One of the core symptoms of fibromyalgia is sleep disturbance. This can mean difficulty staying asleep, sleep apnea, restless leg syndrome, or simply nonrestorative sleep.
Lack of restorative sleep lowers our pain threshold and increases our perception of pain. And increased pain leads to worsening sleep, so the vicious fibromyalgia sleep/pain cycle snowballs.
Poor sleep also leads to worsening fatigue, cognitive function, and psychological distress. So what can we do?
First Things First: Good Sleep Hygiene!
Here are a few key ways you can practice good sleep hygiene:
- Surprisingly, our sleep hygiene begins the minute we wake up. First thing in the morning, get exposure to natural light, which will set your circadian clock for success.
- Don’t nap late in the day, and try to get your exercise early if you can, as too much stimulation or evening napping can cause sleepless nights.
- Avoid television, tablet or phone screens, and any other source of blue light in the evening… we don’t want our brains getting the signal that it is time to be awake.
- Save the bedroom for activities that actually require a bed—not eating, working, or watching TV. Plus, it’s important to make sure the bedroom is comfortable. A firmer mattress can provide better support for aching joints.
- Avoid overeating, over-drinking, or alcohol right before bed.
- Consider adding good habits, like meditation, to improve sleep quality.
Try Cognitive Behavioral Therapy for Sleep and Fibromyalgia Pain
Cognitive behavioral therapy, or CBT, is a type of psychotherapy that aims to improve mental health. It focuses on challenging and changing unhelpful cognitive disorders and behaviors, improving emotional regulation, and developing personal coping strategies to solve current problems.
Interestingly enough, CBT for insomnia had more long-term impact on both pain and sleep than CBT for pain!
Medical Causes of Sleep Issues
Often, sleep issues are more than just bad bedtime habits. For example, if your partner tells you that you snore, stop breathing, or move a lot in your sleep—or if you wake up with headaches and feeling more tired than when you went to bed—ask your healthcare provider for a referral for a sleep study to explore these issues.
What About Medications?
There are many medication options, but the best one is tailored to your specific needs. For example, low progesterone in women can lead to poor sleep, and progesterone treatment works wonders. And for muscle spasms that keep people awake, muscle relaxers can address this. The proper medication can help you have the comfort you need to fall asleep.
If neuropathic pain is keeping you awake, pregabalin (Lyrica) has been approved for fibromyalgia pain—and it makes you sleepy, too! Gabapentin is a similar medication that studies show to be effective in increasing restorative slow-wave (or deep) sleep.
Sometimes, you may need a medication with a more sedating effect. This may be an antidepressant like amitriptyline, which has been shown to improve both pain and sleep in fibromyalgia patients through its effects on neurotransmitters. Another effective medication for pain relief in some fibromyalgia patients is duloxetine (Cymbalta), an SNRI-type antidepressant. In severe cases, a particular medication for sleep called Xyrem can be prescribed.
Sleeping pills can be habit-forming, making insomnia worse when stopped, so we try to use these as a last resort. Instead, we suggest melatonin, as this is our natural sleep-signaling hormone, is available as a supplement, and is a much safer alternative. When studied specifically in fibromyalgia, it has been shown to have an analgesic effect as well as an effect on sleep. Valerian is another natural supplement used to treat sleep that has specifically been studied and shown to have anti-pain effects in animal models of fibromyalgia.
Fibromyalgia is a Multi-Factorial Condition
When we treat Fibromyalgia, it requires us to address multiple issues. Sleep, hormones, infections, inflammation, nutrition, and exercise must be addressed for a complete approach.
As you can see, each area can require complex management. Choose a clinician who will take the time to understand your case and treat the whole picture. To learn more about Fibromyalgia treatment at Renewed Vitality Dallas, click here.
In the meantime, goodnight, and sleep tight!
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