Fibromyalgia and Sleep

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The medical community and society at large have become increasingly aware of fibromyalgia and it couldn’t come soon enough. Millions of people are affected by this condition every year, the vast majority of them women, and more knowledge about fibromyalgia means better systems of support for the people living with it in their everyday lives.

One of the main symptoms of fibromyalgia is sleep disturbance. In fact, over 90 percent of fibromyalgia patients experience sleep disorders. In this article, we’ll explore exactly what fibromyalgia is, how it functions, and how it affects sleep. We’ll also lay out potential weapons in the fibromyalgia patient’s arsenal against the many symptoms of the condition, sleep disruption included.

What is Fibromyalgia?

Fibromyalgia is a disorder that causes widespread pain and stiffness in various parts of the body, as well as sleep problems, fatigue, cognitive problems, and mood issues. Often, the pain comes in heightened waves, which are called “flares.”

Fibromyalgia is relatively common, affecting around 4 million adults in the US (approximately 2 percent of the population.) Women are far more likely than men to experience fibromyalgia: according to the National Institutes of Health, between 80 and 90 percent of people with fibromyalgia are women.

People with fibromyalgia may experience abnormal pain perception processing, meaning they are more sensitive to pain than people without fibromyalgia. Researchers believe this reaction comes from repeated nerve stimulation, which causes an abnormal increase in the production of certain neurotransmitters in the brain that trigger pain. They also believe that in the brains of people with fibromyalgia, the pain receptors may develop a “memory” of the pain, and therefore may overreact to pain signals.

It is not known exactly what causes fibromyalgia. It is most likely caused by a variety of factors working together. It appears that genetics is a factor and that fibromyalgia tends to run in families. Certain illnesses, such as lupus, osteoarthritis, and rheumatoid arthritis, as well as physical or emotional trauma, psychological stress, and obesity also tend to aggravate or trigger fibromyalgia.

The disorder manifests itself very differently from patient to patient, and in severe cases, can be incredibly debilitating. Suffering from fibromyalgia can also be particularly frustrating, since there is no sure cause and not even a consistent test/diagnostic mechanism to verify it. Because the medical community knows so little about fibromyalgia, patients have struggled and continue to struggle to get medical recognition, and often have trouble receiving their diagnosis. This struggle is exacerbated by the fact that fibromyalgia mostly affects women: studies have shown that women are less likely to have their reported systems taken seriously, especially when it comes to chronic pain. This is particularly true when it comes to women of color, and African American women have a higher prevalence of fibromyalgia in the United States than white women. It is important to note here that fibromyalgia is a real disorder, and that patients should be believed about their symptoms.

Like many chronic pain conditions, there is no known cure for fibromyalgia. However, it can be effectively managed with medication and various other treatment strategies, including exercise, relaxation techniques, changes in diet, therapy, and improved sleep habits.

Symptoms and Diagnosis of Fibromyalgia

Fibromyalgia presents differently from person to person, both in terms of the severity of symptoms and symptoms themselves. However, there are a number of symptoms that are common among people with fibromyalgia. They include:

Widespread musculoskeletal pain

This refers to pain and stiffness all over the body (on both sides, and above and below the waist), with particular pain felt when pressure is applied to one or several of 18 known  “tender spots” (which you can see mapped out in the chart below.)

Fibromyalgia pain chart
Sleep disruption and sleep disorders

Fibromyalgia patients often report having their sleep regularly disturbed by pain. They also have a higher incidence of sleep disorders, such as insomnia, obstructive sleep apnea, and restless leg syndrome.

Fatigue
Waking up feeling tired, even if you have slept for a long amount of time.
Cognitive Difficulties

Often referred to as “Fibro Fog”, this symptom presents as difficulty paying attention, thinking clearly, and remembering things.

Mood Issues

Fibromyalgia can affect a patient’s mood, causing mood swings, depression, and/or anxiety.

Tingling
This can represent itself as tingling or numbness in the hands or feet.

Fibromyalgia also often occurs alongside other conditions. They are referred to as “comorbid conditions.” They include:

  • Migraine/Chronic Headache
  • Irritable Bowel Syndrome (IBS)
  • Interstitial Cystitis (Painful Bladder Syndrome)
  • Temporomandibular (Jaw) Joint Disorders

There is no singular test or sure diagnostic mechanism for fibromyalgia. It cannot be detected in blood or seen on an X-ray. Because of this, doctors rely on reported symptoms and factors like genetics and predisposition to confirm a diagnosis.

