The Complete Guide to Sleeping with Fibromyalgia

Is Fibromyalgia Keeping You Up at Night?

What is fibromyalgia?

Fibromyalgia is a complex and, at times, difficult to understand chronic illness. It is primarily characterized by widespread musculoskeletal pain and affects around 4 million US adults (2% of the population). 

Fibromyalgia is usually accompanied by other symptoms, such as fatigue, memory loss, and/or mood swings. While the exact causes of this chronic illness are still unknown, many sufferers of fibromyalgia generally begin experiencing symptoms following some kind of physical or psychological trauma (i.e. an accident, surgery, or prolonged illness), or may be the result of gradually increasing pain overtime.

 The painful sensations that most characterize fibromyalgia are caused by pain signals processed in the brain. The pain and other symptoms associated with fibromyalgia can also negatively affect the sleep habits of the person with the illness. Because sleep is a large factor in allowing the body to rejuvenate itself, when sleep is disturbed, symptoms of fibromyalgia are likely to worsen. This creates an unfortunate conundrum for those with this illness.

Fibromyalgia-related sleep disturbances

Sleep and fibromyalgia

It’s no secret that deep, restful sleep is essential for the body’s overall health and wellbeing. Unfortunately, restorative sleep is often extremely difficult for sufferers of fibromyalgia to achieve. A major symptom of this illness is chronic sleep disturbances. In fact, a majority of those living with fibromyalgia report at least some degree of sleep difficulty that results in waking up feeling unrefreshed and increased in pain or cognitive problems.

An article from the US National Library of Medicine titled explains that, “sleep problems…play a critical role in exacerbating FMS [fibromyalgia syndrome] symptoms.” Lack of sleep related to fibromyalgia and increased fibromyalgia symptoms related to lack of sleep are both increase risk factors of additional illnesses. This fact serves to emphasize the severity of fibromyalgia symptoms and lack of sleep.

If you or a loved one is suffering from fibromyalgia, you/they may also experience symptoms from a variety of health issues and sleep disturbances. Read on to learn about other sleep issues related to fibromyalgia.

Fibromyalgia-related sleep disturbances

If you suffer from fibromyalgia, it is likely that a majority of the time, you wake up feeling unrefreshed. Whether you aren’t sleeping enough or you’re not getting enough of the most restorative type of sleep, the bottom line is that fibromyalgia is wreaking havoc on your sleep cycles.

To understand more about why your sleep and body may be suffering so much, it’s important to understand a bit more about the sleep cycles you go through during the night.

Sleep is generally categorized into two distinct categories: REM (rapid eye movement) and non-REM sleep. Besides these two types of sleep, there are four “stages”. The first and second stages are when your brain is winding down and your brain waves and slowing. By stages three and four, your brain is entering into the “deep” sleep category. These are the stages where it becomes much harder for you to be woken up. This is when the body works to repair muscles, tissues, boosts your immune functions, and generally builds your energy for the next day.

According to an article by the National Sleep Foundation, “you generally enter REM sleep about 90 minutes after initially falling asleep, and each REM stage can last up to an hour. An average adult has five to six REM cycles each night.” Though every stage is important, REM sleep is one of the most crucial stages for living a healthy life day-to-day.

The REM stage of sleep is generally what is the most disturbed stage for those with fibromyalgia. During this stage – also known as the dream stage – our brains are extremely active. Though it may seem counterintuitive for a “restful” night of sleep, brain activity during REM sleep is actually a good thing! REM sleep contributes to healthy brain development, benefiting learning, memory, and mood. We don’t spend all night in the REM sleep cycle, but we pass through multiple cycles of REM as we naturally navigate between light and deep sleep. When we’re woken up in the middle of a REM cycle – or if we’re unable to reach REM stage sleep – that’s when we typically feel the most groggy and least rested.

