Fibromyalgia (FM) patients report early morning awakenings,
awakening feeling tired or unrefreshed, insomnia, as well as
mood and cognitive disturbances; they may also experience
primary sleep disorders including sleep apnea. Longitudinal
studies have demonstrated the chronic nature of these
disturbances in patients with FM. A distinct relationship
exists between poor sleep quality and pain intensity.
Polysomnographic findings during sleep in these patients
include an alpha frequency rhythm, termed alpha-delta sleep
anomaly, which is also seen in normal controls during stage 4
sleep deprivation; deep pain induced during sleep in normal
controls also causes this anomaly. Sleep architecture is
altered in FM patients showing an increase in stage 1, a
reduction in delta sleep, and an increased number of arousals.
Before prescribing pharmacologic compounds aimed at modifying
sleep, adequate pain control and sleep habits should be
achieved; tricyclic antidepressants, trazadone, zopiclone, and
selective serotonin reuptake inhibitors, however, may be
required. More research is needed to elucidate the cellular
and molecular mechanisms involved in the sleep disturbances
occurring in patients with FM.