Treating Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia: Dr. Teitelbaum on Maximizing Sleep Prescriptions

Treating Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia: Dr. Teitelbaum on Maximizing Sleep Prescriptions

Dr. Teitelbaum believes that getting a solid eight to ten hours of restful sleep is absolutely critical to the healing process in ME/CFS and may require taking as many as five or six different sleep aids. Since most of the side effects (and fewer of the benefits) come at higher doses, he believes patients can maximize their benefits by taking small amounts of several sleep aids at once. He states ‘the best way to need less medication in the long run is to take as much as it takes to get eight hours of solid sleep each night for six months” In order to find the optimal doses of sleep medications Dr. Teitelbaum recommends that you:

1. Take the lowest recommended dosage of your and your doctors choice of a medication, either natural or prescription. Except for 5-HT you will know by the morning if its is effective.

2. Increase the dosage until you either

  • get eight to nine hours of sleep,
  • have side effects,
  • stop getting better effects from it.

You should end up the lowest dose that gives you the most benefit.

3. Go on to the next medicine and do the same. As you come up with more ‘hits’ you can try different combinations. If you’re the kind of patient in which a positive effect wears off after a few days then rotate your medications. Once you have found your optimal group of sleep medications stay on them at least six months and then try to taper off them. Dr. Teitelbaum find that most ME/CFS patients can taper off all medications after about 18 months. Some may have to stay on them for years.

During Times of Increased Stress increase your intake enough to be able to maintain seven to eight hours of solid sleep.

Sleep Intro / Good Sleep Hygiene / Sleep Alternative Therapies?/ Sleep Prescriptions



Jacob Teitelbaum, MD., 2007. From Fatigued To Fantastic 3rd. ed., Avery Publishing.

Susie April 13, 2015 at 12:30 pm

I have come across your site and information and was very pleased and impressed.
I have never been diagnosed with CFS, however I have osteoarthritis, RLS and insomnia.
I did have a sleep study done which showed I have RLS, no breathing problems, and sleeping pattern interruptions of waking up several times a night. I also have had severe muscle pain, back and leg, hip and foot pain. At present, all over pain has improved tremendously by using inner-soles for Plantar Faschisitis AND getting off STATINS. Now, I deal with insomnia, which I have had since I was 40. I am 67 yr. old female, overweight, but generally, very healthy.
My question is: I am on Gabapentin 600Mg., Trazadone 50Mg. Klonopin .05 (or 1mg. if needed) and Zolpidem 5mg. (and 1/2 chewed around 2 or 3 a.m.). I have been on this combination for 4 months. Previously, for 3 years, I took only Zolpidem, at higher doses, but side effects were terrible and the medicine stopped working, so I dropped down to 5mg. I still only get about 3 hours max of sleep, then I am up again, at least 2 times a night. Sometimes, I am up every 2 1/2 hours and can’t get back to sleep. Is there a better sequence or order that I can try, to take my medications that would be more beneficial? I would like to try and get 8 hours straight! I usually take the GABA at 10:00 p.m., the Trazadone at 11:00 p.m., the Klonopin at midnight and the Zolpidem at 12:30 a.m and go to bed. It takes about an 1 to 1 1/2 hours to even get to sleep, then I am up again. I then take the 1/2 Zolpidem or 1 Motrin around 3 or 4, give or take. Because I have NEVER had more that 3 1/2 hours sleep at a time, and my sleep is so disrupted, I get up feeling so tired, so un-refreshed and have a hangover effect. Thus, I end up sleeping mostly between 6 and 9 a.m. or so. I do not work, so this is not a problem. I just try and stay in bed for at least 8 hours in case in drop off, even for a short period. My doctor says I have sleep mis-perception. So again, my question, after reading your recommended sleep meds. and seeing that some are for sleep onset and others for maintaining sleep, in which ORDER would you recommend I take my sleep meds. that would maybe be more effective.
Thank you so very much for your time and consideration of this matter.

Susie April 16, 2015 at 11:19 am

I don’t know what ‘your comment is awaiting moderation ” means? I am anxious for a reply from anyone, when the opportunity is convenient.
Thank you.

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