Unfortunately for those with fibromyalgia and sleep disturbances, achieving REM sleep can be really difficult. Studies suggest that lack of sufficient time spent in REM can exacerbate symptoms of fibromyalgia, thus throwing people into a seemingly never-ending cycle of inadequate sleep and excessive fatigue. What this study, published in the US National Library of Medicine and titled, “The role of sleep in pain and fibromyalgia”, found, is that individuals in their study with fibromyalgia demonstrated “similar neural activation to healthy age-matched and gender-matched individuals”. The main difference that was discovered, was that the sufferers of fibromyalgia had a lower pain threshold than the “healthy” group. The fibromyalgia group also demonstrated “reduced short-wave sleep and abnormal alpha-rhythms”, which suggest disruption of REM sleep. This could mean then, that poor sleep quality puts individuals at risk for displaying symptoms of fibromyalgia but, which came first? The pain or the lack of sleep? It truly depends on the individual.

To understand how to combat fibromyalgia-related sleeping problems, it’s important to first understand what these sleep disturbances may look like. Restless leg syndrome, insomnia, sleep apnea, and sleep paralysis are all common sleep disorders linked to fibromyalgia, and deeper explanations of these, and other sleep disorders, are listed below:

1. Restless Legs Syndrome

Restless legs syndrome (RLS) is a common sleep disorder that is characterized by an extremely uncomfortable sensation that results in an uncontrollable urge to move the legs (sometimes the arms or other parts of the body as well). Symptoms for RLS are commonly experienced in the evening hours and while lying or sitting down, making it one of the most common sleep disturbances related to fibromyalgia. Nearly 33% of people with fibromyalgia report experiencing restless legs syndrome, compared to just 2-4% of the general population.

RLS is typically experienced on both sides of the body and is not usually confined to just one leg. The uncomfortable sensations tend to feel as though they are happening inside the limbs themselves, rather than just on the surface of the skin, which contributes to the overall unpleasantness of the sensations. These sensations may feel like crawling, creeping, aching, throbbing, or itching. RLS constitutes perhaps the most substantial sleep disturbance related to fibromyalgia, and is a major contributor to poor sleep quality.

Tips for relieving RLS symptoms:

Symptoms of RLS may be from fibromyalgia, but there are a variety of other underlying factors that may be at play. For some, a simple dietary supplement to combat a deficiency may be all that’s needed. Others may benefit from physical therapy, stretching, cold baths, or massages. Speaking to a medical professional is always recommended to decide on the treatment that is best for you.

2. Insomnia

Insomnia is another prevalent sleep problem among sufferers of fibromyalgia. Insomnia is characterized by the inability to fall asleep or stay asleep. Commonly, those with fibromyalgia tend to have trouble falling asleep, achieving deep sleep, wake up more frequently during the night. Sufferers often report waking up too early in the morning and feeling unrefreshed.

Research indicates that those with fibromyalgia show increased brain arousal during sleep that prevents restorative sleep processes from occurring. Without restorative, deep sleep, we miss out on vital healing that occurs during our time at rest. Our body gets stuck in “catch-up” mode as it tries to compensate for the depletion of important neurotransmitters. This results in not only constant fatigue, but also in the increasing of the body’s inability to respond to stress. These factors combined overwhelms the system and causes increased sensitivity to pain. In other words: lack of sleep causes more frequent and severe symptoms of fibromyalgia, creating a sleepless and painful cycle.

Tips for relieving insomnia symptoms:

A research team from the University of Austin, Texas published an article in the medical journal, Sleep Medicine Reviews. The research team studied the benefits of taking a warm bath or shower before bed. Their research found that bathing in warm water 90-120 minutes before bed helps to down regulate the body’s internal temperature. This mimics the natural rhythm of the body before sleep. The core temperature of the body drops when dropping into the sleep stages, so immersing yourself in the warm water of a shower or bath and getting out an hour or so before bed allows your body time to cool down. It ends up triggering the sleepy-feeling hormones, preparing you for a restorative night of sleep.

3. Sleep apnea

Sleep apnea is an extremely dangerous and potentially life-threatening. It’s a sleep disorder where a person’s breathing temporarily stops. There are three main types of sleep apnea:

• Obstructive sleep apnea is the most common type of sleep apnea. It occurs when the throat muscles relax and block the sleeper’s airway while they are sleeping.
• Central sleep apnea is a kind of sleep apnea caused by a miscommunication between the brain and the body. It occurs when the brain fails to send the proper signals to “breath” to the muscles that control breathing during sleep.
• Complex sleep apnea syndrome is a serious form of sleep apnea that combines both obstructive sleep apnea and central sleep apnea. 

