneas. This causes a chronic low-grade physiologic state of stress, which by itself is known to be detrimental to brain health.

So it’s not surprising that most people with CFS have very small mouths and narrow jaws. Many have had excessive dental extractions for various reasons, or have various degree of jaw underdevelopment. The vast majority definitely can’t sleep on their backs.

This also explains why a simple cold or viral infection (Mono, Lyme, etc.), sudden weight gain, or physical injury that forces you to sleep on your back, can trigger the vicious cycle that leads into the classic symptoms of CFS. All these events suddenly narrow the already narrowed upper airway.

If you have CFS, what was your precipitating event?

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10 thoughts on “Brain Damage in Chronic Fatigue Syndrome and Sleep Apnea

  1. Interesting. I had never seen this before, but it makes a lot of sense. I had a horrendous case of mono in my sixteenth year (I was out of school for an entire academic year because of it). Of course, at that time (1967), there was no such thing as a known diagnosis of CFS, but my symptoms started then, and have grown steadily worse over the passing decades.

    My sleep specialist says that I definitely have the architectural traits of UARS (small mouth, “invisible” oropharynx), and I can ONLY sleep on my left side, no other position. I’m having a brain MRI in the next week or so, to try and track down the cause(s) of my cognitive issues, so it will be interesting to see what that shows in relation to this.

    Thanks for posting it.

  2. I was diagnosed with CFS this past August. I first became sick in mid-January, 2010 with a re-activation of the epstein-barr virus or mono. I never got better. I had to stop working in July, 2010. I did have a sleep study in August that showed mild to moderate sleap apnea. Most of mine were hypopneas but I had way too many of them! My sleep study doctor said that I had a very small throat opening and small mouth. I have issues with nasal swelling which has made it difficult for me to tolerate the c-pap machine, although I am still trying and won’t give up. I can’t sleep on my back. That’s when most of my issues occurred during the sleep study. I also have cognitive issues in addition to the deblitating fatigue and obvious immune dysfunction, as I still have an active epstein-barr virus. And who knows what else has reactivated!

  3. Eliza: If you are anything like me, not only your EBV, but if you have ever had CMV or toxoplasmosis, they might have reactivated at one time or another, as well. And your inflammatory markers (ESR, homocysteine, CPK and C reactive protein (CRP) )could be high, too. No fun, to be sure.

  4. I had a severe case of mono at 15 which required hospitalization. I’m still looking for better treatment of UARS. The CPAP and mandibular retainer have not been effective enough.

  5. I have had intermittent fatigue for over 10 years, which started with my Graves disease, and this was also when my insomnia started. I realize only in retrospect this was probably all from UARS. the cause for me is my narrow airway; my mother and brother have my jaw and they also have sleep disordered breathing. I got worse during my last pregnancy, and sleeping on my back after my C section made my insomnia terrible. but what really crashed me into CFS? it started exactly 3 weeks after starting a diet and losing 10 lb. has anyone else ever noticed that dieting will make their UARS worse?

  6. PS: Jane, what helps me is a tongue retaining device called the aveoTSD. it’s not the greatest long term solution but it works a lot better than CPAP or MAD.

  7. My twin sons got sick with Epstein Barr Virus in 2000,and they have had sleeping problems ever since. They both have been diagnosed with Chronic Fatigue Syndrome twice by different doctors and both have been diagnosed with Sleep Apnea. From age 14 to 27 their lives have been affected by that Epstein Barr Virus,they have both had many health problems .I have tryed to get them on disability but the judge dosen’t seem to understand the illness,she seems to think they both should just stop staying up late,go to bed early ,and she seems to think it is just a matter of a behavior problem because they are young males. They have both been turned down again for disability. From the age of 14 to 27 they lost out on many life lessons do to sleep disorders as well as eating disorders.Also they had Thyroid Dysfunction,Stomach Infections,Lining of the Hearts Inflamed,Severe Headachs ,Severe Body Pain,Swollen Testicles,Severe Irratibility,Confusion,Rapid Heart Beats,Nervous Conditions,and Secondary Depression + More. This Illness changed their lives!

  8. Hi,
    I had to be hospitalized for my mono and an allergic reaction to the penicillin used to treat it when I was 18, it lasted a couple on months, A I am now 50, my problems began at the end of March 2013, I am not diagnosed with anything yet, but have had many tests. I have a MRI coming up Jan 30 2013. I just finished my follow up sleep study. The first said I have a mild apnea. I will begin the mask to see if it helps with the killer headaches and fatigue. (fatigue is my number 1 enemy). I do have a small mouth, and some back teeth missing (lol) I have always breathed through my mouth primarly, one nostril is always somewhat blocked. I gained 40 lbs since March, but I was about 15 underweight, because I had felt so bad I was not eating. I sure sound like a lot of these folks, and even now I feel like I have a mono, tired if I due too much. NO diagnosis yet, but things are being eliminated. ANY input would be appreciated M 50 IL

  9. I “crashed” end of March 13
    , I had been (undiagnosed) taking vicodein 1 to 2 times a day. Before work and the middle to help with knee and back pain, and it seemed to help with energy. This helped make me a good worker who was made full time after a year or so. (insurance then) Anyhow I quit and that required a hospitilization about a week later, I had the whole kitchen sink thrown at me then. I remember them telling me 2 weeks after I should be normal, the bad part was just beginning, and my head was never the same