Fibromyalgia (FM) is a condition that has produced more diverse opinions from researchers and physicians than almost any other. This has made finding a healthcare provider who is willing to manage the FM patient very challenging. Similarly, patient perceptions vary widely from those who strive to live a normal life despite their symptoms vs. those who are unable to cope and “give in” to the disorder. FM occurs in about 2% of the population with the majority of sufferers being women. Common symptoms include muscle aches, joint pain, sleep disturbance, and widespread body tender points or areas. The term “fibrositis” was first reported in 1904 to describe patients with these symptoms with many names being used including myositis, myalgia, fibrosis, myofibrositis, psychogenic rheumatism, and more! Not until the mid-1970s did the term “fibromyalgia” become the accepted term, getting rid of the “-itis” suffix which means “inflammation” and adopting the “-algia” suffix, which means condition or pain. In the 1990s, the American College of Rheumatology published distinct criteria for diagnosing FM requiring 11 of 18 tender points to be identified on examination, but this too has been criticized with new recommendations to accept widespread pain, sleep disturbance, and long-term or chronic symptoms as being appropriate to establish the diagnosis. Most recently, a central nervous system (CNS) origin rather than a localized inflammatory condition is now the current accepted area of the body that is the focus of cause and treatment.
The inability to get to deep sleep (which takes 3-4 hours of continuous sleep) has been identified as a major symptom of FM. Similarly, many of the symptoms of poor sleep coincide with the symptoms of FM such as fatigue, poor concentration, irritability, and diffuse pain. While certain medications and herbal remedies have been focused on and discussed, little has been reported on the changes the patient can make to facilitate sleep. The first order of business to help the sleep pattern is to make sure there are no underlying conditions such as sleep apnea or thyroid disease. Second, what is the FM patient’s sleep habit(s) or routine? This includes the time they go to sleep, the time prior to falling asleep once in bed, how many times do they wake up at night and the length of time to fall back asleep, how rested do they feel in the morning, and how long does it take “to wake up” and what has to be done – coffee, meds, etc., to feel “awake.” Third, identify other reasons for waking – pets in bed, a snoring partner, babies/kids or elderly care, and/or working swing or night shifts. The “treatment” of the FM patient for sleep disturbance includes discouraging daytime long naps – short naps are OK limited to 30 minutes max and at least 8 hours before bedtime. Here’s a summary list of recommendations:
- Reduce room distractions (no pets, no TV).
- Comfortable sleeping temperature and noise level – consider a white noise or “sound machine.”
- Establish a bedtime and awakening time based on the number of hours that it “usually” takes for that person to feel “rested.”
- Start a “wind-down” 60-90 min. before bedtime – reading, writing – to relax and “let go” of the day’s events.
- Avoid stimulating books or movies before bedtime.
- Writing down cares or worries of the day in a journal 45-60 minutes before bedtime.
- Avoid next day planning during the “wind-down” time period.
- Perform deep breathing exercises at bedtime.
- Avoid caffeine, nicotine, and alcohol pre-bedtime.
- Limit exercise after 3 hrs before bedtime.
- Avoid longer than 30 min. naps less than 8 hrs pre-bed time.
- Avoid eating 3 hours before bedtime.
- Avoid clock watching.
- If unable to fall asleep within 15-20 minutes, get up and engage in relaxation exercise and return to bed when feeling sleepy.
- Consider a softer mattress (harder is NOT always better).
- Some sleep centers advocate at least 40 minutes of strong light exposure after rising in the mornings.