One of the most prevalent and obvious signs of sleep apnea is snoring. If you sleep alone, it may be hard to tell whether or not you snore at night. If this is the case, be on the lookout for some common indicators of snoring. These common indicators may include waking up with a dry mouth or a headache. If you do not sleep alone, you may want to ask your partner if they notice any snoring or gasping for air while you sleep.

Regardless of what kind of sleep apnea someone exhibits, the effects of sleep apnea can be quite severe. The body’s response to the pauses in breathing cause you to be jolted awake, often several times during the night. This means that there is more time spent in light sleep and less time spent in deep, restorative sleep.

Tips for relieving sleep apnea symptoms:

A common suggestion for reducing or stopping the effects of sleep apnea is a simple change in sleep position. If you know that you are suffering from obstructive sleep apnea where your airway is blocked during the night, sleeping on your side or your stomach may help. Side-sleeping opens your air passages and allows you to breathe better. If this doesn’t not help or you suffer from a different type of sleep apnea, consulting a medical professional is your best bet.

4. Sleep paralysis

Sleep paralysis is a particularly terrifying sleep disturbance. This is occurs when someone is awake or conscious but completely unable to move. It’s often accompanied by a feeling of choking or pressure. Some people report nightmare-like experiences during sleep paralysis, where they imagine seeing dark figures or even monsters moving about in the room – an even more terrifying thought when in a state where they are unable to respond or flee.

Sleep paralysis happens as our bodies move between stages of sleep and wakefulness. In transitioning between the two, we can sometimes get “stuck” in the in-between, where our minds are conscious and yet our bodies are not awake, and still in a “paralyzed” state.

There are two different kinds of sleep paralysis:

1. Hypnagogic sleep paralysis is when the sleeper experiences sleep paralysis while falling asleep.
2. Hypnopompic sleep paralysis occurs when the sleeper experiences sleep paralysis when they wake up in the middle of a REM cycle.

People with fibromyalgia may experience either type of sleep paralysis, and it is typically induced by a lack of sleep. Unfortunately, lack of sleep is also one of the consequences of sleep paralysis, making it yet another perpetual cycle of poor sleep. Like other fibromyalgia-related sleep problems, sleep paralysis can lead to worsening symptoms, such as an increase in pain, depression, or anxiety.

Tips for relieving sleep paralysis symptoms:

Getting enough sleep plays a huge role is relieving symptoms of sleep paralysis. As with all more serious sleep disorders, talking to a medical professional is an important step to relieving your symptoms.

5. Hyperarousal

Lastly, many people suffering from fibromyalgia experience hyperarousal. Though not necessarily a sleep disturbance in and of itself, hyperarousal often leads to insomnia. In a state of hyperarousal, the brain and body are constantly “on”, though the person may feel physically tired and run down.

This hyper-active state has both physical and mental consequences. People who struggle with hyperarousal are often irritable from lack of sleep and feeling constantly “tightly wound”. They are also prone to anxiety, depression, and all-day fatigue.

As with many sleep disorders and mental health disorders, the symptoms of hyperarousal are usually seen in tandem with other disorders. Post traumatic stress disorder is a common reason for hyperarousal symptoms. PTSD can trigger insomnia, which may trigger fibromyalgia symptoms or vice versa. It’s all related, which is why seeking treatment from a doctor and/or mental health professional is a great way to begin to heal your sleep life.

Tips for relieving hyperarousal symptoms:

Hyperarousal is another serious sleeping disorder that generally requires a multidisciplinary approach to minimize/relieve symptoms. Cognitive Behavioral Therapy may be one approach that is suggested by a medical professional. As with the sleep disorders mentioned above, seeking the advice of a licensed medical professional is the best way to decide the best course of action for your specific symptoms.

