Rest for the Weary
Richard S. Dunlap is the last person you would expect to get sick. "I used to be a bomb-proof young hero," says Dunlap, an architect who lives in Sausalito, California. At the age of 23, he skateboarded and snowboarded professionally, bicycled avidly, and practiced yoga for at least one hour a day. "I was a very active, very motivated person," he says. "In fact, I had just come off a wonderful period of my life. I was doing some professional work in films, and I had traveled the world." Then, quite suddenly, Dunlap, who is now 35, crashed.
Ellen Klein, a new mother who lives in Sea Cliff, New York, tells a similar story. Ten years ago, at the age of 27, Klein lived a dynamic, no-holds-barred life in New York City. Klein, who managed a clothing store in Manhattan's Soho District, pushed herself in every part of her life. "I was working hard, working out hard, going out hard—that whole New York lifestyle," says Klein. "I always did a lot and always tried to fit too much into the day." Then, also quite suddenly, she crashed.
The force of the crash, for both Dunlap and Klein, came from several directions. Dunlap was hit with unexplained dizziness, abdominal discomfort, chills, night sweats, fever, and nausea. Klein was ambushed by headaches, muscle pain, and panic attacks.
And then there was the fatigue—devastating fatigue. With little warning, both Dunlap and Klein catapulted into a world of overpowering exhaustion and lethargy. "I spent a good 10 months doing nothing," says Klein. "Even getting out of bed and going to the bathroom was an issue." The same was true for Dunlap. "I went from being Superman to being in bed. It was crushing."
Although their symptoms differed somewhat, Dunlap and Klein had two things in common: They were both diagnosed—eventually—with chronic fatigue syndrome. And each discovered, after trying numerous conventional and alternative therapies, that what significantly relieved their fatigue, strengthened their spirits, brought them peace, and ultimately restored their health was yoga.
The Mystery Syndrome
You wouldn't wish chronic fatigue syndrome (CFS) on your worst enemy. People with CFS suffer, first and foremost, from profound fatigue that no amount of sleep can relieve. They also have any number of other symptoms, including weakness, muscle pain, impaired memory or mental concentration, insomnia, and post-exertion fatigue that can last more than 24 hours, according to the U.S. Centers for Disease Control (CDC). In some cases, CFS can last for years.
In addition to being debilitating, CFS can be a frustrating disorder to diagnose. A decade or so ago, when doctors knew little about CFS, just getting a diagnosis could in itself be an exercise in aggravation. Some doctors would chalk up the symptoms as psychosomatic or a result of depression.
"In general, what was insinuated was that I was not physically ill, but mentally ill," says Dunlap. "I was accused of being a malingerer. Yes, I was depressed, but I was not sick because I was depressed. I was depressed because I was sick."
Today, doctors know more about CFS, although diagnosing it continues to be an inexact science. Basically, doctors conclude that a patient has CFS after they have ruled out all other possibilities, such as an underactive thyroid, sleep disorders, mental illness, chronic mononucleosis, eating disorders, cancer, autoimmune disease, hormonal disorders, and other ailments.
"Chronic fatigue is a diagnosis of exclusion, because there are many other medical problems that have symptoms similar to it," says Arthur Hartz, M.D., Ph.D., a CFS researcher and professor of family medicine at the Iowa College of Medicine in Iowa City. "There's no test, and that's a major deficiency. Without a test, there's always going to be debate about whether the condition is more than a psychological problem."
After doctors rule out everything else, they make a diagnosis of CFS if, according to CDC guidelines, a patient has both of the following:
Severe chronic fatigue that lasts six months or longer.
Four or more of the following symptoms—substantial impairment in short-term memory or concentration; sore throat; tender lymph nodes; muscle pain; multi-joint pain without swelling or redness; headaches of a new type, pattern, or severity; unrefreshing sleep; and malaise lasting more than 24 hours after exertion.