The American College of Rheumatology specifies three things as the diagnostic criteria for fibromyalgia:

  • Widespread pain (pain on both sides of the body, as well as above and below the waist) that lasts for at least three months.
  • Presence of other fibromyalgia symptoms, such as fatigue and cognitive issues.
  • No other underlying conditions that may be causing the symptoms.

In the past, diagnostic criteria also required additional pain when firm pressure was applied to at least 11 of the 18 common “tender spots.” However, it has been shown that fibromyalgia symptoms can come and go. A patient might experience tenderness in 11 spots one day, but, say, only 3 the next. Therefore, though having more than 11 tender spots when examined by a doctor is an indicator of fibromyalgia, it is no longer necessary for a diagnosis.

Because fibromyalgia symptoms are also common in other conditions (including but not limited to rheumatic diseases, neurological diseases, and certain mental health problems), and because fibromyalgia cannot be confirmed with lab work, much of the diagnostic process for fibromyalgia consists of ruling out other conditions. This often includes getting a careful physical exam of muscles and joints, a neurological exam or scan, a blood count, thyroid tests, a Vitamin D test, and/or an erythrocyte sedimentation rate test (which tests red blood cells for inflammation in the body). A doctor might also ask you if you experience problems that frequently exist alongside fibromyalgia, if you have a family history of fibromyalgia, or if you recently experienced a mentally or physically traumatic event, which can trigger fibromyalgia.

How is Fibromyalgia Treated?

Treatment for fibromyalgia usually addresses individual symptoms, since there is no known cure for the underlying condition as a whole. Treatments vary from person to person and include medication and various types of therapy. Many treatments are specifically geared to improve sleep.

Medications
Therapy
Medications

Common prescriptions for fibromyalgia include pain relievers, both over-the-counter (such as Advil, Motrin, Aleve, and Tylenol), and prescription (such as tramadol). Anti-seizure drugs (such as Gabapentin and Lyrica) are also used: in fact, Lyrica was the first drug prescribed by the Food and Drug Administration to treat fibromyalgia. Certain antidepressants (most commonly Cymbalta and Savella) are sometimes used to treat both mood and pain symptoms of fibromyalgia, and muscle relaxants such as cyclobenzaprine are used to promote sleep. Generally, narcotics are not recommended for people with fibromyalgia, since they may cause dependence and worsen symptoms over time. However, they can be used in the short term for some patients. Therapy

Therapy

A number of different types of therapy can be helpful when addressing fibromyalgia symptoms. Physical therapy, which consists of a therapist helping you develop physical strength and stamina, is very commonly prescribed, as is occupational therapy, which helps you adjust your work environment to ease symptoms. Dialectical therapy, or “talk therapy,” can be useful in addressing the psychological and emotional issues caused by fibromyalgia, and cognitive behavioral therapy can help you develop coping mechanisms to deal with stress and pain and to develop and stick to healthy habits.

Symptoms and Co-occurring Conditions

Many people with fibromyalgia opt for alternative treatments, either in conjunction with or as a replacement for medical treatments. This is especially true for patients who want to avoid using pain medication (whether prescription or over the counter), since the long term use of either can pose health hazards.

To be clear, we are not offering specific medical advice with this list. Rather, we are presenting alternative treatments that have worked to alleviate symptoms for some fibromyalgia patients. All treatments, alternative and otherwise, should be discussed with a doctor or medical professional.

Acupuncture

Acupuncture is a practice based in traditional Chinese medicine, in which fine needles are inserted into various points in the body and left there for around half an hour. It is commonly used to treat chronic pain, and specifically fibromyalgia symptoms (as 1 in 4 fibromyalgia patients try the practice within 2 years of diagnosis). There is still a good deal of research that needs to be done on the effects of acupuncture on fibromyalgia, but according to current data, it does appear to be beneficial as part of fibromyalgia treatment for many patients.

Medical Marijuana

Medical marijuana has been increasingly utilized to treat the symptoms of many health conditions, including fibromyalgia. Marijuana contains two active compounds: tetrahydrocannabinol (THC) and cannabidIol (CBD). THC is the compound that acts as a psychoactive (or, produces the “high”), while CBD is a non-psychoactive compound. Products used for fibromyalgia include those with only TCH, those with only CBD, or those with both. Though there is still research to be done on the subject, there is data to suggest that this might be an effective treatment for the symptoms of fibromyalgia, including chronic pain and fibromyalgia-related sleep problems.