 

How fibromyalgia-related sleep disturbances affect women

Online resources from the Center for Disease Control (CDC) explain that women are more likely than men to develop fibromyalgia. Women also tend to experience its symptoms more severely. Women sufferers of fibromyalgia report experiencing a flare in fibromyalgia symptoms during their menstrual cycle, and a significant increase in menstrual pain, called dysmenorrhea. It isn’t entirely clear why these symptoms flare during menstruation and menopause, but it’s likely due to the change of hormones within a woman’s body. Pain sensitivity increases when a woman has her period or is in menopause, and this pain can make it hard to fall asleep and stay asleep.

Similarly, there is evidence to suggest that fibromyalgia can exacerbate the symptoms of menopause. This can mean more intense night sweats and hot flashes that interrupt sleep. It may also lead to feelings of low energy, cognitive fog, and and an increase in fibromyalgia-related pain.

 

Solutions for Achieving Restful Sleep with Fibromyalgia

Just because a person may have fibromyalgia does not mean that he or she is destined for a lifetime of non-restful sleep. Though fibromyalgia is a frustrating condition that can sometimes be challenging to treat, it is nevertheless, still treatable or at the very least, there are ways to reduce the negative side effects of fibromyalgia symptoms. There are solutions available that can help those suffering from fibromyalgia achieve more restful sleep. This can, in turn, ease other symptoms of the disease and increase one’s overall quality of life.

While medication may be part of your fibromyalgia treatment plan, sleep aids can often have unintended consequences. Though prescription medications may help you fall and stay asleep, their effects often times persist after waking. Like any medication, use sleeping medications with caution and under the supervision of a medical professional.

If you’re a person who struggles with fibromyalgia-related sleep disturbances, here are some things you can do to achieve more restful, quality sleep:

1. Develop good sleep hygiene

Developing good sleep hygiene can help you fight against fibromyalgia-related sleep troubles. Sleep hygiene consists of the beneficial routines and habits that we practice in order to fall asleep more easily, stay asleep, and wake up feeling rested and refreshed. There are many components to good sleep hygiene. Some of the ways to develop good sleep hygiene habits include:

• Limiting daytime naps: Daytime naps are discouraged as part of healthy sleep hygiene habits. Mayo Clinic explains that, “short naps generally don’t affect nighttime sleep quality for most people. But if you experience insomnia or poor sleep quality at night, napping might worsen these problems. Long or frequent naps might interfere with nighttime sleep.” Do your best to avoid naps during the day. If you must take a nap, try to limit it to 20-30 minutes and do it mid morning/late afternoon. This will decrease the likelihood that the nap will interfere with nighttime sleep. Keep in mind that naps won’t make up for inadequate nighttime sleep, but may temporarily help you feel more alert.
• Avoid stimulants and alcohol at night: Stimulants, like caffeine in coffee or tea, can make it hard to fall or stay asleep. An article in the News Medical Life Sciences website written by Dr. Ananya Mandal, MD, explains that, “the half-life of caffeine (time taken for the body to eliminate one-half of the caffeine)…is approximately 5 to 6 hours” in “healthy adults.” This means that even if you drink a cup of coffee at 9am (or even two or three cups…), half the amount of caffeine that you consumed in that one cup will still be in your body 5-6 hours later. Now think about those days that you splurge on that second or third cup/shot of espresso and push the limit to 12 or 1pm. Is it any wonder why you may be having difficulty sleeping?
• Avoid alcohol before bed: Similarly, though alcohol may help you fall asleep faster, it will disrupt your sleep in the latter half of the night, as your body begins to process the alcohol. According to an article from the National Sleep Foundation, “alcohol may affect the normal production of chemicals in the body that trigger sleepiness when you’ve been awake for a long time.” In addition, drinking alcohol close to bedtime can block REM sleep, “which is often considered the most restorative type of sleep. With less REM sleep, you’re likely to wake up feeling groggy and unfocused.” Skip the nightcap and save your sleep life.
• Limit light and other electronic stimuli: The blue light emitted by electronic devices such as smartphones, tablets, and televisions wreak havoc on our sleep. Experts recommend avoiding these devices for at least one hour before bedtime to allow the brain to calm down and prepare for rest.           An article from Harvard Medical School explains an experiment conducted by Harvard researchers and colleagues, “comparing the effects of 6.5 hours of exposure to blue light to exposure to green light of comparable brightness.” What the Harvard research team found was that “the blue light suppressed melatonin for about twice as long as the green light and shifted circadian rhythms by twice as much (3 hours vs. 1.5 hours).” Melatonin, being the sleepy-feeling hormone secreted by the body to trigger nighttime relaxation and preparation for sleep, plays a significant factor in regulating the body’s internal clock (circadian rhythm). When these two things are thrown off kilter, it confuses the body and disrupts regular sleep patterns, and may play a large role in sleep troubles.
• Maintain a regular bedtime and wake time: Lo and behold, bedtimes aren’t just good for children. Going to bed and waking up at the same times every day and night is extremely beneficial for your sleep. An article in Scientific Reports explains a research study conducted by Jessica Lunsford-Avery, an assistant professor of psychiatry and behavioral sciences at Duke University in Durham, N.C. Her research studied over 1,900 adults. She discovered that those without a regular sleep schedule, on average, weighed more, had higher blood sugar levels, higher blood pressure, and were at higher risks of stroke and heart attack within 10 years. 