Those who have fewer than four symptoms but meet all of the other criteria are said to have chronic fatigue, rather than chronic fatigue syndrome. That one word may seem to be only a subtle difference, but to CFS sufferers, it matters; according to Hartz, many patients believe the medical establishment takes them more seriously if they are diagnosed with the syndrome rather than chronic fatigue.
Often CFS begins as just a routine flu or other infectious illness. The difference is that it lingers. "Instead of going away in a week or two," Hartz says, "it just never seems to get better."
Although anyone can get CFS—some 836,000 Americans are believed to have it—women are twice as likely to get it as men, according to a recent study published in the Archives of Internal Medicine (1999; 159: 2129-2137). It strikes most commonly among people ages 30 to 60, and more specifically, 40 to 49.
Doctors are on equally shaky ground when it comes to treatment. Because they don't know what causes CFS—the laundry list of possibilities includes viruses, immunologic dysfunction, central nervous system disorders, a type of low blood pressure, nutritional deficiency, environmental factors, and emotional stress—they treat CFS by addressing the symptoms, rather than the cause of the disease.
Say a patient's symptoms are muscle pain, nighttime sleep disturbances, depression, and headache. The doctor will likely prescribe muscle relaxants, sleeping pills, antidepressants, and headache remedies and also recommend meeting with a physical therapist, massage therapist, and psychiatrist. And the doctor will probably recommend the patient begin incorporating small amounts of activity into the day, beginning with as little as five minutes of slow walking per day and building up from there. It is a slow, arduous process.
Some Surprising Research
Many of the CFS patients Hartz and other doctors treat feel discouraged that medical science can't do more for them. They try prescription medications by the handful, with mixed results. They also tend to experiment with myriad alternative health treatments. (Dunlap, for example, used massage and traditional Chinese medicine, including herbs and acupuncture, to assist in his recovery.) For some patients, medications and psychotherapy help; for others, they are less effective. The same is true of alternative therapies—sometimes they are beneficial and sometimes they aren't.
Searching for solid scientific data on what works and what doesn't, Hartz and his associate Suzanne Bentler launched a study four years ago. They asked about 150 patients with chronic fatigue to list all of the interventions they were using for their fatigue—from the alternative to the conventional, including physical activity and pharmaceuticals. About two years later, the researchers contacted the study subjects again and asked how they were doing and whether their CFS had improved. When the researchers compiled their data recently, they found some unexpected results: Yoga appeared to help the CFS patients more than anything else. Hartz was shocked.
"Yoga was one of the few things that predicted improvement," says Hartz. "The people who did yoga felt better than the people who tried other things." What makes this finding even more surprising is the fact that Hartz and his team had no inkling that yoga would be so beneficial. "I know almost nothing about yoga," says Hartz. "This finding just sort of came out of the blue. We weren't looking for it."
Hartz warns that these results are preliminary and further study is needed to verify the findings; in fact, his team hasn't even finished fully analyzing the study data. And if yoga is indeed as helpful as the study suggests, Hartz won't know without further research whether CFS patients benefit from yoga's gentle physical activity, meditative component, or some other factor. Even with all of those caveats, however, Hartz's research offers CFS sufferers an exciting possibility for effectively treating their ailment.
Of course, Dunlap and Klein have known for years what Hartz and his team discovered in their research labs—that yoga helps CFS sufferers to heal. In fact, they say yoga just about saved their lives.
Out in the Trenches
After he got sick, Dunlap's world turned upside down. He dropped 20 pounds and had trouble thinking clearly. It became hard for him to support himself. His sickness put such enormous strain on a romantic relationship that it eventually ended. His friends offered little support because they didn't understand what was wrong with him. He felt abandoned by the medical community and sank into depression.
"It was like the person I had been died. That's what it felt like—I couldn't be that person anymore. My body wouldn't do it," says Dunlap. "It was really kind of hellish. I was in a fragile state and being a young, formerly healthy, virile man—that was tough. It was brutal."
