We all know that a good night sleep sets you up for the day and maintains health, but why? The actual reason for sleep has always been a mystery. Healthy sleep is critical for everyone, since we all need to retain information and learn skills to thrive in life. An average adult needs 7-9 hours of sleep per night.
The amount of sleep is important but it is the quality of sleep that governs whether a person wakes up refreshed or not after a night in bed. Analysis of the sleep cycle has revealed different stages of sleep. The rapid eye movement (REM) sleep and the N:Rem sleep. The N:Rem sleep is further divided into 4 stages depending on the length and frequency of wave patterns in the brain. Brainwaves are produced by synchronised electrical pulses from masses of neurons communicating with each other. Deep refreshing sleep occurs during the slow, high amplitude delta wave stage of the cycle and the more delta wave we have at night the more refreshed we usually are during the day.
In the last few years we have now discovered the reason why delta wave is so important and how it helps us wake up healthier, happier and more relaxed and energised to face life’s challenges. To understand this we need to look at the work of Manchester osteopath and scientist Dr Ray Perrin who specialises in conditions such as Chronic Fatigue Syndrome CFS/ME and Fibromyalgia which can cause immense problems with pain and sleep.
When one thinks about backs and beds we first think about supporting the spine to prevent conditions like ‘slipped discs’ and reducing the wear and tear of the spine. We have been inundated through the media about how a good bed will prevent aches and pains but, although it is extremely important to keep the spine and joints healthy with a well supportive mattress to prevent all of the above, there is so much more to a healthy posture at night than just to keep our joints and muscles going.
A chance discovery in 1989 by Dr Perrin revealed a possible association between certain biophysical dysfunctions and the incidence of two very common and extremely debilitating conditions, CFS/ME and Fibromyalgia1-4. He recognised that postural strain on the spine and disturbance in the integrity of the cranium could lead to a dysfunction of the nervous system controlling drainage of toxins from the brain and the spinal cord.
The lymphatic system is a drainage system in the body secondary to the blood which allows molecules of toxins to drain away from the tissues in the body which are too large to enter through the blood capillary walls.
The central nervous system is the only region in the body that was always believed to contain no true lymphatic vessels. The explanation for this has been that since the blood brain barrier (BBB) prevents large molecules entering the brain there is no need for lymphatic vessels in the CNS, as cerebral blood vessels will be adequate to drain the smaller molecular structures away.
However hormones, which are large protein molecules, continually enter the brain at an area of the brain known as hypothalamus to enable the control of the endocrine system via a mechanism known as bio-feedback. Therefore, the BBB, even if undamaged is not as impenetrable as previously thought. There are gaps in the BBB allowing large toxic molecules to enter the brain such as heavy metals, bacterial infections and especially pro-inflammatory protein molecules known as cytokines. So, there has to be an alternate drainage system for the brain and spinal cord to remain in good health and if this drainage system is compromised illness ensues5.
In 2012 research at Rochester University, New York employed new scanning technology to provide the first visible evidence of the existence of this drainage system for proteins and other large molecular structures from the central nervous system which involves cerebrospinal drainage through channels known as perivascular spaces into the lymphatic system6.
These scientists explored what was happening in Alzheimer’s disease to this pathway when the drainage of large protein molecules known as beta amyloid was unable to occur. They discovered that one of the main areas of toxic build up was the thalamus in the brain . The thalamus relays sensory and motor signals to the cerebral cortex and besides being involved in pain regulation, is also involved in regulation of consciousness, sleep and alertness. Further studies on this drainage revealed it to occur mostly during delta wave sleep7.
Delta wave sleep, which as we have said is the deep restorative sleep, is shown to be low at night in patients with CFS/ME, who have high levels of non-restorative Alpha wave sleep8. However, researchers at Stanford University in California have shown that in the day during the awake cycle there are high levels of delta wave in CFS/ME9. The resultant drainage of toxins during the day would leave patients feeling fatigued and unwell. The increased activity at night prevents the healthy drainage and leaves patients in the state referred to as “Wired and Fired” as suggested by Dr Perrin1.
The existence of this neuro-lymphatic pathway has been further validated last year by a team at Virginia University in the USA who discovered previously unknown lymphatic channels in the membranes at the surface of the brain10. Another group of neuroscientists in Finland published similar findings shortly after 11. The above pathway, together with a disturbance of drainage of cerebrospinal fluid to lymphatics along the spine, Perrin believes, is compromised as part of the common mechanism leading to CFS/ME and fibromyalgia 1-4.
In CFS/ME and Fibromyalgia it is the drainage pathways, both in the head and the spine, that are not working sufficiently, leading to a build-up of toxins within the central nervous system. The aetiology may be traumatic, congenital and may even be hereditary. If the structural integrity of the spine and brain are both affected leading to reduced drainage, the increased toxicity (often following a viral or bacterial infection) plus stress factors (physical, chemical, emotional, immunological and/or environmental) leading to disturbed control of the central lymphatic vessels causing further back-flow and worsening toxicity in the central nervous system leading to disease.
Improving the postural mechanics of the spine is therefore important to healthy sleep. Of course, to benefit from a good night in bed, sleep hygiene must be observed. This includes reducing caffeine at night and avoiding looking at screens just before bed. However, providing the most comfort to one’s spine ensures that the spine functions better and helps the drainage of toxins from the central nervous system.
