A reader asks:
I am a 22-year-old female who has had chronic fatigue syndrome (CFS) for almost two years. During that time, my sleep has been awful. I’ve had difficulty falling asleep, staying asleep, have experienced severe body aches for hours on end, and awoken from 2-4 hours of unrefreshing sleep feeling worse than before. I dreaded bedtime and began taking melatonin supplements at night; I noticed immediate results. I can now generally get 6-8 hours of somewhat refreshing sleep at night, although the beginning and ending times are extremely variable (10:15pm – 2:00am start, 4:00am-9:30am end). I have never had any reason to suspect SAD before, but have noticed since the onset of CFS symptoms that I feel significantly worse on cloudy days. I am much more fatigued than other days, feel rather drab, cannot concentrate as well, and combat feelings of disappointment and sadness at times. I have noticed myself subconsciously staying near brightly lit places. I’m wondering if light therapy might be useful. I don’t want to take any more pills than I already am and don’t want to waste money for something unbeneficial. What’s your opinion?
Answer:
We bet you have not seen CET President Michael Terman’s article with CFS expert Susan Levine: “Chronic fatigue syndrome and seasonal affective disorder: comorbidity, overlap, and implications for treatment.,” American Journal of Medicine 1998;105:115S-124S. It turns out that the hallmark symptoms of SAD occur just as frequently in patients with CFS. In a series of case studies, light therapy produced marked improvement. Patients with SAD also often slump during a string of dark, rainy summer days–and they find their light boxes as useful then as in winter. More importantly, we think, patients with CFS spend an inordinate amount of time indoors and in bed, creating an artificially darkened environment.
As we have learned from recent clinical trials of patients with non-seasonal depression, light therapy can work year-round. Indeed, long winter nights are just one of many ways we come to spend excessive time in the dark. Our advice is to follow the guidelines we offer on our website for light box selection and scheduling (take the Morningness-Eveningness Questionnaire). It would be best to do this under monitoring by your clinician, since if you show gains it may be possible to taper your medication regimen. If your clinician is inexperienced with or skeptical about lights, refer him or her to the August 2005 issue of the journal CNS Spectrums for a comprehensive review. One word about melatonin use inconjunction with light therapy: never employ the latter in the hours after taking melatonin, because it is a photosensitizer. As a general rule, schedule evening melatonin at low dose, 12 hours before you use the lights.
