Fibromyalgia and Sleep

Are you having trouble sleeping because you have fibromyalgia? Most people with fibromyalgia complain of trouble sleeping. No matter how long they sleep, it is rarely restful. Here's some information that can help you get a better night's sleep.

What sleep problems are common with fibromyalgia?

Sleep problems with fibromyalgia include insomnia or difficulty falling asleep as well as frequent awakening in which you become awake enough to remember them the next day. An even more common problem is awakenings that you don't remember but that definitely interrupt your "deep" sleep. Also, other sleep disorders -- such as restless legs syndrome and sleep apnea -- may be more common in people with fibromyalgia.

People with fibromyalgia talk about waking up day after day feeling exhausted with no energy. Usually, they feel more tired in the morning, and many go back to sleep during the day to ease their fatigue. Also, it's common for people with fibromyalgia to have great difficulty concentrating during the day, a condition called "fibro fog."

Why can't I sleep at night with fibromyalgia?

Some researchers believe it's the constant pain of fibromyalgia that causes sleep interruptions. Others have found evidence that fibromyalgia may be related to an abnormality of deep sleep. Findings have shown abnormal brain waveforms in deep sleep with fibromyalgia patients. These patients tell of feeling "awake" or being in a shallow state of sleep throughout the night, instead of experiencing restful, deep- level sleep.

The problem with achieving only a shallow state of sleep is that, during deep-level sleep, your body repairs and replenishes itself. For example, studies show that people with fibromyalgia have a low level of a hormone called somatostatin. Somatostatin is produced during deep sleep and is vital for maintaining the health of muscle and other soft tissue. If the amount of deep sleep you get is reduced over a long period of time, your body may have less ability to "repair and replenish" energy as well.

What stages of sleep are important in fibromyalgia?

People with fibromyalgia lack the deep, restorative level of sleep, called "non-rapid-eye-movement" (non-REM) sleep. Consequently, patients with fibromyalgia often wake in the morning without feeling fully rested. Some patients wake up with muscle aches or a sensation of muscle fatigue as if they had been "working out" all night.

Is restless legs syndrome related to fibromyalgia?

Restless legs syndrome is a neurologic disorder characterized by an overwhelming urge to move the legs at rest. It's true that restless legs syndrome is more common among those who have fibromyalgia than in those who don't have fibromyalgia.

There is treatment for restless legs syndrome, so talk to your doctor if you have this problem.

Are there sleep strategies to help people with fibromyalgia?

Establishing better sleep hygiene is vital in managing the symptoms of fibromyalgia. Improving your sleep may help decrease your pain, fatigue, and "fibro fog." Try the following strategies and see if they help your sleep. In addition, ask your doctor about a sleeping pill that's safe and effective to get your body back on a restful sleep regimen.

• Sleep only as much as needed to feel refreshed and healthy the following day, not more. Curtailing the time in bed seems to solidify sleep. Excessively long times in bed seem related to fragmented and shallow sleep.
• Keep a sleep diary. Write down how you slept each night and triggers that may have interfered with your sleep. Reviewing your notes over several weeks may give you insight into your sleep problems.
• Have a regular time to wake up each morning. A regular arousal time helps strengthen circadian cycling and leads to regular times of sleep onset.
• Use relaxation therapies. A gentle massage, deep breathing, and other relaxation techniques are all generally considered beneficial to managing fibromyalgia and boosting restful sleep.
• Exercise regularly (but avoid exercising 3 hours before bedtime). Exercise may exert its beneficial effect by promoting a deep level of sleep (non-REM sleep).
• Sound-attenuated bedrooms may help those who must sleep close to noise. Occasional loud noises -- for example, aircraft flyovers -- disturb sleep even in people who are not awakened and cannot remember them in the morning.
• Avoid daytime naps. Napping in the afternoon interferes with nighttime sleep.
• Keep the temperature in your room cool. An excessively warm room disturbs sleep.
• Hunger may disturb sleep; a light snack of carbohydrates may help sleep.
• Avoid caffeine or alcohol in the evening. They both disturb sleep.

Can medicine help me sleep with fibromyalgia?

The most effective medications in the treatment of fibromyalgia have been the tricyclic antidepressants, medications traditionally used in treating depression. In treating fibromyalgia, tricyclic antidepressants are taken at bedtime in doses that are a fraction of those used for treating depression. Tricyclic antidepressants appear to reduce fatigue, relieve muscle pain and spasm, and promote deep restorative sleep in patients with fibromyalgia. Scientists believe that tricyclics work by modulating nerve transmitter chemicals in the brain, including serotonin.