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with Michael Breus, PhD, ABSM

Sleep disorders include a range of problems -- from insomnia to narcolepsy -- and affect millions of Americans. Dr. Michael Breus shares information and advice on sleep disorder and insomnia treatments and causes.

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Thursday, January 5, 2012

Sleepless and in Pain: a Link Between Fibromyalgia and Sleep

By Michael J. Breus, PhD, ABSM

There’s some important news for millions of people—most of them women—who suffer from the syndrome fibromyalgia: a new study suggests that sleep deprivation is associated with an increased risk of developing fibromyalgia.

The study was conducted at the Norwegian University of Science and Technology and included 12,350 women. At the outset of the study, all the women were free of physical impairment, musculoskeletal pain and fibromyalgia. A decade later, 327 of the women—2.6% of the study population—had developed fibromyalgia. Researchers asked all the women in the study to report on their sleep habits and their sleep problems. They found that women who reported sleep problems were significantly more likely to have developed fibromyalgia than women without sleep problems. The researchers also found that the risk of fibromyalgia increases with a woman’s age and with the severity of sleep problems:

  • Women who reported having difficulty sleeping “always” or “often” had nearly 3½ times greater risk of fibromyalgia as women who did not have problems sleeping
  • Women age 45 and older who “always” or “often” had sleep problems had more than five times the risk of developing fibromyalgia as women without sleep problems
  • Younger women, ages 20-44, who “always” or “often” had difficulty sleeping were at three times greater risk of developing fibromyalgia than their counterparts who didn’t have trouble with sleep

It’s important to make clear that this study does not prove that sleep deficiencies cause fibromyalgia. What it does do—for the first time—is establish a strong connection between sleep problems and fibromyalgia by showing the increased risk of fibromyalgia that is associated with lack of sleep.

What is fibromyalgia? It’s a syndrome whose main characteristic is chronic pain. Pain is often felt throughout the body, in muscles, tendons and soft tissues. With fibromyalgia, the pain is often felt at certain trigger points, and radiates from those points outward. People with fibromyalgia often experience daytime fatigue, which can be severe, as well as depression, anxiety and memory problems. Women ages 20-50 are at the highest risk for fibromyalgia. Men do develop fibromyalgia, but women are more than 10 times as likely as men to develop the syndrome.

Fibromyalgia has a history that’s both contentious and mysterious. For a long time, there was no consensus in the medical community about whether it even existed, whether it was a “real” disorder or an “imagined” one. This has changed, and the medical establishment now overwhelmingly accepts that fibromyalgia exists as a very real disorder. But much about the syndrome—including and especially what causes it—remains unknown. For this reason, and because there is no single test that can positively identify fibromyalgia, it remains difficult to diagnose. Since it can’t be tested for, a diagnosis of fibromyalgia comes by way of eliminating other possible conditions.

There are signs of possible genetic and environmental links, since fibromyalgia seems to sometimes run in families. Researchers have explored links between fibromyalgia and other diseases and disorders, including arthritis, depression, anxiety, chronic fatigue and restless leg syndrome, but no conclusive evidence has been found to demonstrate a causal link between fibromyalgia and these conditions. That said, all of these disorders are found more often in people with fibromyalgia than in the general population.

Is sleeplessness a cause of fibromyalgia? Again, we just don’t know, and this current study doesn’t answer that question. The relationship between sleep and chronic pain is complicated, and there is a lot we do not understand about cause and effect. Here’s some of what we do know: The presence of chronic pain, such as with fibromyalgia, makes falling asleep and staying asleep more difficult. Sleep deprivation, in turn, can make people more sensitive to pain. Evidence that disrupted sleep can lead to a lower pain threshold can be found in this study. Researchers took a group of healthy, pain-free middle-aged women and disrupted their sleep cycle, depriving them of deep, slow-wave sleep for three consecutive nights. They then tested their threshold for musculoskeletal pain, tenderness and also mood. After only a few nights of disrupted sleep, the women experienced a significantly decreased pain threshold (meaning they felt pain more quickly and intensely), as well as increased fatigue and general discomfort.

We don’t need to know the root causes of fibromyalgia to know that improving sleep is at the core of a strong treatment plan for the condition. If you’re struggling with sleeping because of fibromyalgia or chronic pain, keep these strategies in mind to help improve and protect your sleep:

  • Emphasize your rest. People with fibromyalgia simply cannot shirk their sleep routine. Make sure sleep stays a top priority by setting up a schedule that allows for plenty of rest and by creating a sleep environment that is relaxing, quiet, dark and conducive for sleep.
  • Exercise. Regular exercise can help manage pain itself. It will also strengthen your sleep-wake cycle and help you sleep better. Schedule exercise earlier in the day, and outdoors in sunlight if you can.
  • Use relaxation techniques. Meditation, massage and mind-body exercise are also powerful tools for pain management and for sleep as well. One study found that after three months of regular Tai Chi practice (two hour-long sessions per week), pain and depression among fibromyalgia patients had declined, and sleep had improved.
  • Avoid alcohol, tobacco and caffeine. These chemicals may make you feel “better” in the very short term, but they disrupt sleep and increase stress, among other negative consequences. With fibromyalgia, your body is coping with enough stress without exposing it to taxing chemical stimulants and depressants.

There is so much that we still need to learn about fibromyalgia itself, as well as the relationship between chronic pain and sleep. One thing that’s not in question? Sleep is powerful healing tool. It costs nothing and doesn’t require a prescription. Make sure you’re using it to its greatest effect.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

Have you struggled with sleep problems or fibromyalgia? Join the discussion in our Sleep Disorders and Fibromyalgia communities or share your thoughts in the comments below.

Posted by: Michael Breus, PhD, ABSM at 1:43 pm

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