Sleeping with fibromyalgia decreases the quality of sleep experienced. Poor sleep quality exacerbates the symptoms of fibromyalgia, making the relationship between sleep and Fibromyalgia bi-directional. In a study of healthy individuals, deliberate sleep deprivation led to fibromyalgia type symptoms after the quality of sleep they experienced was reduced for just three days.
Let’s highlight that point. Healthy people who are deprived of deep sleep experience the same type of pain and other symptoms as those associated with fibromyalgia syndrome! This points to a connection between quality sleep, something it is difficult to get when you’re in pain, and symptom reduction. This doesn’t mean that lack of sleep is the sole cause of fibromyalgia. It does say that poor sleep quality can contribute to symptoms and their persistence.
Fibromyalgia syndrome (FMS) is a type of Functional Somatic Syndrome (FSS) that causes chronic musculoskeletal pain. All Functional Somatic Syndromes are considered stress-related disorders. The symptoms of this musculoskeletal disorder include:
When some people hear that psychological factors contribute to the onset and maintenance of fibromyalgia, they assume it means they are being told that fibromyalgia syndrome is in their head. Nothing could be further from the truth. Psychological stress plays a role in most physical and mental illnesses. Stress has numerous effects on the body including:
Decreased Immune Function
Reduced pro-health behavior
The mind and body are connected and cannot be separated. Biochemical changes occur rapidly in the body as physical manifestations of stress.
Before researchers understood fibromyalgia, many patients were told that the symptoms were all in their head. This was probably partially due to 80 – 90% of those who suffer from fibromyalgia being middle aged women. Today, more is understood about this illness but it is still not fully understood and is routinely underdiagnosed. 1.75% of the population suffers from fibromyalgia syndrome. Although fibromyalgia is not yet fully understood, today only the most out of touch clinicians would consider it all in the patient’s head.
Physical Health and the Physical Effects of Psychological Stress
Our healthiest state is relaxed. The mind and body communicate in numerous ways when stress is experienced. This appears to be the body’s way of getting our attention so that we will tend to the cause of the stressor.
Psychological stress immediately changes the detectible cortisol levels in our bloodstream. Stress is also immediately communicated in the emotions of healthy individuals. Additionally, our energy level changes almost immediately in response to stress. When we believe we can do something about a problem, a surge of energy occurs. However, when our perception of the situation is powerless or hopeless, it feels as if our energy has drained away. Low energy is another indicator of high stress.
Think about what the body communicates with us about.
The need to go to the bathroom
Every one of these senses is needed to sustain life across generations. Pleasure encourages reproduction so the species will continue to survive. The other senses all provide information that is vital for maintaining the health of our bodies. Researchers have theorized that emotions as an indicator of stress were the earliest form of communication from our bodies pointing to single celled organism that react to their environments with either approach (positive emotion) or avoidance (negative emotion) responses.
Difficult to diagnose pain is often the result of multiple factors working together.
Poor Sleep Quality
Pain is affected by physical, psychological, and general health characteristics. Sleep deprivation creates a highly stressed state for the mind and body which can increase the risk for other problems including infection, pain, and increases in autonomic nervous system activity. Sleeping with fibromyalgia often causes sleep deprivation.
When fibromyalgia patients enjoy a good night’s sleep, they are more capable of dealing with the pain the next day than when they don’t sleep well. Sleep deprivation causes people to focus on negative things more which changes their perception of the world and their ability to cope with the pain.
Research has revealed that they experience less pain because of the way their body processes information after a good night’s sleep compared to the way the body processes information when the person is sleep deprived. Quality of sleep is more important than the quantity. Fibromyalgia patients tend to sleep about the same duration as the general public, but they don’t get as much deep (REM) sleep.
Lack of sleep causes both psychological and physical changes that make us experience more pain and struggle more to cope with the pain we experience.
On days when patients wake up feeling tired, stiff, and in pain, one thing they can do is be kind to themselves. Being kind to our self reduces the stress we experience. Internal dialogues (self-talk) that berates, demeans, or questions our value or worth is stressful. That means we harm ourselves when we engage in negative self-talk.
Research shows that we don’t have to tear ourselves down to motivate ourselves. The more we believe we are competent and capable, the more we achieve. When we beat ourselves up with our self-talk, we are less likely to take action. Treat yourself with respect. It matters.
Since FMS is a stress related syndrome, reducing any sort of stress can be helpful. Psychological stress negatively impacts sleep in otherwise healthy populations. The combination of psychological stress and pain has serious consequences for our ability to sleep.
When a critic or bully lives in your head, they generate a lot of stress that you can eliminate.
