Patients with severe ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) face unique challenges due to prolonged bed rest, including reduced mobility and limited exposure to fresh air. This lack of movement and upright positioning often leads to diminished oxygen levels in the blood (hypoxia), which can exacerbate symptoms and hinder recovery. In this post, we explore the detrimental effects of prolonged immobility, the role of oxygen in ME/CFS, and actionable strategies to mitigate hypoxia and its consequences.

The Impact of Prolonged Bed Rest on ME/CFS

Prolonged bed rest, common in severe ME/CFS, has detrimental effects on overall health, including:

• Muscle atrophy and bone loss

• Reduced venous return and cardiovascular risks

• Decreased lung volumes, leading to hypoxia

• Impaired red blood cell production and oxygen-carrying capacity

Hypoxia and ME/CFS Pathophysiology

A 2018 study from Cornell University highlighted how oxidative stress and imbalances in redox status contribute to cellular hypoxia in ME/CFS patients. Hypoxia triggers inflammatory pathways, worsens fatigue, and leads to cognitive deficits. Prolonged immobility further exacerbates these effects by reducing red blood cell mass and erythropoietin (EPO), the hormone that stimulates red blood cell production.

Oxygen Therapy for Severe ME/CFS

Hyperbaric Oxygen Therapy (HBOT)

HBOT involves administering oxygen at higher-than-atmospheric pressure in a pressurized chamber. While studies suggest HBOT can improve symptoms in ME/CFS and fibromyalgia, access can be challenging due to cost and availability.

• Fibromyalgia Study: A study of 60 women found significant symptom reduction and improved quality of life after 40 HBOT sessions (90 minutes/day, 5 days/week).

• ME/CFS Study: 16 patients undergoing 15 HBOT sessions reported reduced symptom severity and improved quality of life.

Home Oxygen Therapy

For bed-bound patients unable to access HBOT, home oxygen therapy may offer a practical alternative. Even an hour of daily oxygen treatment has shown promise, as used by the now-retired ME/CFS specialist Dr. Paul Cheney. Consultation with a respiratory therapist is recommended to ensure safe and effective use.

Breathing Techniques to Improve Oxygenation

When formal oxygen therapy isn’t an option, breathing exercises can enhance oxygen intake and improve respiratory muscle function. These techniques, often used in chronic lung diseases, are simple yet effective:

1. Diaphragmatic Breathing

Promotes deeper breathing by engaging the diaphragm.

1. Lie down or sit with shoulders relaxed. Place one hand on your chest and the other on your stomach.

2. Inhale deeply through the nose for a count of 2, feeling your stomach rise.

3. Exhale slowly through pursed lips, gently pressing on your stomach to release air.

4. Repeat as tolerated.

2. The 4-7-8 Technique

Adopted from yoga, this exercise calms the nervous system and improves oxygen efficiency.

1. Place the tip of your tongue behind your upper front teeth.

2. Exhale forcefully through the mouth with a whooshing sound.

3. Inhale through the nose for a count of 4.

4. Hold your breath for a count of 7.

5. Exhale through the mouth for a count of 8, making the same whooshing sound.

3. Equal Breathing

Balances inhalation and exhalation.

1. Inhale deeply through the nose for a count of 4.

2. Exhale evenly through the nose for a count of 4.

3. Gradually increase the count for deeper, slower breaths.

Why Addressing Hypoxia Matters for ME/CFS

Mitigating hypoxia is essential to improving overall health in severe ME/CFS patients. By addressing oxygen deficiency through therapies and breathing techniques, patients can reduce inflammation, improve energy production, and support better quality of life. These strategies, though simple, can have profound effects on the well-being of those most severely impacted by ME/CFS.

References

Winkelman, C. (2007) Inactivity and Inflammation in the Critically Ill Patient. Crit Care Clin 23: 21–34.

Germain A. et al (2018) Prospective Biomarkers from Plasma Metabolomics of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Implicate Redox Imbalance in Disease Symptomatology. Metabolites. 8(4): 90.

Pavy-Le Traon, A et al. (2007). From space to Earth: advances in human physiology from 20 years of bed rest studies (1986–2006). European Journal of Applied Physiology, 101(2), 143–194.

Morris G. et al (2018) The putative role of oxidative stress and inflammation in the pathophysiology of sleep dysfunction across neuropsychiatric disorders: Focus on chronic fatigue syndrome, bipolar disorder and multiple sclerosis. Sleep Med Rev. 41:255-265.

Efrati S. et al (2015) Hyperbaric oxygen therapy can diminish fibromyalgia syndrome--prospective clinical trial. PLoS One. 10(5):e0127012.

Akarsu S. et al (2013) The efficacy of hyperbaric oxygen therapy in the management of chronic fatigue syndrome. Undersea Hyperb Med. 40(2):197-200.