It can be difficult at first to maintain these strict habits with yourself, especially on the weekends and especially if you struggle with sleeping regularly. However, the proof is in the research; maintaining a regular wake-up time will help train your body and mind to develop a regular time for sleep onset, allowing you to sleep longer, deeper, more restoratively.

2. Invest in a good mattress

Of course, a good mattress is part of a comfortable sleeping environment. However, for those suffering from fibromyalgia and fibromyalgia-related sleep disturbances, a good mattress is even more important. A comfortable mattress can help alleviate some of the pain associated with fibromyalgia. A good mattress relieves pressure points and provides support to align the spine and lessen stress on the joints. Less pain will help you sleep better at night, which will continue to lessen pain symptoms during the day.

3. Get regular exercise

Regular exercise is vital to overall health and wellness, and is a major contributor to healthy sleep. Research indicates that regular aerobic exercise can decrease insomnia and promote deeper, more restorative sleep. However, there is a catch when it comes to using exercise to help improve sleep: time of day can matter.

It seems that the term “cortisol” is thrown around along with the term “stress” lately, and it is true that this is the bodily hormone that is secreted when we have that stressed-out feeling. Cortisol is also secreted when our body is under physical stress and exertion like when we are working out. It’s something that we need because it is something that regulates our body’s natural circadian rhythm. Having an inverse relationship with melatonin, cortisol is supposed to peak in the morning and gradually decline throughout the day. This means melatonin levels rise and become much higher in the evening. In a study done at Appalachian State University,individuals in group A exercised at 7am, group B exercised at 1pm, and group C exercised at 7pm. The research found that group A spent up to 75% more time in the deepest most rejuvenative stages of sleep. This doesn’t necessarily mean you have to hit the gym at 7am if you want to sleep well at night. The research suggested that it’s more about regulating your body’s natural rhythm by encouraging that normal cortisol spike in the morning. Experts suggest that some form of cardio whether it’s five minutes of jumping jacks or some power yoga, just something to get your body moving can help your body’s natural rhythm.

A bonus benefit to regular exercise is that it also treats other symptoms of fibromyalgia – particularly symptoms of pain. It may seem counterintuitive to move your body when you are in pain, but Mayo Clinic explains that “it is crucial to be physically active. Research has repeatedly shown that regular aerobic exercise improves pain, function and overall quality of life.” Fibromyalgia sufferers should make a point to prioritize low-impact workouts, especially if not used to exercising regularly. Stretching, yoga, tai chi, or swimming, are examples of low impact exercise that will minimize aggravation in the joints and pain as a result of fibromyalgia.

