Sleepless And In Pain: A Link Between Fibromyalgia And Sleep

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. The study 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 percent 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 3.5 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 to 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 to 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 sleep 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 includes 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


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Comments

[MRstoner2udude]

01:10 PM on 02/01/2012

I only scanned the article but saw no mention of eliminating foods that my cause "pain" and sleep problems. Eliminating gluten and all grains is worth a try. Also, goats milk products are for me, much easier to digest than cow's milk. Why? If you, like me, went thru a long period of stress, prescription drugs/anti biotics and little sleep, you may have compromised your digestive system. Check out eliminating some foods to see if they help and the amino acid L glutamine to heal your body's digestive ability. Also adding some chelated magnesium to your diet will probably help.

[Brian Abaluck SleepMD]

06:11 PM on 01/08/2012

Dr. Breus,

I appreciate that you separated correlation from causation in your discussion of fibromyalgia and insomnia. I agree that we cannot infer which illness causes which from such an observational study.

Pain syndromes are incredibly common and correlate closely with sleep disorders. Yet, we see very few pain patients in our Sleep HealthCenters sleep clinics in Boston. So, I suspect that the overwhelming majority of patients with pain syndromes never see sleep physicians. Given how difficult such syndromes can be to treat- and the side effect profiles of pain medications- I encourage primary care physicians to discuss sleep with their pain patients and refer when necessary. As you often discuss in your posts, there is much we can do for sleep outside of prescribing drugs.

Brian Abaluck, MD
www.sleepandyou.com/blog
Sleep HealthCenters Physician

[TalkingCures]

04:09 AM on 12/23/2011

All illness is caused by a process of the Mind following Childhood Emotional Trauma, like many so-called Research papers that claim to have proven! Sleep, as in this case, causes FM it fails to take into consideration the possibility of the person within the study having other or many long-term illnesses that have defied the best scientifically proven medicines futile attempts to create the cure desired. Therefore Sleep Time is the seedbed for destruction - the time we create ALL our illness - this being the only link between FM and Sleep deprivation and is only to be considered a pathway to further science defying and mysterious symptoms and will continue until Medical Scientists, our dedicated Doctors and all of the population link the mind and body as one.
Peter Smith Talking Cures UK
http://talkingcures.co.uk/Mystery_of_illness.html

[Willow712]

02:01 PM on 12/22/2011

My rheumatologist told me that one of the reasons for fibromyalgia is disturbed sleep over a period of time. Wake someone up a lot and they will develop fibro. I am on a board called Talk about Sleep, and I am willing to bet that over 50% of us narcoleptics have fibro also. My narcolepsy caused me to wake up over 16 times an hour, therefore I was sleeping 16-20 hours a day and not getting any refreshing sleep. Both fibro and narcolepsy are in the brain, fibro is not in the arms and legs and shoulders. It is our mind's reaction to minor things, causing us to ache and hurt. So in reality, both Narcolepsy and fibro are "all in my head." When you think your arm hurts, it is your thought that it hurts that much, there is nothing wrong with the arm. Both fibro and narcolepsy are exhausting to live with. I think that's what causes so much of the fatigue and lack of energy.

[JBS]

01:27 PM on 12/22/2011

I think your studies appear to be missing a bit of a "chicken or the egg" aspect. Many of these chronic discomforts are as much a cause of sleeplessness as they are an effect of not getting enough sleep.

There IS a connection, but do I have chronic leg pain because I don't get enough sleep, or am I unable to sleep because my legs hurt all the time?

Or perhaps some third, as yet unidentified factor, is responsible for both the pain and the sleeplessness.

[dpkjj]

12:53 PM on 12/22/2011

Duh - people who have chronic pain have trouble sleeping? Surprise!