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Sleep and Fibromyalgia

fibromyalgia and chronic fatigueOne 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.

Liver detoxWhat 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!

 

 

References:

Amutio, A., Franco, C., Sánchez-Sánchez, L. C., Pérez-Fuentes, M., Gázquez-Linares, J. J., Van Gordon, W., & Molero-Jurado, M. (2018). Effects of Mindfulness Training on Sleep Problems in Patients With Fibromyalgia. Frontiers in psychology, 9, 1365. doi:10.3389/fpsyg.2018.01365

Choy EH. The role of sleep in pain and fibromyalgia. Nat Rev Rheumatol. 2015;11:513–520.

Citera G., Arias M.A., Maldonado-Cocco J.A., Lázaro M.A., Rosemffet M.G., Brusco L.I., Scheines E.J., Cardinalli D.P. The effect of melatonin in patients with fibromyalgia: A pilot study. Clin Rheumatol. 2000;19:9–13. doi: 10.1007/s100670050003.

doi:10.1038/nrrheum.2015.56

 Crofford LJ, Rowbotham MC, Mease PJ, Russell IJ, Dworkin RH, Corbin AE, Young JP, Jr, LK LM, Martin SA, Sharma U, et al. Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2005;52(4):1264–1273. doi: 10.1002/art.20983.

Kwiatek R. (2017). Treatment of fibromyalgia. Australian prescriber, 40(5), 179–183. doi:10.18773/austprescr.2017.056

Lee, H., Im, J., Won, H., Kim, J.Y., Kim, H., Kwon, J. … Kim, H. (2018). Antinociceptive effect of Valeriana fauriei regulates BDNF signaling in an animal model of fibromyalgia. International Journal of Molecular Medicine, 41, 485-492. https://doi.org/10.3892/ijmm.2017.3203

McCrae  CS, et al. Cognitive behavioral treatments for insomnia and pain in adults with comorbid chronic insomnia and fibromyalgia: clinical outcomes from the SPIN randomized controlled trial, Sleep, Volume 42, Issue 3, March 2019, zsy234, https://doi.org/10.1093/sleep/zsy234

Miro E, Martinez MP, Sanchez AI, Prados G, Medina A. When is pain related to emotional distress and daily functioning in fibromyalgia syndrome? The mediating roles of self-efficacy and sleep quality. Br J Health Psychol. 2011;16:799–814. doi: 10.1111/j.2044-8287.2011.02016.

Moldofsky H, et al. The Journal of rheumatology. 2011 Dec;38(12):2653-63. Effects of bedtime very low dose cyclobenzaprine on symptoms and sleep physiology in patients with fibromyalgia syndrome: a double-blind randomized placebo-controlled study.

Moldofsky H, et al. Journal of rheumatology. 2010 Oct;37(10):2156-66. Effects of sodium oxybate on sleep physiology and sleep/wake-related symptoms in patients with fibromyalgia syndrome: a double-blind, randomized, placebo-controlled study.

Moore RA., Derry S., Aldington D., Cole P., Wiffen PJ. Amitriptyline for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. CD008242.doi:10. 1002/1 4651858.CD008242.pub2. 2012;12

Reiter RJ, AcunaCastroviejo D, Tan DX. Melatonin therapy in fibromyalgia. Curr Pain Headache Rep. 2007;11:339–342. doi: 10.1007/s11916-007-0215-3. 

Roth T, Lankford DA, Bhadra P, Whalen E, Resnick EM. Effect of pregabalin on sleep in patients with fibromyalgia and sleep maintenance disturbance: a randomized, placebo‐controlled, 2‐way crossover polysomnography study. Arthritis Care and Research 2012;64(4):597‐606. [DOI: 10.1002/acr.21595]

Wilhelmsen M, Amirian I, Reiter R J, Rosenberg J, Gögenur I. Analgesic effects of melatonin: a review of current evidence from experimental and clinical studies. J Pineal Res. 2011;51(3):270–277.

Zareba G. (2008). New treatment options in the management of fibromyalgia: role of pregabalin. Neuropsychiatric disease and treatment, 4(6), 1193–1201.

 

July 9, 2019 By Wayne Baumgarten Leave a Comment

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RENEWED VITALITY of DALLAS TX IS AN IDEAL CHOICE TO FIND RELIEF FROM WEIGHT GAIN, MENOPAUSE, ANDROPAUSE, LOSS OF ENERGY, THYROID DISORDERS, AND MANY TYPES OF HORMONE IMBALANCES. VERY SUCCESSFUL OUTCOMES TREATING CHRONIC FATIGUE & FIBROMYALGIA, CHRONIC VIRAL SYNDROMES, AND OTHER CHRONIC ILLNESSES ARE ALSO TYPICAL.

 

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