Dietary Changes

There is no singular “fibromyalgia diet.” However, there are a few dietary changes that are commonly suggested for fibromyalgia patients. A well-balanced diet, with fresh fruits and vegetables, healthy fats, and lean protein, is generally recommended for people with fibromyalgia. It is specifically recommended that fibromyalgia patients “eat for energy:” since they are prone to fatigue, they should avoid sweets, and combine protein/fats with carbohydrates to slow their absorption and reduce the likelihood of an energy crash. There are also certain foods that may trigger fibromyalgia symptoms. Some of the most common triggers that have been reported are certain food additives and chemicals (including aspartame and MSG), gluten, and FODMAPs (fermentable oligosaccharide, disaccharide, monosaccharide, and polyols, which are short-strain carbohydrates that are more resistant to digestion).

Supplements

A number of natural supplements are used as a part of fibromyalgia treatment regimens. The most common ones include:

  • 5-HTP: Also known as 5-Hydroxytryptophan, an amino acid that helps with the production of serotonin. According to recent studies, 5-HTP raises serotonin levels, which can improve mood, ease anxiety, reduce insomnia, and lessen fibromyalgia-related pain and stiffness.
  • SAMe: Also known as S-Adenosyl-L-Methionine, SAMe is a natural bodily chemical that is a byproduct of methionine, an amino acid found in meat, fish, and dairy products. It regulates key cellular functions and is also important in the production of serotonin and dopamine, both of which are generally depleted in fibromyalgia patients. More research needs to be done when it comes to SAMe’s effectiveness in treating fibromyalgia symptoms, but some studies suggest that it can help with pain, fatigue, mood, quality of sleep, and morning stiffness.
  • Melatonin: Melatonin is a supplement most commonly used as a sleep aid. In supplement form, it actually contains a synthetic form of the hormone/neurotransmitter that helps regulate the sleep-wakefulness cycle, and also helps the body perform a number of other functions. The body uses serotonin to make melatonin, and people with fibromyalgia are more likely to have depleted serotonin, so melatonin production might also be depleted. Some studies have shown that melatonin supplements taken before bedtime can reduce pain and improve sleep in people with fibromyalgia.
Massage

Massage is a very common alternative treatment used by people with fibromyalgia. When done correctly, massage can alleviate pain and stiffness by encouraging blood circulation and tissue oxygenation. It can also release endorphins, and relieve stress and anxiety. However, not all massages are created equal. There are several specific massage styles recommended for people with fibromyalgia. They include:

  • Trigger Point Therapy: TPT focuses on painful spots located in the bands of muscle fibers, and can also be used to relieve pressure in tender spots for fibromyalgia patients. Studies have shown that TPT, also known as “connective tissue massage,” can decrease pain and increase pain thresholds.
  • Swedish Massage: This method combines kneading, gliding/sliding, and friction to release muscle tension. It is more gentle than deep tissue massage but still has the circulatory/stress release benefits, making it ideal for people with fibromyalgia. Some patients who regularly receive Swedish massage have reported a positive impact on pain and stress symptoms related to fibromyalgia.
  • Myofascial Release: Targeting knots in the myofascial connective tissues, this method uses gentle pressure to help fascia (connective tissues) elongate and release tension. It is one of the most commonly used massage techniques for fibromyalgia patients  and has been noted to reduce pain, increase flexibility, and, in particular, to have a significant positive impact on sleep.
  • Passive Stretching: Passive stretching, also known as “relaxed stretching”, is particularly helpful as a treatment form because it can be adapted to use on your own at home. It involves standing, sitting, or lying down, and then exerting external force on a limb to move it into a new position and hold it there for a period of time. This method is useful for fibromyalgia patients because it loosens muscle joints, which often stiffen due to muscle spasms.
Yoga

Yoga can also be helpful for people with fibromyalgia. It can help loosen tight muscles and joints, increase flexibility, and reduce pain. People who practice yoga also sometimes report improved mood and sleep, as well as reduced stress. Other meditative movement practices, such as tai chi and qigong, have also been reported to reduce sleep disturbances and fatigue. Anyone with a chronic disorder should check with their doctor before adopting a new practice, but yoga is generally considered safe for fibromyalgia patients.

Meditation

Mindfulness meditation is another common method of fibromyalgia symptom management. It is often, but not always, practiced in tandem with yoga. Mindfulness meditation consists of focusing non-judgmentally on the here and now. It has been shown to reduce pain-related stress and anxiety, and may actually make changes in the brain that calm the body’s sympathetic nervous system, reducing sensitivity to pain. It can also help fibromyalgia patients develop healthier, more consistent sleep patterns, which improves quality of life overall.

