Sleep Care

Fibromyalgia and Sleep

Fibromyalgia is a chronic pain disorder of the muscular and skeletal systems. To be diagnosed, the pain needs to last for three or more months and be present in at least eleven of eighteen “tender point sites”, such as the lower back, shoulders, and ankles. This pain should occur in the absence of any more clearly diagnosable conditions, like tendonitis, that could explain it.

Although fibromyalgia can affect people of any age or gender, it is nine times more likely to occur in women than in men, and usually doesn’t show up until middle-age. Worldwide, it’s estimated that fibromyalgia affects between 2% and 6% of people.

There appear to be a variety of factors that lead to the development of fibromyalgia. Periods of repeated stress, injuries, and traumatic events such as automobile accidents can trigger the pain symptoms associated with fibromyalgia. While it can run in families, researchers aren’t sure if this is due to genetic or environmental causes.

A Debilitating Impact on Sleep

As might be expected, fibromyalgia has a very negative impact on a person’s sleep. One study that examined brain wave characteristics of fibromyalgia noted that while 10-30% of normal people will report unrefreshing sleep, those numbers jump to 76-90% of people suffering from fibromyalgia.

A number of sleep disorders are associated with fibromyalgia. Fatigue and insomnia are common. Sleep studies done on patients suffering from fibromyalgia typically show a decreased level of slow wave sleep, the stage of sleep that is deepest and is often associated with feeling rested and refreshed upon waking up in the morning. Additionally, increased levels of stage one sleep and arousals are usually noted, which indicate the patients spend much more time in a lighter sleep that is generally easier to wake up from than normal sleep for adults. The greater number of arousals may be due to the chronic pain that is defining characteristic of the condition. Patients with fibromyalgia will also generally have a greater sleep onset latency than usual—indicating they take longer to fall asleep than what is considered normal—and spend less time in REM sleep, where most dreaming occurs. Reductions in REM sleep can be associated with problems of memory, focus, and concentration.

Restless leg syndrome is another sleep disorder common to fibromyalgia sufferers. Patients with restless legs during sleep (also called periodic limb movements) have an overwhelming urge to move or kick their legs—sometimes to

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the extent that it disrupts their sleep. The relationship between restless legs and fibromyalgia is significant enough that doctors are encouraged to screen new fibromyalgia patients for restless legs.

Because the effects of fibromyalgia on sleep can be similar to sleep apnea, physicians may order a sleep study when considering a potential diagnosis of fibromyalgia. Interestingly, there may be a potential gender difference in this area: a 1993 study investigating sleep apnea and fibromyalgia found that while sleep apnea did not appear to be a significant cause of fibromyalgia symptoms in women, it did show up in a large percentage of men.

A Variety of Approaches for Treatment

Treatment for fibromyalgia usually focuses on treating its symptoms and often involves a combination of medication and behavioral or lifestyle changes.

Drugs commonly prescribed to improve fibromyalgia symptoms include analgesics (Tylenol, Advil, Aleve, etc.), antidepressants (Prozac, Cymbalta), and anti-seizure drugs such as Neurontin or Lyrica. Sleeping aides can sometimes be used as well, but patients’ pain should be adequately controlled and good sleeping habits should be established before these are considered. More information about good sleep hygiene can be found here.

Behavioral treatments for fibromyalgia often include physical therapy and other forms of exercise, such as swimming and stretching. Applications of hot and cold compresses or creams to specific areas can be beneficial as well.

Since fibromyalgia is a chronic condition, behavioral counseling can be useful to make lifestyle adjustments and aid in developing strategies to deal with stressful situations that can worsen pain symptoms. For example, a 1993 study evaluating a ten-week, group outpatient meditation-based stress reduction program found that while all participants showed progress, more than half displayed significant improvement in evaluations after completing the program.

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