Sleep Improvement is the Key to Less Pain & Better Function in Fibromyalgia
Many abnormal findings that have been detected in patients with fibromyalgia are associated with poor sleep. These include fatigue, pain, depressed mood, memory deficits, etc. One of the most important problems for fibromyalgia sufferers is called “hyper-arousal”. This means that they are “wound-up” and irritable almost all the time. This hyper-active state has physical as well as mental consequences. Despite being constantly in “high gear”, the ability of fibromyalgia patients to respond to mental and physical stress is strongly diminished. In other words, their energy is low and their “batteries” are nearly empty. Thus it is very important to “recharge your batteries” and improve your response to everyday stressful events.
A word of caution, however: Many fibromyalgia patients have additional physical sleeping problems, including sleep disordered breathing, intermittent airway obstruction, sleep apnea, etc. These abnormal findings can generally be detected during a sleep study (sleeping in a sleep lab for one night). If present, weight reduction, discontinuation of certain medications, simple manipulations, like CPAP (constant positive airway pressure), or minor surgery may improve your sleep. You should discuss this with your health care provider if you think any of these may be contributing to your difficulty sleeping.
General Guidelines (Sleep Hygiene)
- Keep a regular daily schedule (e.g. 11 pm to 7 am) even on days off and weekends. A consistent sleep schedule helps set your “internal clock”, there isn’t evidence that sleeping in helps make up for lost time on other days, but there is some evidence that it can upset your internal clock and make it harder to sleep the next night.
- Establish a regular, relaxing bedtime routine.
- If you spend more than 30 minutes trying to fall asleep, getting out of bed to read or listen to relaxing music can help you calm down and get ready for bed. Repeating a relaxing part of your bedtime routine may also help.
- Try to avoid daytime naps to see if they contribute to your trouble sleeping at night. Additionally, you should limit your naps to 15-20 min and try to avoid taking naps later in the day.
- Avoid exercise and eating too close to your bedtime. Exercise can help you fall asleep faster and stay asleep longer, but if you exercise too close to bedtime, your body produces more cortisol, which keeps your body in a more active state.
- Avoid drinks and food containing stimulants (e.g. coffee, tea, sodas, chocolate), especially within 4 to 6 hours of bedtime.
- Avoid alcohol intake within a few hours of bedtime.
- Avoid nicotine at sleep onset and during the night.
- Keep your bedroom dark and cool and create a sleep-promoting environment with a comfortable bed and secure surroundings.
- Remove as much environmental sources of disturbance as possible (e.g. pets, noise, etc.).
- Avoid turning on bright lights at night, use a night light.
- Use your bedroom only for sleep or sex (not work or arguments with spouse/partner).
- Reduce intake of fluids before bed, resist getting up to use the bathroom.