Fibromyalgia is a chronic disorder of widespread pain and stiffness in muscles and joints. About 4 million people in the US have fibromyalgia, and although the cause of this condition is unknown, patients can treat and manage their symptoms through medication, therapy and lifestyle changes. 

Sleep disturbances are common in those with fibromyalgia. For some, a lack of sleep can actually exacerbate their pain symptoms and lead them to a vicious cycle of pain that ruins sleep and lack of sleep that increases pain. This can make life seem almost unbearable and ruin every aspect of one's life. However, by practicing good sleep hygiene and adapting healthy sleep habits, one can alleviate fibromyalgia-related sleep issues. Continue reading to learn how to manage fibromyalgia through sleep. 

How Fibromyalgia affects sleep 

Individuals with fibromyalgia have a low pain threshold, meaning they are more sensitive to pain than those without fibromyalgia. This is known as abnormal pain perception processing, and several studies examining the neurology of individuals with fibromyalgia seem to support this as a factor of the illness. 

Non-restorative sleep and daytime fatigue are two common symptoms of fibromyalgia. Polysomnographic data success that those with fibromyalgia experience wakefulness during the NREM stages of sleep and receive less slow-wave sleep as a result. NREM stage 3 sleep is the deepest, and normally hardest to wake up from. This is because so much growth and repair is happening during this stage of sleep. Without it, however, there is no restoration, or repair happening which can be detrimental to those dealing with chronic conditions. Pain is most likely the culprit keeping these individuals up all throughout the night. 

This relationship is bidirectional as pain prevents individuals from getting enough rest, poor sleep can exacerbate feelings of pain and tenderness. A loss of sleep can also further reduce a person's pain threshold. As a result, a lack of sleep can cause fibromyalgia symptoms to happen in those who are, otherwise, very healthy. 

Fibromyalgia can happen to anyone at anytime, but most patients are middle-aged and women. Certain diseases predispose individuals for developing fibromyalgia, like rheumatoid arthritis, spinal arthritis and lupus. Fibromyalgia has also been linked to other sleep disorders like insomnia and restless legs syndrome. 

Insomnia in Fibromyalgia Patients 

Insomnia is a sleep disorder characterized by difficulties falling asleep, and/or staying asleep. This leads to excessive daytime sleepiness and daytime impairment (trouble concentrating, easy fatigability, poor memory). Insomnia is common in those with fibromyalgia because the pain makes it hard to fall asleep and stay asleep. 

Insomnia patients may receive cognitive behavioral therapy for insomnia (CBT-I). This is a structured and evidenced-based treatment program that pinpoints thoughts, feelings and behaviors that can be contributing to their symptoms. 

Sleep medication has also been shown to reduce pain in fibromyalgia patients. A study found that suvorexant, a medication approved for the treatment of insomnia, slept longer and experienced less pain the next day compared to participants who took a placebo. 

These are two potential treatment options for those who are experiencing insomnia secondary to fibromyalgia. 

Fibromyalgia and RLS 

Restless legs syndrome, or RLS, is a sensorimotor disorder that consists of a strong desire to move the legs, or tingly/itchy feelings that are only relieved by moving the legs. This syndrome alone can cause severe sleep disturbances. Pair it with pain of the entire body, and Fibromyalgia/RLS patients are in for a very long night. 

There is a consistent overlap between fibromyalgia and rLS because both conditions are associated with sensory abnormalities. Treating the underlying cause of RLS can actually cure it, especially if the underlying cause is fibromyalgia, in this case. 

Improving sleep with Fibromyalgia 

Managing fibromyalgia is the first step to getting a good night's rest. If you do not minimize the pain enough to try and fall asleep, then it's not going to happen. Work with your physician or pain management team to determine the best course of action. 

After your pain is at least managed, then it's time to work on actively improving sleep. One way is to set a sleep schedule and stick to it. Our bodies like routine and going to bed and waking up at the same time everyday is key to establishing our sleep schedule.

This schedule needs to be maintained even on the weekends and holidays, and can help you get an adequate number of hours of sleep everyday. Prioritize sleep, and don't let other commitments stop you for getting a good night's rest. Pick a sleep schedule that works best with your job and lifestyle, and practice going to bed and waking up at the same time everyday. 

Exercising physically and mentally are also great ways to get better sleep. Exercise has been shown to reduce the feelings of pain, and also has a positive relationship with sleep. You also just feel good about yourself when you're active and building muscles.

Mental exercises are important as well. Practices like mindfulness meditation can be relaxing and help you focus on the task at hand which is going to bed. You can learn how to shut out the fears and anxieties you have about bedtime, while also putting yourself in a state of deep relaxation that will be very helpful for going to bed. 

Another treatment option you can consider are vitamin D supplements. There may be a link between vitamin D deficiency and sleep problems. People with fibromyalgia often have low vitamin D levels. Supplementation can not only reduce the feelings of widespread pain. Talk with your doctor to see if this deficiency is indeed something that you're dealing with and can help your sleep disturbances. 

If you continue to struggle with getting enough sleep, then please click the orange button below to take a free online sleep test and talk with one of our sleep health professionals. 

https://www.sleepfoundation.org/physical-health/fibromyalgia-and-sleep#:~:text=Sleep%20and%20fibromyalgia%20share%20a,lower%20a%20person's%20pain%20threshold.