CFS was brutal for Klein, too, although in different ways. After being sick for two months, Klein was forced to leave her job managing a clothing store. She spent 10 months in bed, out of work, and going from doctor to doctor, looking for help. She gulped down beta-blockers, anti-inflammatories, anti-anxiety drugs, and painkillers. In addition to CFS, she developed fibromyalgia, a disorder characterized by achy pain and stiffness in the ligaments, muscles, and tendons. After a year, she forced herself to go back to work and took a job as a buyer at a major department store chain. But even then she continued to suffer as she put every ounce of strength into her job. "I would live two lives—I'd go to work and I'd work hard, and then I went home and did nothing else." When financial troubles hit the chain, she was one of the first to be let go. "They were on to me," Klein says. "I was actually home sick when they fired me and it was such a relief."
It was at this rock-bottom point—when Dunlap and Klein both felt they could bear no more—that they turned to yoga. For Dunlap, it was a return to a discipline he had loved and practiced for six years before he got sick. During the year before CFS struck, Dunlap had set himself on a course of serious yoga study—he practiced enthusiastically daily. But when he got sick, he left yoga behind for six months. Although he loved yoga, he felt so tired, depressed, and unmotivated, he couldn't even rouse the desire to practice. Finally, though, he returned to it.
He began with meditation, journal writing, and gentle asanas—forward bends on the floor, straddle splits, hip stretches, Bridge Pose, and Savasana. He practiced for one-half hour a day—a pittance compared to his previous strong practice. But for Dunlap, it made a huge difference in how he felt.
"It was really important for me at the time to feel like I could invest my spirit in something that would yield a positive return," says Dunlap. "That's what I got out of yoga. I learned how—through a very intuitive, sensitive monitoring of my own breath, my own patterns of energy, and my own patterns of thought—to bring myself into a state that was relaxed and accepting of what was happening to me. It also brought comfort to my body, which was just so welcomed. That's what kept me coming back to it every day."
Of all the asanas Dunlap tried, the most comforting were inversions. "Inversion was just a panacea for me," he says. When he was too weak to do Shoulderstand, he practiced it with chair support. "Sometimes I would engage in general pPranayama in that position. Sometimes I'd even fall into a deep sleep, which was blissful. Finally my whole system would relax enough so I could go into a deep physical sleep."
When Hartz heard about Dunlap's success with inversions, he was fascinated. According to Hartz, as many as 60 to 70 percent of CFS patients have neurologically mediated postural hypotension—which means their blood pressure drops when they're standing. Doctors ordinarily treat this condition with medications that increase blood volume, but Hartz says inversions are an intriguing nondrug treatment. That's no surprise to Dunlap. "This is exactly what the tradition tells us, that these are the most important poses. My own experience verified that."
Dunlap practiced yoga gently for six months and then spent a year working his way back to his previous strength levels. Gradually, he regained his health. Today he practices yoga daily, teaches classes at The Yoga Studio of Mill Valley in Mill Valley, California, and is writing a master's thesis on sacred architecture.
For Klein, yoga was a completely new experience. After she had been laid off, she dedicated herself to getting better. She gained some strength in physical therapy, but it wasn't until she began yoga—her sister had practiced yoga a bit and suggested that Klein give it a try—that she really began to improve. A beginner class left her exhausted, so she signed up for private lessons twice a week.
Klein started slowly. Her instructor began with breathwork and then moved on to gentle poses. "Sometimes if I was having a bad day, my practice was just lying in bed breathing or doing poses lying on my back," says Klein. "But I did something every day. I started getting better slowly. I loved the yoga—I did it every day, no matter how lousy I felt, even if I just lay on the floor for five minutes, using a strap to stretch my hamstrings, or lay over a bolster and breathed."
Looking back, Klein realizes that the breathing, meditation, and body awareness were the most crucial parts of her healing process. "I was walking around for years being totally unaware of my body," she says. "I'd go to the gym and work out to try to get in shape and get tight abs and all that stuff—but I wasn't aware of the body I was living in." Over time, she healed, and one by one, Klein stopped taking her medications. After a year, she was ready to work again.
