Fibromyalgia articles

How is it possible for sufferers to wake up in the morning feeling more tired than when they went to bed the night before? Some sufferers do not realise that this problem is recognised as one of the major symptoms of Fibromyalgia.

Many people with FMS do not progress through the five stages of sleep. They may go to sleep easily, but wake up early in the morning (3 to 5am) unable to go back to sleep, or to go back into deep sleep. Others may have difficulty getting to sleep and then have interruptions during the night. 

Some even sleep through the night unaware of any difficulties, but may not be experiencing a deep restorative sleep. Other similar sleep scenarios are experienced by many people with Fibromyalgia.


Alpha-Delta Sleep Anomaly

This sleep disturbance in Fibromyalgia occurs in stage 4 of the sleep cycle. A disturbance in the brains’ electrical activity occurs, resulting in arousal, preventing the normal progression through the sleep cycle.

The sleep disturbance is referred to by researchers as the Alpha-Delta sleep anomaly, a condition in which brief periods of awake-like brainwaves (alpha waves) interfere with deep level (delta wave) sleep. It can be described as a state of partial wakefulness within sleep itself.

When this disruption occurs in stage 4 of the sleep cycle the body is not restored during sleep, this non restorative sleep is believed to be associated with the pain, fatigue and other symptoms of Fibromyalgia.

While the Alpha-Delta Sleep Anomaly is the most common sleep disorder found in Fibromyalgia patients, it is not the only one. John Russell MD. Studied 44 Fibromyalgia patient and discovered the following sleep disorders: Alpha- Delta sleep anomaly (43%), Sleep Apnea (25%), Sleep Myoclonus (16%)(involuntary arm and leg jerking during the night) and Teeth Grinding (14%).

The Link Between Serotonin, Sleep and FMS

Serotonin is a major neurotransmitter (a chemical that helps nerves transmit their messages) which is essential for the induction of deep level, slow wave sleep. An important component of the sleep disturbance in Fibromyalgia involves serotonin.

People with Fibromyalgia have been found to have low levels of serotonin in their blood and spinal fluid. At this time doctors are prescribing medications that increase the availability of serotonin in the body, with the ultimate goal being an improvement in the patient’s quality of sleep (more time in delta sleep) and reduced pain sensitivity.

More research must be done on the relationship between prescribed medications and the alpha-delta sleep anomaly. While these medications do influence the availability of serotonin the exact mechanism by which they operate is still not understood. There are still many questions to be answered.

How To Improve The Quality Of Your Sleep

  • Consult with your Doctor about the necessity of taking a medication to improve your sleep quality
  • If you are experiencing morning grogginess while taking a medication to improve sleep quality, take the medication as early as 6 pm
  • Allow time to wind down before bed
  • Follow a bedtime ritual (i.e. a warm bath, relaxing music, reading)
  • Eliminate caffeine after 12 noon
  • Reduce or eliminate fluid intake after 6pm. if you have a need to urinate during the night. Medications such as diuretics and blood pressure medications that get rid of excess fluid should be taken earlier in the day, whenever possible  (you will need to consult with your doctor first)
  • Use relaxation tapes
  • Develop a programme of gentle aerobic exercise, but avoid exercising in the evening
  • Actively deal with problems that interfere with sleep (e.g. pain and discomfort, crying baby, uncomfortable mattress or pillow, snoring spouse, concern about issues etc)
  • Seek treatment for depression, anxiety and/or stress if you are experiencing these
  • Avoid taking a nap late in the day as it may be more difficult for you to go to sleep at your normal time, or you may sleep for a few hours, then find yourself awake and be unable to get back to sleep
  • Don’t work in your bedroom
  • A glass of milk before bed may be helpful

To Sleep Or Not To Sleep?!

Establish a routine. Go through the same routine each night and have a consistent bedtime regime. Prepare for bedtime by reducing your activity level several hours before bedtime, and by having ‘going-to-bed’ rituals, that you do consistently at the same time every night.

Things like a warm drink, brushing your teeth, taking your meds, and maybe a bit of light reading every night can help you wind down and get ready psychologically for sleep.

  • Use your bed only as a place to sleep (Ahhem!.. erm there is one exception ! ) do not use your bed for other things….. such as eating, reading, paying bills or watching television. Avoid caffeine and alcohol within 6 hrs. of bedtime. Both can interfere with sleep.
  • Get up and go into another room to read or do something else relaxing when you cannot sleep. Tossing and turning all night keeps the muscles tensed and active. This may also contribute to you waking in pain and feeling tired.
  • When you begin to feel sleepy go to bed and try again, you may need to repeat this pattern several times during the night.
  • Try to get some regular exercise during the day or early evening, to help you feel physically tired. This will help you sleep better, but be sure to finish exercising several hours before bedtime.
  • Have a comfortable environment, try to provide yourself with a good mattress or mattress topper, and control light, noise and temperature (note: Noise, Ahhem….this includes snoring by your partner!).
  • Limit daytime napping, unless this doesn’t disturb your sleep at night, in which case you may need more rest.
  • Unwind and cleanse the mind, taking all your problems off to bed with you heightens anxiety and makes it difficult to relax, try writing down any issues and put them in a box, put the lid on and leave them till tomorrow.
  • Set up a sleep schedule, based on the number of hours sleep you need per night (no less than 7 hrs a night) incorporate your bed-time rituals, and what time you need to get up. It makes it easier to work out when you should start your bedtime regime.
  • Use relaxation or distraction techniques to fall asleep, such as concentrating on your breathing, peaceful calming background music.
  • Get up at the same time, setting an alarm so that you keep a routine by getting out of bed at the same time every day, can help you to adjust back to more normal hours

Working With Medical Professionals

One of the most important members of your healthcare team is your Doctor.