External Sources of Stress
External stressors are best dealt with by increasing your stress management skills. Life is stressful for anyone who has unhealthy habits of thought. Developing healthy, empowered habits of thought reduces stress. Attempting to withdraw from stressful activities deprives you of the life you want to lead. Good stress management skills that help you develop healthy habits of thought prepare you for life so normal stressors don’t cause as much stress.
When the negative contribution stress has on overall health and well-being was first identified over fifty years ago, people were advised to cut down on their activities in order to reduce stress. Most people were only able to cut out the activities they enjoyed, the ones that gave their life joy and meaning. This path led to an out of balance situation that made matters worse for countless individuals.
A single root cause of fibromyalgia syndrome has not been identified.
One of the most recent theories about fibromyalgia theorizes that the “‘central nervous system origins of or amplification of pain’ may not be a disease process, but the normal way that humans respond to certain physiological and mental stresses.” When sleep deprivation is viewed as a form of stress, this theory lines up with the research. Given that the many indicators of stress are designed to make us aware that our mind and body need something, much like hunger and thirst, it would not be surprising if this theory were someday proven.
Afterall, if other things that our bodies signal need tending aren’t addressed, the body experiences more serious problems. It makes sense the body evolved to alert us to situations when we need to tend to a problem. Hunger lets us know that we need nourishment. If we don’t nourish the body, serious problems can occur. It is the same with thirst. Given the multiple signals that occur as the result of stress, it makes sense that it is the body’s way of signaling that assistance is needed.
Fibromyalgia Syndrome is Often Disabling
55.8% of individuals who suffer from fibromyalgia are so severely affected they are not able to function well enough to work. In other words, fibromyalgia results in a high rate of disability. Research indicates that better sleep quality lessens the symptoms and pain experienced. This makes improving sleep quality a worthwhile pursuit that has the potential to improve physical functioning and potentially stave off the need to go on disability.
On a day-to-day basis, the amount of sleep we experience influences the way we perceive pain. When we do not receive adequate sleep, we experience a wider range of sensations as painful than we do when we are well rested. In other words, something that hurts today may not hurt tomorrow if you didn’t sleep well last night and you are able to sleep well tonight. This difference is reflected in our daily experiences.
This means that finding ways to improve the amount of and quality of sleep we achieve can reduce the amount of pain we experience. So, let’s explore some ways to improve sleep quality.
Nighttime awakenings far more often than those observed in healthy populations
Not feeling rested after sleeping
When sleep quality is poor, pain and depression increase while physical functioning decreases. Decreased sleep, physical functioning, and increased pain also increase depression. It’s a difficult cycle to experience and hard to escape.
Researchers found that FMS patients have longer periods of Stage 1 sleep and shorter periods of REM sleep. REM sleep is essential for health. This may be because the pain they are experiencing keeps them partially aroused which interferes with the ability to sleep deeply.
It wasn’t until 2005 that the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties recognized sleep medicine as a medical subspecialty. As recently as 2006, the Institute of Medicine reported that “physician education regarding the recognition, diagnosis, management, and treatment of sleep disorders is still inadequate (Strohl et al., 2003; Owens, 2005).”
This is good news. Recognizing that the way we spend 1/3 of our lives is a significant source of health or illness, depending on the quality of sleep we receive, will generate research that may find answers.
Treatments and Coping
There is not yet a known cure for fibromyalgia, however, the symptoms tend to fluctuate across time and even improve or worsen at different times of day.
Sleeping less than 5 hours a night, or more than 9 hours, is associated with increased pain.
Good sleep hygiene can improve the quality of sleep which can then alleviate or reduce the amount of pain experienced. Good sleep hygiene ultimately involves whatever works best for you. However, there are certain behaviors that foster better quality sleep.
Sleep Apnea is common in fibromyalgia patients. Being checked for sleep apnea and pursuing treatment with a CPAP machine can help to alleviate symptoms.
A recent review found that 61% of male and 32% of female fibromyalgia patients also suffered from sleep apnea. The evidence has led some researchers to theorize that untreated sleep apnea is a pathway to the development of fibromyalgia. Sleep deprivation, which is a common outcome in individuals who have sleep apnea, decreases the threshold at which pain is experienced. When this happens, it makes it more difficult to sleep deeply which is why fibromyalgia suffers often spend enough time sleeping but never feel rested.
Control Noise in Your Sleep Environment
Reducing the noise in your bedroom can involve a variety of strategies, including potentially moving to a home in a quieter area or changing which bedroom you use for sleep. White noise machines can mask noises that could startle you awake. Earplugs are another option but you want to be sure you would hear a fire alarm, especially if you have children or elderly people you would need to assist if there was a fire.
Spend Time Outside
Sunlight helps your circadian rhythm and provides Vitamin D which is essential for maintaining good health. Fibromyalgia patients tend to have lower levels of Vitamin D than healthy individuals. Also, low levels of Vitamin D are associated with higher levels of pain.
