Q: You said that all of these different stresses could suppress the hypothalamus. What happens then?

A: The hypothalamus is kind of like the orchestra conductor of the brain. It controls four main areas:

1. Temperature regulation. With hypothalamic suppression one will tend to have a low body temperature. Where most people are running a temperature of 98.6 Fahrenheit, CFS/FMS patients often run 1 to 2 degrees lower than this. This has as severe an impact as running a fever. The body's metabolic functions are very temperature sensitive -- and low temperature itself can leave you feeling tired. Temperature regulation is bundled in the hypothalamus with the other three processes below -- likely because it is so critical to life and health, and the functions below are important in temperature regulation.
2. Hormonal function. Your pituitary gland controls the major hormone producing glands in the body. Your hypothalamus controls the pituitary gland! People who have pituitary injury routinely are placed on up to eight different hormones to correct the problem. The same eight hormones are, understandably, therefore often needed in CFS/FMS while waiting for the hypothalamus to heal up with treatment. Unfortunately, most hormonal blood tests are interpreted based on primary gland failure. The blood tests normal ranges may not be reliable in the presence of hypothalamic suppression. Despite this, many doctors still mistakenly tell patients that their hormonal function is normal based on these blood tests -- even though clinically people often improve dramatically with hormonal treatment.
3. Autonomic function. This controls blood flow, pulse, blood pressure and other related functions. You may find that your hands and feet are cold, you have low blood pressure and/or get dizzy with standing, you have a rapid pulse, etc. In addition, neurally mediated hypotension (NMH) is also common in CFS. Because the tilt table test for NMH is expensive (approximately 1000 to $2000), often not covered by insurance, and often leaves people feeling very sick I do not routinely check it. I prefer to treat based on the patient’s symptoms, and I find this approach works well.
4. Sleep. It is very rare to find somebody with CFS/FMS who is able to get 8 hours of solid sleep a night (without medications) without waking. I usually ask my audiences this question when I am giving a lecture. Usually, less than three out of 300 to 700 people in the audience answer that they're able to get 8 hours solid sleep without taking sleep treatments. I often talk to these people after the talk and find that they have another problem, and not CFS/FMS. The sleep problems can manifest many ways. Many people have trouble falling asleep because, even though they're exhausted, their mind is wide awake at bedtime. After falling asleep, most people with FMS/ CFS find that they wake-up frequently during the night, especially between two and 4 AM. In addition, sleep is disrupted by pain and frequent urination. All in all, many people are only able to get four to five hours of solid sleep a night without treatment. The disrupted sleep then results in immune suppression and chronic widespread pain.

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Dr. Teitelbaum is a board certified internist and director of the Annapolis Research Center for Effective CFS/Fibromyalgia Therapies, where he sees CFS/Fibromyalgia/Chronic pain patients from all over the world (410-266-6958). Having suffered with and overcome these illnesses in 1975, he spent the next 28 years creating, researching, and teaching about effective therapies. He is the author of the best-selling From Fatigued to Fantastic!" and the newly released "Three Steps to Happiness! Healing through Joy". His web site can be found at: www.vitality101.com