4. Cognitive behavioral therapy

The brain is one of the most powerful tools we have in achieving wellness. Depression and anxiety are some of the symptoms that often accompany fibromyalgia. These illnesses are naturally worsened by lack of sleep or poor sleep quality. Cognitive behavioral therapy (CBT) is one way to take care of the brain that can actually help improve sleep when faced with sleep challenges related to fibromyalgia. By working with a licensed therapist that is trained in CBT, you may find ways to train your mind to redirect anxious or depressed thoughts that may be causing you to lose sleep.

Sufferers of fibromyalgia and accompanying sleep problems may also experience anxiety surrounding fibro-related insomnia. This may be due to a fear related to sleep and sleep issues. This is often a cruel cycle, as the fear of insomnia often results in worsening the insomnia itself. Cognitive behavioral therapy can help resolve the negative thought spiral that leads to anxiety and insomnia. It may also help anxiety-related sleep paralysis, another common sleep disturbance experienced by those with fibromyalgia.

5. Treatment for sleep apnea

If you’re someone with fibromyalgia who is also losing sleep due to sleep apnea, it’s a wise idea to see your doctor to seek treatment and improve the quality of your sleep. Things like weight loss, quitting smoking, and changing sleep positions, can help alleviate sleep apnea. If you’ve tried these suggestions (or if they’re not an issue) and you are still experiencing sleep apnea due to fibromyalgia, your doctor may advise you to try a CPAP machine.

CPAP stands for Continuous Positive Airway Pressure. This form of treatment involves wearing a mask over the nose and/or mouth while sleeping. The mask is attached to a machine that delivers a continuous flow of air into the nose in order to keep airways open and breathing regular. A CPAP machine has a success rate of about 90% when it comes to resolving sleep apnea.

Some doctors may also suggest a dental apparatus as a way to treat sleep apnea in patients with fibromyalgia. In some rare cases, surgery may be required.

6. Natural sleep remedies

If you’re hoping to avoid prescription sleep aids, there are some natural remedies that may help improve sleep.

• Eating a small snack before bed can sometimes help people fall asleep faster and avoid waking up at night due to hunger. The key here is to make it a small, healthy snack – if you’re too full, you’ll be uncomfortable and possibly unable to fall asleep. Keep the snack carbohydrate-based; if it’s too rich, it could cause stomach upset. A banana and a small cup of oatmeal is an example of a nice nighttime snack.
• Herbal teas, like chamomile, have calming properties that make it a great sleep aid for people suffering from insomnia. 
• Herbal supplements, such as melatonin, valerian, or kava kava, may help you fall asleep and stay asleep. These supplements may also fight stress and anxiety, two major contributing factors to insomnia and other fibromyalgia symptoms. 

7. Meditation

Meditation is an excellent, completely natural, and oftentimes overlooked tool to use that can help symptoms of fibromyalgia-related sleep troubles. An article published by Harvard Medical School discusses, “a study published a few years ago in JAMA Internal Medicine.” The study “included 49 middle-aged and older adults who had trouble sleeping.” The study found that mindfulness meditation is a technique that stimulates the body’s “relaxation response”. Dr. Herbert Benson of Harvard,, used his research to explain that “the relaxation response can help ease many stress-related ailments, including depression, pain, and high blood pressure. For many people, sleep disorders are closely tied to stress.” The pain experienced by sufferers of fibromyalgia is certainly a stress-inducing condition.

Another huge factor in regulating your body’s natural sleep rhythm is getting some sun exposure during the day. By getting some early morning sunlight, between roughly 6 and 8am, your cortisol rhythm will be much more regulated and helps to lower cortisol levels at night. This is why a good night’s sleep starts the moment you wake up in the morning. By taking these steps you’re taking measures to regulate your body’s natural rhythm to induce a great night of sleep.

Sleeping well despite fibromyalgia

Living with fibromyalgia can be a frustrating, painful, and exhausting experience, but it doesn’t have to be. Though fibromyalgia sufferers may find it difficult to achieve restful and rejuvenating sleep, these difficulties can be eased using the above strategies as part of a comprehensive treatment plan in collaboration with a medical professional. The bottom line is that there is hope. You can achieve quality sleep with fibromyalgia, and also experience a reduction in your fibromyalgia symptoms and improved quality of life with the right steps forward.

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