In conditions like CFS/ME and fibromyalgia the muscles become very tender. A supportive mattress which doesn’t create too much pressure in painful areas like the shoulders and the hips is so important to encourage deep restorative sleep. Having a bespoke mattress specially designed for the individual sleeper would be the ideal and has never been available until now.
The N:rem sleep system allows the individual to reduce the pressure to specific areas of the body, thus ensuring the maximum comfort that can be easily changed if different areas of the spine and body become affected.
Dr Perrin also believed that the drainage problem is a cause for specific physical signs in CFS/ME, the existence of which has been confirmed by independent research at Hammersmith Hospital London in 201112 and a new blind controlled trial at The University of Central Lancashire in conjunction with the Wrightington, Wigan and Leigh NHS Trust, due to be published soon13.
An earlier clinical trial on CFS/ME at The University of Salford concluded that a major cause of the muscle fatigue is lack of lymphatic drainage of the muscle due to sympathetic dysfunction. This would lead to an excess of lactic acid in the muscles of CFS/ME patients 4. In 2013, researchers in Newcastle, showed that disturbance in brain’s blood flow, associated with sympathetic dysfunction, is related to excess skeletal muscle lactic acid leading to the fatigue in CFS/ME14.
These latest findings support the long held view of Dr Perrin that CFS/ME is a disorder of the neuro-lymphatic drainage system, leading to neurotoxic build up within the central nervous system and the ensuing cascade of many symptoms of autonomic dysfunction seen in diseases such as CFS/ME and fibromyalgia.
Sleep disturbance is one of the most common symptoms of CFS/ME15,16. A recent study showed that many patients with CFS/ME and Fibromyalgia had trouble staying asleep17. In all the different criteria, including the NICE guidelines developed to diagnose CFS/ME, sleep disturbance and unrefreshing sleep are near the top of the lists of common symptoms that affects most patients with this debilitating disease18.
Dr Perrin says about the N:rem Mattress
“Any aid to increase good, deep, restorative delta wave sleep is important for health as it will aid the drainage of poisons from the brain and spinal cord. This will help maintain a healthy body and mind.
By choosing the bespoke mattress through the N:rem sleep system, one gives a chance of a healthier spine and improved drainage from the central nervous system. This can play a major contributing factor in the prognosis of illnesses such as CFS/ME and fibromyalgia and possibly many others such as Alzheimer's Disease.”
Dr Raymond N Perrin DO, PhD
Registered Osteopath and Neuroscientist
Specialist in Chronic Fatigue Syndrome/ME
- Perrin RN, The involvement of cerebrospinal fluid and lymphatic drainage in chronic fatigue syndrome/ME , PhD Thesis University of Salford: 2005; 125.
- Perrin RN. Lymphatic Drainage of the Neuraxis in Chronic Fatigue Syndrome: A Hypothetical Model for the Cranial Rhythmic Impulse. Journal of the American Osteopathic Association, 2007; 107(06), 218-224.
- Perrin R. The Perrin Technique, Hammersmith Press, London. 2007.
- Perrin RN, Richards JD, Pentreath V, Percy DF. Muscle Fatigue in CFS/ME and its response to a manual therapeutic approach: A Pilot Study. International Journal of Osteopathic Medicine, May 2011.
- Kinmonth JB. The Lymphatics, 2nd Edition. London: Edward Arnold, 1982.
- Iliff J et al. A Paravascular Pathw Facilitates CSF Flow Through the Brain Parenchyma and the Clearance of Intayerstitial Solutes, including Amyloid Beta. Sci Transl Med 2012; 4, 147ra111 (Aug) .
- Xie L et al. Sleep Drives Metabolite Clearance from the Adult Brain. 2013 Science. 2013; 342: 373-377
- Van Hoof E et al. Defining the occurrence and influence of alpha-delta sleep in chronic fatigue syndrome Am J Med Sci. 2007 Feb;333(2):78-84.
- Zinn M & Zinn M. Delta waves in awake cycle in CFS/ME. Proceedings at The Symposium on CFS/ME , Stanford University, California 2014.
- Louveau A et al. Structural and functional features of central nervous system lymphatic vessels, Nature 2015.
- Aspenlund A et al. 2015, Journal of Experimental Medicine June 15:. 212 (7) 991-999
- Puri BK et al.. Increased tenderness in the left third intercostal space in adult patients with myalgic encephalomyelitis: a controlled study. JInt Med Res 2011;39(1):212-4
- Hives L et al. 2017, Examining The accuracy of a physical diagnostic Technique for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A blind controlled study.
- He J, Hollingsworth K, Newton J and Blamiria A, 2013. Cerebral vascular control is associate with skeletal muscle pH in chronic fatigue syndrome patients both at resand during dynamic stimulation. Neuroimage Clin. 2013; 2: 168–173.
- Krupp LB. 1993. Sleep Disturbance in C.F.S. J. Psychosomatic Research. 37: 325-331.
- Stores G, Fry A, Crawford C. 1998. Sleep abnormalities demonstrated by home polysomnography in teenagers with chronic fatigue syndrome. Journal of Psychosomatic Research. Jul; 45,1: 85S-91S.
- Schaefer KM. 1995. Sleep disturbances and fatigue in women with fibromyalgia and chronic fatigue syndrome. Journal of Obstetrics Gynaecology and Neonatal Nursing. 24, 3: 229-233.
- National Institute for Health and Care Excellence: Clinical guidelines, CG53, 2007 & 2011.