Sleep disorders are a major contributor to the list of symptoms experienced by those that suffer with chronic pain. There are over 80 sleep disorders according to the National Institute of Health. Many are beginning to recognize the importance of sleep especially in the pain community.
This month our H4P will be focusing on sleep and its benefits to the pain community. The organization “Sleep Help” reached out to H4P and asked us to share some of their research. Sleep Help is a non profit organization that aims to help others get a great night’s sleep. They have been researching the impact of fibromyalgia on sleep quality and wanted to share some of their findings. You can check out their findings here: https://www.sleephelp.org/fibromyalgia-and-sleep/. or enjoy this article, attached for you viewing.
Fibromyalgia and Sleep
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 painSleep disruption and sleep disordersFatigueCognitive DifficultiesMood IssuesTingling
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.MedicationsTherapy
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.
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.AcupunctureMedical MarijuanaDietary ChangesSupplementsMassageYogaMeditation
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:InsomniaDepression and AnxietySleep ApneaMigrainesPhotophobia/Painful Light SensitivityIBSTMJInterstitial CystitisLupusRheumatoid Arthritis
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:
- National Fibromyalgia Association: A national association that hosts information and facilitates programming to improve the quality of life for people with fibromyalgia.
- Chronic Pain Support Groups: A database of national support groups to reach out to and connect to other people with fibromyalgia and chronic pain.
- Finding a Fibromyalgia Doctor: Harvard Health’s guide on how to find the right doctor to treat your fibromyalgia.
- Womanshealth.gov Fibro Site: An excellent source of information, including a toll-free information/support hotline.
- National Library of Medicine Fibromyalgia Page: If you’re looking for extensive information about fibromyalgia in simple terms, this site is for you. You can also find an extensive catalog of research articles.
- Fibromyalgia Support Net: Aimed at giving support to fibromyalgia patients and their loved ones, this site offers message boards and information resources.
- Mayo Clinic Fibromyalgia Home Page: The basic nuts and bolts explanation of fibromyalgia and an extensive source of fibro-related support.
- National Institute on Arthritis and Musculoskeletal Skin Diseases: This resource includes multi-lingual information on fibromyalgia and alerts about clinical trials.
- National Center for Complementary and Integrative Health: A scientifically vetted source of peer-reviewed information about alternative therapies for fibromyalgia.