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chronic pain

Sleep issues and fibromyalgia

Fibromyalgia is associated with fatigue, insomnia, and excessive sleepiness during the day. Many people with fibromyalgia report waking up frequently and when they do sleep, they don’t feel rested.

Studies in sleep labs confirm that fibromyalgia is associated with a reduced sleep efficiency (meaning the total sleep time versus the time in spent in bed). Sleep efficiency is actually about 75% for people with fibromyalgia, meaning if they are in bed for 8 hours, they are only sleeping for 6 hours.

Many factors probably contribute to sleep issues, such as:

  • Sleep apnea, which is a problem for about 80% of people with fibromyalgia.
  • Restless leg syndrome, which affects about 1/3 of people with fibromyalgia.
  • Pain
  • Poor sleep hygiene (a common problem for many people with insomnia)

Getting a good nights sleep is important. We know that healthy people who don’t have pain experience more pain when they are sleep deprived. And we also know that people with chronic pain will have less pain if they are able to get restorative sleep. This is a very important point. Doctors and patients alike down play the importance of sleep. They shouldn’t. Also, sometimes when health care professionals talk about sleep issues, people hear, “You think my pain is all in my head,” but that is the farthest thing from the truth. We sleep for a reason. If our brain and body didn’t need the downtime, we wouldn’t have evolved to need sleep. Many times, lack of sleep is the missing piece in the pain puzzle. Keep in mind that medications and procedures are going to be less effective if you are exhausted and not getting enough restorative sleep.

What can you do about it?

If you have fibromyalgia, ask your doctor to be screened for sleep apnea. There are questionnaires that can help identify people who should be tested. The testing is pretty easy and typically involves wearing a device on your wrist at home while you sleep (or try to sleep) in the comfort of your own bed.

Ask about a cognitive behavioral program for sleep. This involves strict attention to how and when you try to sleep. This can be done with a therapist or even via an on-line program.

The basics of CBT for sleep involve a set wake up time every day, only sleep and sex in the bedroom (that means no TV, reading, or eating in bed), and no naps. Also it is important to turn off the TV and all electronics at least an hour before bed to give your brain a chance to wind down from all that digital stimulation).

CBT is very effective. In one study 50% of fibromyalgia patients who did a specific CBT program for sleep had a 50% reduction in their sleep disturbance (meaning more time asleep!) versus 3% who didn’t do the program. The more sleep you have, the better pain control you can expect. While medications can be considered, it is really important to focus on sleep hygiene. Sometimes it seems easier for both doctors and patients to reach for a pill, but CBT really works and it has no side effects. Many people with fibromyalgia have medication sensitivities and others are on multiple medications and so medications interactions may be a concern. Those are not issues with CBT.


Different people may need different interventions. If you have fibromyalgia and are fatigued, having trouble sleeping, or your pain control is sub-optimal start the conversation with your doctor about sleep.




Remember, this post is not direct medical advice


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