fibromyalgia and sleep Insomnia

Fibromyalgia, sleep hygiene and insomnia

When I was younger with Fibromyalgia I had some serious insomnia. In fact it was the first symptom to present itself. I never found it to be problematic until, well, life insisted I have a sleep cycle of a certain sort that my brain rather disagreed with. Which leads to sleep deprivation. And sleep paralysis in my case.

Often what you get from doctors is sleep hygiene at first. They tell you all the don’t to take care of before sleep. And I basically had been told this around the age of 12. Didn’t stop me from getting this lecture, well, now. But here it is for those that have not heard it.

 • Avoid stimulants such as caffeine up to four hours prior to bedtime. Caffeine builds up in the body through the day so it is best to avoid after lunch. (we should avoid stimulants anyway… but seriously this is hard to do when you feel so fatigued from Not Sleeping)

• Maintain a consistent sleep pattern of waking up and going to bed at the same time. (Well going to bed at the same time, not necessarily falling asleep at the same time obviously)

• Avoid late night snacks. If you do snack stick to small snacks that have a lot of carbohydrates in them as these tend to aid in making you feel drowsy. (I pretend chips count, but let’s pretend I didn’t say that.)

• Never exercise before bedtime but try to exercise regularly even if that exercise is going for short walks, yoga or doing some stretches.

 • Have no distractions in the bedroom. No TV, video games, iPhone or laptops. Do not do your work in the bedroom. Or snack. The bedroom should be reserved for sleeping or sex and we don’t want our brain to be associating the space with other waking activities. The blue light from computers and smartphones is the main issue. I use Flux on my computer to dim the blue light at night and my new iPhone actually dims it for me as well, so this isn’t as a issue as it once was… as it can be addressed.

• Make the room as comfortable as possible for sleep. Use blackout curtains to reduce light or a sleep mask. Use some method to reduce background noise whether that is earplugs, meditation music or a white noise machine. Ensure the room is not too hot or too cold.

• Do not take frequent naps but if you feel that you need to keep them under an hour. (I have a hard time with this one. I have the overpowering need to nap sometimes… being sleep deprived and all. But sometimes I set my iPhone alarm to wake me. And sometimes I ignore it)

 • Do not watch TV at least an hour before bed because it is stimulating for the brain and makes it difficult to relax. The same can likely be said for being on the computer. (Also if you are an insomniac like me, don’t read a good book… or you might just read it to the end. Read a crappy book instead.)

So those are the sleep hygiene tricks of the insomnia trade.

However with chronic pain like Fibromyalgia and especially with added chronic pain like migraines stacking on there… you get painsomnia. Too much pain to sleep.

 

This is an added complication that generally you need to see your doctor about because it either needs the assistance of sleeping medications or pain management to deal with. Personally my pain is such that I had to reduce my work to part time so that even if I get little sleep, I can catch up the follow off day. It is a fact of the matter that I deal with a lot of painsomnia on slow release painkillers and a sleeping medication. If you are having severe insomnia you might want to ask your doctor about sleeping medications such as hypnotics. I am on zopiclone myself.

Nevertheless, even without pain the FM causes delayed onset insomnia with me, so it takes hours to fall asleep, and frequent wakings through the night. And it really doesn’t matter what medication I am on, this is the result, just a little Less so on some. However, apparently I am a severe case, so I would not say insomnia due to FM and pain is impossible to treat, only that it can be quite complicated. And certainly you want to maintain the sleep hygiene first and foremost to start the process.   

Regular sleep and FM sleep
A normal person’s sleep cycles every 90 minutes from light stage Alpha one sleep into deeper stage Beta two and stage Gamma three until they reach stage Delta four sleep. Delta sleep is the most refreshing and restorative of the stages whereas alpha is also known as REM (rapid eye movement) sleep where we do most of our dreaming.  One thing about frequent waking is that I really remember a lot of my dreams, assuming I actually make it into that stage and actually sleep. But yes, remember a lot of my dreams. A perk? Maybe.

People with FM have been shown to have disrupted Delta sleep. This means while they can sleep for 8, or whatever, hours we still wake up feeling tired and like we didn’t get any at all  because the sleep is not restorative, since stage four sleep is where energy is recovered and muscles are repaired. It can also cause the level of growth hormone in the body to be lower as growth hormone is primarily distributed during stage four sleep (80% comes from delta sleep). Lower levels of growth hormone leads to more muscle pain and degeneration. Lack of stage four sleep also causes cognitive impairment or brain fog as well as fatigue and muscle aches. It has actually led some researcher to believe FM is a sleep dysfunction disorder, just one of many theories.

Some people with FM also have low levels of a hormone called cortisol during the day causing fatigue and high levels at night causing insomnia. Cortisol is generally released during REM sleep but can be during any stage of sleep and its peak production is early in the morning prior to waking.

Another issue has to do with dysfunction in the automatic nervous system. It has been suggested that with FM the sympathetic part of the automatic nervous system which essentially controls our fight or flight responses is perpetually stuck ‘on’. Makes us all hyper-aware when we should be preparing for sleep. This prevents the body being able to really relax in order to sleep deeply. It ensures we are very light sleepers, essentially still on alert. Leading to the common frequent wakings and difficulty falling back to sleep again.

General issues:
  • -Insomnia
  • -Frequent waking
  • -Difficulty falling back to sleep after waking
  • -Difficulty reaching stage four sleep
  • -Unrefreshing sleep
  • -Sleep apnea
  • -Restless leg syndrome
  • -nighttime muscle contractions, twitching or nocturnal jerks
  • -Grinding teeth (bruxism)
Herbal treatments:
  • Hops
  • L-theanine
  • Passionflower
  • Valerian root
  • Melatonin
  • Wild Lettuce leaf
  • Kava kava
I personally always liked Valerian root. Make sure if you try any of these to inform your doctor because they do come with their own side effects and contradictions. Melatonin is one doctors often recommend before medication for example. It was suggested to me when my medication wasn’t sufficient.
Prescription sleep aids
 
Antidepressants: antidepressants are used for FM because they help with pain and increase serotonin which has been shown to be low with FM. Low doses of certain antidepressants are often used to aid with sleep. Common ones for FM are Trazodone and Elavil. I am on Trazadone myself in addition to my sleeping pill, which does make it more effective for me. It does come with a side effect of drowsiness in addition to being an antidepressant.
Hypnotics: Drugs such as Lunesta, Ambien, Restoril, Imovane and Sonata. These are sleeping pills that are generally not considered for long term use because they are habit forming.

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