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Fibromyalgia and Sleep: What Disrupts It, What Helps?

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By Cathy Seegers, APRN,  The Center for Interdisciplinary Medicine at Health South Rehabilitation Hospital

Fibromyalgia (FM) is marked by various symptoms, including fatigue and sleep problems. Studies show that most people with FMS have abnormal sleep patterns, such as difficulty falling asleep and/or waking up through the night. This can cause people to wake up from a night's sleep feeling tired and un-refreshed. It can also result in moderate to severe fatigue in approximately 90% of cases and decreased activity endurance throughout part or all of the next day.

What is Sleep?

Sleep is a natural built-in part of the functioning of our biological clock called the circadian rhythm. This 24-hour clock regulates all patterns of our body's functions, including sleep, by following the cycles of day and night. The circadian rhythm keeps all the body processes in order, so that body functions match with our daily living routine.

While it appears that we are resting during sleep time, our bodies are actually doing many things to rebalance body chemistry, repair tissues, release certain essential hormones that can only be signaled during sleep, regulate organ systems, and store information in the brain to be retrieved more easily later.

Stages of Sleep

We spend about 1/3 of our lives sleeping. Throughout the night, sleep takes place in different stages. People generally spend most of the night in stages 1 and 2 of sleep. Stage 1 is a transition between being awake and asleep and stage 2 is the first level of a light sleep. Sleep that is restorative and refreshing for the body are stages 3 and 4. Stage 3 is characterized by moderately deep sleep and stage 4 is the deepest sleep phase in which certain substances like growth hormone are released for essential body tissue repair and replenishment. REM sleep, a dream stage in which a lot of rapid eye movement (REM) occurs, has been found to be critical for psychological well-being.

People with FMS tend to have mostly REM, stage 1 and 2 sleep and not enough stages 3 and 4 sleep. This results in less restorative benefits from sleep, fatigue, daytime sleepiness, and impaired daytime functioning.

What Could Disrupt Sleep?

Many medical conditions can disrupt sleep such as pain, restless leg syndrome, bladder or prostate problems, headaches, hormonal changes, hot flashes, and heartburn. Breathing problems such as asthma, allergies and sleep apnea are disruptive as well as excess activity in the sympathetic nervous system. It is this system which activates the "fight or flight" response during stress and increases pulse rate and adjusts other body functions to ready a person for quick action.

Sleep can be disrupted by certain over-the-counter and prescription drugs such as beta-blockers, stimulating antidepressants, corticosteroids and decongestants such as some cold and allergy medications.

Other conditions or circumstances that can disrupt sleep are overuse of certain medications, illicit substance use, caffeine, alcohol, tobacco, sleepwalking, nightmares, shift work, travel, and high levels of stress. Mood disturbance such as depression, anxiety, grief, and excessive worrying can also affect sleep. So can daytime napping, a sedentary daily routine, lack of exercise, and an uncomfortable sleeping environment.

Identify Poor Sleep Habits

It's important that poor sleep habits be identified. Poor sleep habits can lead to a repeating pattern of insomnia. We are creatures of habit, especially when it comes to our daily routines. When we have recurrent sleep problems, somewhere in our minds we begin to associate lying in bed with unpleasantness. The more we struggle with a sleep problem over time, the deeper we become conditioned to sleeplessness. This disrupts the ability to fall asleep as well as the regular sleep rhythm and routine.

What Could Help Sleep?

There are many things people can do on their own and/or together with a health care professional. If you have questions about medications that may help sleep, talk them over with your health care provider.

Here are some tips you can try on your own:

• Keep a regular daily schedule to all your activities, including sleep habits.

• Go to sleep and get up at the same time every day so your body has a regular sleep rhythm. As you regulate your sleep-wake patterns, you'll likely find yourself waking up on your own at around the same time every morning.

• Beware of sleeping pills, as most interfere with the deep sleep stages.

• Exercise regularly at least 20-30 minutes three times a week, before 6 PM.

• Be in bright light (outdoors or an east facing window) in the earlier part of the morning to help keep the sleep-wake pattern established.

• Avoid going to bed with a full stomach or feeling hungry. Try a light bedtime snack of carbohydrates, walnuts, or milk which may increase a natural brain chemical called serotonin that can promote sleep.

• Keep your fluid intake down in the evenings to avoid nighttime bathroom trips.

• Stay away from nicotine, caffeine, alcohol, and spicy or sugary foods.

• If you must nap, keep it short, less than an hour and before 3 PM.

• Set aside an hour or so before bedtime to relax and unwind from the day. Simple relaxation techniques help your body and your mind be ready for sleep and improve the quality of deep sleep.

• Try other relaxing activities during the evening such as gentle stretching, a warm bath, soft music, a good book, or self massage.

• Use dim or soft lighting in the evening time.

• Avoid stimulating or worrisome activities just before bedtime.

• If you have a lot on your mind, try writing down your worries on paper and make a "to do" list. Then put it aside for tomorrow and think of something pleasant.

• Make your sleep environment as quiet, dark, and comfortable as possible.

• Use your bedroom only for sleeping and being physically close to your partner.

• If it takes longer than 30 minutes to fall asleep, get up and go to a different room for a quiet activity such as reading, listening to soft music, or a relaxation technique. Then try to go to sleep again. This also applies if you wake up in the middle of the night.

Try new ideas to see which ones can help you. Become your own self-manager. No one can do that for you. Learning the unique things that help you manage your symptoms and every day challenges is one of the most important things you can do to take care of yourself.

Source: The Arthritis Foundation (www.arthritis.org).

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