A regular exercise routine helps tire your body which can aid your efforts to sleep well. Individuals with fibromyalgia syndrome should discuss any new exercise routine with their physician. Water aerobics, swimming, walking, yoga, Pilates, and Tai Chi are good low-impact options to consider. Exercising more than three hours before bedtime is recommended.
A review of studies indicates aerobic exercise has a positive effect on overall well-being and physical functioning and may positively affect pain. Strength training may beneficially effect functioning and some symptoms, but the results were not conclusive. The researchers encouraged further study in this area.
The effectiveness of meditative therapies including Qigong, Tai Chi, and Yoga on reducing pain, fatigue, depression, sleep problems, and health-related quality of life were reviewed with positive results for depression, health-related quality of life, fatigue, and sleep problems. Yoga also improved pain.
Heat or Cold Treatments
Alleviating muscle aches using heat or cold may help you achieve deeper pain relief. Discuss the options with your physician. A heated mattress pad provides gentle, all over warmth. Bio-freeze can be used to dull intense pain.
Massage can help you relax and ease aches and pains so you can sleep better. While most people cannot afford a nightly session with a massage therapist, they may be able to afford a handheld massager or a massage chair. If massage improves the quality of sleep achieved which improves daytime functioning, it may be a worthwhile investment. If it prevents or delays the onset of disability, it will pay for itself. Massage, especially with a qualified therapist, can also restore some loss of motion.
Relaxation exercises, such as contracting and releasing the muscles in your body one at a time, can also help your body relax into sleep.
Psychological stress management techniques help a lot of people get to sleep faster and return to sleep quicker if they wake up during the night. Stress and pain are two primary causes of sleep deprivation. Learning stress management strategies can make you feel more in control of your sleep and your life, both of which will reduce stress.
Reducing your exposure to light, especially blue light from computers, televisions, and phone screens for a few hours before bed helps your body prepare for sleep. Blue light can trick your body’s circadian rhythm and make it more difficult to sleep. Many people sleep better when their room is completely dark. Blackout curtains can help. Covering lights from electronics may also help you sleep.
Listening to soothing music during this time can help your mind prepare to sleep.
Adjust the Temperature
Most people sleep better in a cool bedroom.
Use a Comfortable and Supportive Mattress
Many people use old mattresses that are no longer comfortable that leave them achy and in pain even without fibromyalgia. A quality mattress in good condition can help you sleep well. You’ll want a mattress that doesn’t create any pressure points while providing the support your back needs.
Uncomfortable blankets or sheets can also impair your ability to sleep well. The cost difference between quality bedding and inferior products isn’t much over the long term because higher quality products generally last longer.
Your doctor can prescribe medications to help you sleep or medications to reduce the pain you’re experiencing so it is easier to achieve deep sleep.
Hypnosis and Guided Imagery
Hypnosis, including hypnotic recordings and self-hypnosis, can be effective sleep aids that can provide the bonus of reducing stress. There aren’t many clinical studies for hypnosis or guided imagery but a review of the studies that exist indicates improvements in pain that exceed traditional treatments.
Research into energy healing techniques has now documented the benefits of these practices to the point where they are being used as complementary treatments in hospitals. Both practices can be self-administered by someone who is trained in the practice. In several trials, Reiki was more effective than Placebo at reducing pain.
Make Sleep a Priority
Give sleep a high priority in your life. Recognize its connection between your level of pain and physical functioning. You deserve to take care of yourself. Chronic pain can easily create a sleep deficit that can worsen the pain you experience and cause other problems associated with sleep deprivation.
Individuals on a normal daytime sleep schedule are encouraged to stop using caffeine by noon.
While alcohol can help you get to sleep, it is associated with increased wakefulness later during the sleep cycle making its overall effect a negative one.
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy is one way to reduce stress and end unhealthy habits of thought that cause insomnia.
Taking a warm bath can help relax you. As your body cools, it mimics the way a body naturally cools down as it begins sleeping which is also thought to aid in going to sleep.
Avoid Stimulating Your Mind
Avoid reading or watching things that will rev up your mind before bedtime. Also, avoid altercations and don’t dwell on things that upset you.
While it is disconcerting to suffer from a condition with no known origin or cure, it doesn’t mean you are helpless or hopeless. There are many steps you can take to ease symptoms that make sleeping with fibromyalgia difficult.
It is important not to give up or resign yourself to a painful and difficult life. If your healthcare provider doesn’t take your symptoms seriously, find one who will. There is ongoing research that may provide answers that will help make sleeping with fibromyalgia easier. In the meantime, there is a long list of things you can do on your own.