 

How Fibromyalgia Affects Sleep

While we remain unsure exactly what causes fibromyalgia, and while fibromyalgia symptoms vary from person to person, sleep disturbances affect the vast majority of people with the disorder.

Sleep disorders, such as insomnia and obstructive sleep apnea, are hallmark symptoms of fibromyalgia, so much so that they affect over 90 percent of fibromyalgia sufferers. These sleep disorders are often exacerbated by other common fibromyalgia symptoms, especially pain, mood disorders, and cognitive issues. In turn, disturbed sleep exacerbates the effects of those symptoms, and worsens existing fatigue that is experienced by many fibromyalgia patients even when they get a full night’s sleep. In short, sleep disorders and other fibromyalgia symptoms can easily fall into a vicious cycle, where each worsens the other.

Chronic sleep disruption can affect every part of a person’s life. It can make functioning on a day to day basis extremely difficult, or even impossible.

Related Disorders, Treatment and Sleep

Fibromyalgia is nearly always comorbid with other conditions that can seriously disrupt sleep and negatively impact a person’s daily lifestyle. These include:

Insomnia

Insomnia is consistent difficulty falling asleep and staying asleep. In fibromyalgia patients, it is often caused by pain, which either prevents the person from falling asleep or wakes them up once they have fallen asleep. It may also be caused by a lack of serotonin, which plays a crucial part in the body’s sleep-wake cycle.

Depression and Anxiety

People with fibromyalgia very frequently experience depression and anxiety. These conditions can naturally arise alongside fibromyalgia and can be worsened by sleep disruption, as well as the stress of living with a chronic illness (especially one that we know so little about), as well as the effects of isolation.

Sleep Apnea

Sleep apnea causes a person to frequently stop breathing while they are asleep. People with fibromyalgia frequently suffer from sleep apnea. The most common type of apnea experienced by people with fibromyalgia is called obstructive sleep apnea, which is caused by the blockage of an airway, either through excess or relaxed tissue. Some sleep apnea symptoms are also fibromyalgia symptoms, including fatigue, mood issues, and cognitive difficulties. Additional symptoms include loud snoring, gasping for breath while asleep, and high blood pressure.

It is not clear exactly why sleep apnea and fibromyalgia are connected. It is possible that sleep deprivation caused by apnea contributes to the development of fibromyalgia, and it is also possible that lax connective tissues common among people with fibromyalgia cause sleep apnea.

Migraines

People with fibromyalgia are more likely to experience migraines: more than half of fibromyalgia patients report migraine symptoms. Chronic migraines can also increase the intensity of fibromyalgia flare-ups. Some research has suggested that people with fibromyalgia tend to get migraines because both conditions involve issues with how the nervous system processes pain.

Photophobia/Painful Light Sensitivity

Many fibromyalgia patients develop photophobia, which is a painful sensitivity to light. Certain types of light, such as fluorescent lighting, are particularly likely to trigger photophobia. It is theorized that this condition comes from ongoing external sensitivities that overwhelm the patient and lower the pain threshold, otherwise known as “sensory overload.” Photophobia is also a migraine symptom, which means that patients are more likely to develop this condition if they also experience migraines.

IBS

IBS, or Irritable Bowel Syndrome, is frequently comorbid with fibromyalgia. In fact, up to 70 percent of people with fibromyalgia also have IBS. IBS also causes chronic pain, specifically in the abdomen, as well as digestive discomfort, diarrhea, and constipation. Both fibromyalgia and IBS are linked to hypersensitivity and hyper-reactiveness of brain cells to stimuli, which is one reason why they occur together so frequently.

TMJ

TMJ or Temporomandibular joint disorder, causes pain in the temporomandibular joints, which connect the jaw to the skull, as well as pain and tenderness in the muscles and ligaments around those joints. It causes discomfort and difficulty chewing, difficulty opening and closing the jaw, headaches, and lockjaw. It is more common in people with fibromyalgia than in the general population. Like many other comorbid conditions, it is unclear what makes fibromyalgia patients more vulnerable to developing TMJ. It is possible that TMJ could occur before fibromyalgia, and could contribute to the hypersensitivity of the central nervous system. It is also possible that because people with fibromyalgia feel pain more acutely than others, they are more likely to suffer from pain-related conditions.

