Treatment for sleep problems in fibromyalgia

Fibromyalgia is a chronic condition that causes pain in multiple areas throughout the body, affecting muscles, tendons, ligaments, and other soft tissues. Unlike arthritis, where pain is the result of inflammation and tissue damage, the underlying cause of fibromyalgia pain is neurological. Though the causes are not fully understood, it is believed to be caused by a problem with how the nervous system processes pain signals.

While fibromyalgia is accurately described as a chronic pain disorder, pain is not fibromyalgia’s only symptom. Fatigue, problems with concentration and memory (sometimes called brain fog or “fibro fog”), psychiatric symptoms like depression and anxiety, and sleep disturbances are all considered core features of this condition.

The relationship between fibromyalgia and sleep

People with fibromyalgia often report problems with sleep, including problems falling asleep, staying asleep, daytime fatigue, and non-restorative sleep, where a person feels poorly rested even after sleeping for an adequate number of hours.

The relationship between fibromyalgia and sleep is complex and multidirectional, and the factors influencing the relationship vary from person to person. This means your best source of information will be a healthcare provider, who can assess symptoms, prescribe treatment, and refer you to other specialists who can address any coexisting conditions, such as mental health professionals and sleep specialists.

A cyclical relationship between pain and other symptoms

Pain can make it difficult to fall asleep, stay asleep, or get restful sleep. The following day, poor quality sleep worsens other fibromyalgia symptoms, including pain, fatigue, and cognitive function.

Coexisting sleep disorders

Some people with fibromyalgia have a coexisting sleep disorder. Two examples include sleep apnea and restless leg syndrome. Sleep apnea causes a person to stop breathing during sleep. Restless leg syndrome causes uncomfortable sensations in the legs and an uncontrollable impulse to move the legs while lying down.

Coexisting mental health conditions

Psychiatric disorders are common among people with fibromyalgia and have their own complex relationship with the condition. Depression and anxiety are common examples. Sleep disturbances are a common feature of many psychiatric disorders.

Medications

Fibromyalgia can coexist alongside many other health conditions, and medications taken for other health conditions can sometimes interfere with sleep. Medications can also interact with each other in unintended ways.

All healthcare providers should have an up-to-date list of all medications you take, including prescription medications, over-the-counter medications, and supplements (including herbal supplements).

Your pharmacist is also a valuable source of information.

Non-restorative sleep

In order for sleep to feel restorative—meaning you wake up feeling rested and refreshed—the body needs to move through several sleep phases, stages, and cycles, which are regulated by the nervous system. In other words, sleep is regulated by activity in the brain.

There is evidence that fibromyalgia is associated with anomalies in brain activity that disrupt sleep at a neurological level, contributing to non-restorative sleep.

Keep in mind that this is a simplified explanation of a complex topic.

Working with your healthcare provider

Like other parts of a treatment plan, addressing sleep issues will be individualized. There is no cure for fibromyalgia, and treatment focuses on managing symptoms. Improving sleep is considered a critical goal of treatment, and your healthcare provider will be your best source of information.

Treatment for fibromyalgia typically involves a combination of lifestyle interventions, medications, and supportive therapies. The choice of treatment will depend on symptoms and contributing factors.

For example, if a healthcare provider determines nighttime pain is a main contributor to poor sleep, a provider may recommend heat and gentle massage as you wind down for bed, or medications taken at bedtime to reduce pain and promote sleep. If there is a coexisting condition that is interfering with sleep—like sleep apnea, restless leg syndrome, depression, or anxiety—treatment will focus on addressing that underlying condition.

Some sleep strategies that may help:

• Track your sleep and share this information with your healthcare providers. Include the number of hours slept and how rested you felt in the morning.
• Also keep track of symptoms, including symptoms that occur around bedtime.
• Maintain consistent bedtimes and wake times.
• Sleep in a cool, quiet, dark environment.
• Avoid substances that can interfere with sleep, like caffeine, nicotine, and alcohol.
• Avoid large meals before bed.
• Avoid strenuous exercise or other activity two hours before bed.
• Avoid screens and electronics within an hour before bed.

It can take time to find the treatment approach that works for you. Remember that you are a key member of your healthcare team, and your providers rely on you to provide information on your symptoms, your sleep patterns, and other important insights about how you are feeling.