How should I approach the management of a patient with ME/CFS who is experiencing significant sleep disturbances?

Approach to managing significant sleep disturbances in a patient with ME/CFS:

• Begin with a comprehensive assessment to identify and manage any underlying or contributing factors to sleep disturbance, including coexisting conditions such as anxiety or depression, which are common in ME/CFS and can affect sleep quality ¹,².
• Discuss and develop an individualized energy management plan with the patient that includes strategies to balance activity and rest, as poor sleep quality and disturbed sleep are common in moderate ME/CFS and can exacerbate symptoms ¹.
• Offer advice on sleep hygiene, including avoiding excessive sleep, daytime sleeping, or naps, to improve sleep quality ².
• Consider cognitive behavioural therapy (CBT) tailored for ME/CFS, which includes components to improve sleep, activity, and rest, and helps patients develop self-management plans to enhance functioning and quality of life ¹.
• Review the patient’s medication and other treatments to ensure no adverse effects are contributing to sleep problems, and manage any coexisting conditions according to best practice ¹.
• Provide information and support resources, such as NHS leaflets on sleep and tiredness and Action for ME, to empower self-management ².
• Arrange regular reviews in primary care to monitor sleep and overall symptom management, and refer to ME/CFS specialist teams if symptoms worsen or new issues arise ¹,².