Interstitial Cystitis

This condition is characterized by pain in the bladder and pelvic region, often accompanied by frequent and/or urgent urination. Many Interstitial Cystitis (IC) patients experience fibromyalgia in comparison to the general populace. IC patients have very similar symptomology to fibromyalgia patients. It is hypothesized that this is because both IC patients and fibromyalgia patients share an increased sensitivity to pain.

Lupus

Otherwise known as Systemic Lupus Erythematosus (SLE), lupus is an autoimmune disease in which the immune system attacks healthy tissues. It causes inflammation, pain, and tissue damage, and can attack any part of the body. People with lupus have an elevated risk of developing fibromyalgia, and the two are frequently comorbid. It is possible that lupus pain can lead to the central sensitization that may trigger fibromyalgia.

Rheumatoid Arthritis

Rheumatoid Arthritis (or RA) is also an autoimmune disorder. It causes the body to attack the lining of a person’s joints, and can also damage the skin, eyes, heart, lungs, and blood vessels. Around 10 to 20 percent of people with RA also have fibromyalgia, and their common symptoms (including fatigue, stiffness, and sleep disturbance) often exacerbate one another. RA also tends to cause pain, which can both trigger fibromyalgia and be experienced more severely by a pain-sensitive fibromyalgia patient.

 

Sleep Help for Fibromyalgia and Chronic Pain Disorders

As we’ve covered above, the vast majority of people with fibromyalgia experience disturbed sleep, insomnia, and daytime fatigue, so much so that it is considered one of the hallmarks of the condition. Some recent research indicates that non-restorative sleep can actually play a role in the development of chronic pain conditions and the lowering of pain thresholds, creating a sort of “chicken-egg” scenario in which it can become unclear whether the pain condition causes the lack of sleep, or the lack of sleep causes the pain condition.

In any case, chronic sleep disturbance and the ensuing sleep deprivation can be significantly detrimental to everyday life and can exacerbate the other symptoms of fibromyalgia (as well as almost all comorbid conditions).  That’s why getting better, more restful sleep on a regular basis is a key part of almost all fibromyalgia treatment plans.

In addition to the basics, like keeping a regular bedtime and limiting screen time in the bedroom, as well as the treatment options we have explored in our “treatment” section, there are a number of fibromyalgia-specific steps you can take to improve your sleep. They include:

  • Treating Underlying Sleep Apnea: Because of the high rate of sleep apnea among people with fibromyalgia, it’s important to determine whether or not apnea is an issue for you, and, if it is, to treat it. The most common treatment for obstructive sleep apnea is the use of a Continuous Positive Airway Pressure (CPAP) machine, which keeps airways from being obstructed. Other treatments include losing weight (since being overweight increases your chances of experiencing obstructive sleep apnea), and, if the apnea is caused by a jaw issue, the use of a dental device.
  • Vitamin D and Trazodone: Studies have found that Vitamin D positively affects both the quality and the quantity of our sleep. Vitamin D, among other things, helps to regulate the musculoskeletal system and prevent pain and hypersensitivity. Recently, one study found that fibromyalgia patients given Vitamin D with a low dose of the antidepressant Trazodone showed significant sleep improvements, as well as a reduction in other fibromyalgia symptoms (including daytime fatigue, pain, and cognitive impairments).
  • Comfortable Sleep Environment: A controlled, well-regulated sleep environment is absolutely crucial for people with fibromyalgia. To address chronic pain issues (especially in the morning), invest in a comfortable but supportive mattress. Fibromyalgia patients should also be careful to design their sleep environment in a way that avoids known triggers. For instance, if you’re one of the many fibromyalgia patients who experience photosensitivity, make sure you have blackout curtains and can fully control the stimuli around you as you are sleeping and waking up.

It should be noted that people with fibromyalgia, especially severe fibromyalgia, should absolutely create a treatment plan with a doctor or medical professional. Major depression and suicidal ideation are also common among people with fibromyalgia, especially when there is chronic sleep deprivation involved. If you are experiencing major depression and/or suicidal ideation, seek immediate medical attention.

 

Learn More About Chronic Pain and Sleep

Living with a chronic pain disorder like fibromyalgia can be extremely difficult. Beyond the physical symptoms, you have to deal with on a daily basis, it’s easy to feel overwhelmed, and is also easy to feel isolated, and like no one understands what you’re going through. However, you are not alone, and don’t have to go through this on your own: millions of other people are going through a similar struggle. We’ve compiled a list of 10 excellent resources for people with fibromyalgia here:

 

Need to improve your sleep? Read our in-depth, unbiased mattress reviews to find the perfect bed.