This time, though, she didn't go back to retailing. "Whenever I would sit and meditate, it would always come up that I wanted to teach yoga," says Klein, "and I said, 'This is crazy!' Even though I was getting better, I wasn't strong." But her yoga teachers saw through her physical weakness and trained her to instruct others. She has been teaching ever since.
Why Does Yoga Work?
Scientists don't know why yoga helps people with CFS, but yoga instructors believe they do. They cite the following reasons.
YOGA HELPS WITHOUT HURTING. Research shows that mild exercise can help people with CFS recover their strength. Yoga's gentle, restorative poses increase circulation and oxygen flow—keys to healing—without irritating the body. (Raising heart rate and blood pressure and creating more lactic acid in more rigorous forms of exercise can trigger a worsening of symptoms.) "The body responds to gentleness," says Jenni Fox, a yoga teacher in Santa Cruz, California, and co-owner of Yoga-Nia Adventures. "What's important is to make space for energy to flow within the body and open the heart. You can do all the 'right' restorative poses, but if you see the poses as a way to 'fix' the body rather than a way to take you to a state of compassionate acceptance, it's difficult to receive the healing yoga can bring."
YOGA BALANCES. Often, people with chronic fatigue are out of touch with their natural human rhythms. They moved too fast, did too much, and their bodies have run down. Yoga helps them find a slower, more natural pace. "It's about getting such people to listen to themselves," says Charles Matkin, codirector of Mind Body Therapies at Haelth, a complementary health center in New York City. "It's about forming discipline—the discipline of peace surrounding something you feel out of control with. Rather than a discipline of more and more, it can be the discipline of less and less, a nonobsessive daily practice."
YOGA ENERGIZES. "A person with CFS struggles with depleted energy, and yoga helps restore energy to the fatigued body, allowing the cells, senses, and nerves to quiet down," says Fox. Some helpful poses include the following:
Forward bends soothe the nervous system by allowing energy to flow to the spinal column while increasing blood and oxygen flow to the heart and head.
Adho Mukha Svanasana (Downward-Facing Dog) fosters blood flow to the head, neck, and heart.
Uttanasana (Standing Forward Bend) soothes the nervous system, gradually increases blood flow to the brain, and frees the respiratory muscles of the neck from tension.
Lying over cross-bolsters can help stimulate the nervous system in a quiet way and increase circulation to the adrenals, thyroid, and kidneys, which are a storehouse of energy.
YOGA EMPOWERS. Instructors agree it empowers CFS sufferers in a way nothing else can: "Those who suffer get better when they're actively involved," says Fox.
YOGA TEACHES STILLNESS. "Patanjali says if we can sit quietly with our bodies for a while, we grow in our capacity to be," says Fox. "I think that for people who have CFS, it can be a gift to learn how to remain in a place for a longer period of time. Life is always flowing through us, even when we're not moving outwardly. Being still is an opportunity to listen to the many beautiful things the body has to say that we haven't been listening to."
Twelve years after being waylaid by CFS, Dunlap feels better—and he is not as obsessively driven as he once was. He continues to have some CFS symptoms, including an intense sensitivity to cold and certain foods, but the greatest change is who Dunlap has become spiritually.
"I look back and think, my God, if I had to live it again, I don't think I could, or would," he says. "But there's this feeling that a certain grace has befallen, a certain wisdom has opened, and I can see the world through eyes that are not tainted by selfishness, narcissism, and this great impenetrable feeling of immortality."
As for Klein, life is good. She continues to teach yoga, but perhaps the greatest change in her life is that she has—thanks to yoga—learned to slow down and live healthfully. "Before, I wasn't in touch with myself or my body," says Klein. "I didn't have healthy habits at all—I smoked and I drank. Now I feel much healthier. I really do attribute getting better to yoga. I don't think I would have gotten better without it."
Alice Lesch Kelly is a freelance writer living in Massachusetts.