By Robert Rosenberg, DO
Sleep disturbances are among the most common symptoms of fibromyalgia, a chronic condition affecting the spinal cord and brain that causes people to feel pain and fatigue, and affects concentration. In fact, along with the tiredness, pain and psychosocial distress, sleep disturbances are a core feature. In the last few years, it has become increasingly clear that treating the associated sleep disturbance improves the daytime symptoms of fibromyalgia.
Here are eight things you need to know about fibromyalgia and sleep.
1. It is estimated that 2 percent to 10 percent of the population suffers from fibromyalgia.
2. Three quarters of those with fibromyalgia have sleep complaints. The most common is a feeling of non-refreshing or non-restorative sleep.
3. Insomnia, characterized by an inability to either fall asleep or stay asleep, is very common in fibromyalgia. Treating the insomnia with cognitive behavioral therapy and good sleep hygiene has been shown to improve symptoms of fibromyalgia.
4. People with fibromyalgia show less deep sleep, increased lighter stages of sleep and more frequent arousals during the night than do others. Many of the newer medications approved for use in fibromyalgia such as pregabalin (Lyrica) work in part by increasing deep sleep.
5. In several studies of normal sleepers, disrupting deep sleep nightly for seven to 14 days with either noise or awakenings resulted in symptoms indistinguishable from patients with fibromyalgia.
6. The incidence of restless legs syndrome has been found to be in excess of 50 percent of people with fibromyalgia, as opposed to 7 percent of the general population. Fibromyalgia patients experience improvement in their symptoms of fatigue and sleepiness when restless leg syndrome is treated.
7. The incidence of sleep apnea in fibromyalgia was found to be 61 percent in men and 32 percent in women, according to a 2013 study published in Clinical and Experimental Rheumatology. A particular variant of sleep apnea called upper airway resistance syndrome is very common in women with fibromyalgia. Treating sleep-disordered breathing improves both pain and fatigue in fibromyalgia.
8. Sodium oxybate (Xyrem) is a drug used in narcolepsy that works in part by increasing deep sleep. I am often asked by patients with fibromyalgia if it is available to them. In 2010 the FDA rejected its use for fibromyalgia as being too risky. It is chemically very similar to the date rape drug GHB and they felt that the risks of wide dissemination outweighed the benefits.
In my practice I see many patients with fibromyalgia who come to me for their associated sleep disturbance. Whether it is insomnia, restless legs syndrome, or sleep apnea, I can say that treating the associated sleep disturbance has a very positive effect on their fibromyalgia. My colleagues and I see an improvement in fatigue, cognitive function and pain when the sleep disorder is addressed.