His/Her job is to provide you with advice, treatment and hope. Your job is to help health care providers to help you. This shouldn’t be a one sided relationship, you cannot expect your doctor to wave a magic wand.

Recognise that will be inherent frustrations for patients and doctors when treating a condition that continues to hold mysteries for the researchers. There are constructive ways that you can help.

  • Prepare for your appointment ahead of time to make the best use of the time with your doctor. Be sensitive to your own symptoms and concerns and give some thought to the questions you might ask.
  • Take time to write down your questions and symptom complaints in an organised format, i.e. what the symptom is, how often you experience it, how it is affecting your life; if you have previously been prescribed medication, is it helping you cope with the symptom.
  • If you are experiencing pain, keep a diary and record the level, on a scale of 1-10, duration, and location of the pain (use a body outline, and shade the areas).
  • During surgery appts. be prepared to ask for what you need to manage your Fibromyalgia. Try to be concise (easier said than done I know!) and ( even harder ) not ramble.
  • Remember that sharing information is important, but listening is just as important, ask your doctor to repeat or clarify information that is unclear and write things down. It is helpful to summarise your understanding of what the doctor has just told you.
  • You can’t expect your Doctor to be your friend, but you can expect them to treat you with respect, and listen to your concerns and requests.
  • As there is no magic bullet for Fibromyalgia, great patience is required to find a combination of therapies and medication to bring about improvement. Work with your doctor to develop a plan of action should you have a flare up, so you can initiate treatment on your own, i.e. can you increase your sleep medication or can you have a standby medication that works for you, with your existing combination. What else can you do during a flare-up to reduce your symptoms? Consider other resources such as your pharmacist.
  • Realise that much of your treatment is up to you; exercise, relaxation, stress management, pain management, and pursuing additional complimentary or holistic therapies such as massage.
  • Your doctor can’t guarantee that a particular medication will work for you, but you can ask why he/she has recommended it and what they hope to accomplish by prescribing the drug.
  • Consult your doctor if you feel that your symptoms require investigation, do not be tempted to put everything down to Fibromyalgia.
  • Learn as much as you can about your illness, since you are the one who will manage the day to day problems that occur. Remember that you are in charge of your own treatment plan
  • Don’t forget that even Non-prescription treatments (herbs, vitamins, supplements) can interact with prescription medications. It is better to be safe than sorry and let your doctor know about everything you are taking.
  • Be respectful of the time constraints.

Not only is pain the main symptom of Fibromyalgia, it is a symptom that can be treated in a variety of ways. People with Fibromyalgia have different types of pain, so it is important to work with your Medical Professional to find out what treatment is best suited to your needs.

Sometimes multiple treatments are used at the same time, because they may have a better chance of reducing the pain more quickly. Fibromyalgic pain may not be the only pain that people with Fibromyalgia are experiencing- they may suffer with other types of pain too.

  • Understand that medication is not the only tool for treating pain. There are many non-medical treatments that can be used to help ease fibromyalgic pain i.e. hot or cold treatments. Self-help measures can be used to help cope with symptoms i.e. self-supervised gentle exercise programme (start with gentle stretching) and eating a balanced diet.
  • Set pain management goals and follow through on them. Pick your greatest pain problems and set goals to focus on each one.
  • Check your progress, use a chart or log to mark your progress as you meet each goal, keep a list of what does (and doesn’t !) work for you
  • Plan each day, use a ‘to do list ‘or a schedule for exercise or other activities, but don’t overdo it.
  • Seek and accept support, from friends, family, support group members or carers, they can help keep you on track, and help on difficult days
  • Prepare for difficult situations, make a list of trouble areas with your pain, and create a plan. Being prepared can help to decrease anxiety and lessen stress. Try putting a remedy box together.
  • Reward yourself, treat yourself to something nice when you reach a goal or complete a pain strategy. This will strengthen your positive attitude and your successes.
  • Review treatment strategies from time to time. Discuss with your medical professionals what you have found works for you, and share it with support group members! If you are contemplating trying complementary therapies, discuss this with medical professionals before you begin treatments. Never just stop taking prescribed medication.

Don’t be too hard on yourself, be patient and try to understand and accept that Fibromyalgia is not life threatening, and though it can be life changing, maintaining a positive attitude means this can sometimes be for the better.