Sleep Disturbances and Lyme Disease: A Vicious Cycle

Most patients suffering from Lyme and other tick-borne illnesses are exhausted. Fatigue is one of the most common symptoms of Lyme, making patients feel like they have a chronic flu. Even patients who have been accurately diagnosed and are being treated for Lyme battle intense fatigue; their bodies are working hard to fight the infections, and are often weighed down by a build-up of toxins.

In many cases, the only thing these patients want to do is sleep, but they can’t. Lyme disease can cause intense insomnia, hindering people from getting the rest they so desperately need to get well. One hundred percent of Lyme patients involved in a study published in the journal Sleep had sleep disorders.[1]

Why is it so difficult to sleep with an illness that causes fatigue? And what can you do about it?

Lyme disease bacteria, called spirochetes, can cross the blood-brain barrier, causing neurological and psychological impairments. As Dr. Robert Bransfield explained in his talk “The Assessment and Treatment of Sleep Disorders Associated with Lyme/Tick Borne Diseases” at the 2016 International Lyme and Associated Diseases Society (ILADS) conference, Lyme particularly damages the ventrolateral pre-optic area of the brain, more commonly known as the sleep center. This damage can cause insomnia, non-restorative sleep, blunting of or shifting in circadian rhythm, sleep apnea, nightmares, narcolepsy and sleep paralysis, REM behavioral disorder, restless leg syndrome, and paroxysmal nocturnal limb movement (involuntary spasms of limbs).[2]

Other common behaviors associated with sleep may occur at the wrong time (like hypnagogic hallucinations, or dreaming before sleep). Once asleep, patients’ sleep cycles may be affected. Many Lyme patients cannot get the deepest and most restorative level of sleep, known as delta sleep. Lack of delta sleep impedes immune function, making it harder to fight the very disease that causes the insomnia in the first place.

Whether or not Lyme crosses into the central nervous system, it is a systemic inflammatory infection, and that inflammation itself can cause sleep disturbances. This creates a reciprocal effect; a patient becomes sleep deprived in a pro-inflammatory state, and the pro-inflammatory state itself causes sleep deprivation. For some patients, the more sleep deprived they are, the more hyper-vigilant they become, another vicious cycle.[2]

If you are being treated for Lyme and/or other tick-borne illnesses and are still experiencing sleep trouble, here are some things you can do to improve your chances of getting a good night’s rest:

  • Practice good sleep hygiene: Make sure your body and brain are well prepared for sleep. Power down all electronics and stay away from screens an hour before bedtime. Try not to do anything too engaging during that time. You might read a light book or magazine, take a bath, meditate, or listen to relaxing music.
  • Keep your room completely dark: Glowing light can disrupt sleep. Turn off your phone and make sure there aren’t any lights from computers or clocks in the room.
  • Stick to a regular sleep schedule: With your circadian rhythm already disturbed by Lyme, it’s important that you try to set a good schedule for your body. Keep the same bed time and wake time every day, even on weekends.
  • If you can’t sleep, move to another spot: If you lie in bed worrying about not sleeping, you will begin to associate your bed with anxiety. If after twenty minutes you can’t fall asleep or fall back asleep, move to another quiet place like a couch or chair.
  • Use your bed only for sleep: Don’t read, work, text, or do other engaging activities in bed; signal to your brain that bed is a place for relaxation.
  • Cover the clock: Staring at the clock thinking, “Now I only have four hours to sleep until I have to get up” will just increase arousal and anxiety. Do not look at the clock in between bed time and wake time.
  • Eat a protein-based snack before bed: Lyme disease can affect adrenals and blood sugar levels. A drop in blood sugar can cause patients to have to get up in the night, or can bring about nightmares. Keep your blood sugar steady by eating a small snack with protein (such as a protein shake, a piece of cheese, or a handful of nuts) before bed.
  • Avoid stimulants: Caffeine and alcohol can affect the ability to fall or stay asleep. Certain medications such as extended-release antihistamines and ADD/ADHD medications can also be stimulating so should not be taken late in the day.
  • Keep a log: Keep track of how many hours you slept each night. Over the course of a week, you’ll be able to see patterns, which you can report to us when you come in for appointments, to help us best help you get a good night’s sleep.

Specific natural supplements can help improve sleep, and may address underlying issues like hypothalamus-pituitary-adrenal (HPA) axis dysfunction.  Occasionally prescription medication may need to so a patient gets adequate sleep.  Ultimately, sleep is extremely important in healing, so sufficient and restorative sleep is paramount to your recovery.

 

1. Greenberg HE, Ney G, Scharf SM, Ravdin L, Hilton E. Sleep Quality in Lyme Disease. Sleep. 1995 Dec;18(10):912-6.

2. Bransfield RC. The Assessment and Treatment of Sleep Disorders Associated with Lyme/Tick-Borne Diseases John Drulle Memorial Lecture. 2016. Available at: http://ilads.org/ilads_media/wp-content/plugins/wp-cart-for-digital-products/mask.php