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, and 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!
Surprisingly, this starts when we first wake up. Get exposure to natural light first thing in the morning to set your circadian clock for success. Avoid napping late in the day, and try to get your exercise early if you are able. Too much stimulation or napping in the evening can both have you awake when it is finally time for some shut-eye. 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. 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 or cognitive behavioral therapy, which have both been shown to improve sleep quality in studies. Interestingly enough, CBT, or cognitive behavioral therapy, for insomnia had more long-term impact on both pain and sleep than CBT for pain!
Cognitive behavioral therapy is defined as 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 the development of personal coping strategies that target solving current problems.
Medical Causes of Sleep Issues
Many times, sleep issues are more than just bad bedtime habits. 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 lots of options, but the best option is tailored to your specific needs. Low progesterone for ladies can lead to poor sleep, and simply treating with progesterone for these patients does wonders. Muscle relaxers can address those muscle spasms that keep us awake, and allow us to finally have the comfort we need to fall asleep.
If it’s neuropathic pain keeping you awake, pregabalin (Lyrica) has been approved for fibromyalgia to address pain (and it makes you sleepy too!), and gabapentin (a similar medication) has also been shown to be effective in increasing restorative slow-wave (or deep) sleep. Sometimes a medication with a more sedating effect is needed. This may be an antidepressant like amitriptyline, which has been shown in fibromyalgia patients to improve both pain and sleep through its effects on neurotransmitters. Another antidepressant that is known to be effective for pain relief in some patients with FM is duloxetine (Cymbalta), an SNRI type antidepressant. In severe cases, a special 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. Melatonin is our natural sleep signaling hormone, and is available as a supplement and 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 FM.
Fibromyalgia is a Multi-Factorial Condition
As always, FM is a multi-factorial condition, requiring us to address multiple issues. Sleep, hormones, infections, inflammation, nutrition, and exercise all must be addressed for a complete approach. As you can see above, each of these individual areas 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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