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Fibromyalgia and Sleep

By Dr Ananya Mandal, MD

Fibromyalgia is typically characterized by widespread pain and is present in around 0.5-10% of the worldwide population with a seven times higher presence among females than males. Apart from pain there are symptoms of fatigue, sleep disorders, stiffness, headaches, irritable bowel syndrome, memory or concentration problems etc.

Sleep difficulties and fibromyalgia

According to the 1990 American College of Rheumatology (ACR) criteria for diagnosis of fibromyalgia, sleep difficulties are not an essential part in the diagnosis of fibromyalgia.

However, complaints of inability to sleep, insomnia and poor and non-restorative sleep is common among patients with fibromyalgia. Non restorative sleep is thus part of the latest criteria for diagnosing fibromyalgia given by the ACR in 2010.

Types of sleep problem associated with fibromyalgia

Some early studies have shown that 65.7% of patients with fibromyalgia report sleep that leaves then feeling un-refreshed. Recent studies have shown that more than 90% of patients with fibromyalgia complain of sleep problems that include:-

  • difficulty falling asleep
  • difficulty falling back to sleep after waking up at night
  • un-refreshing sleep or non-restorative sleep

Sleep improvement

Further treatment and management of fibromyalgia is monitored using sleep parameters that tend to improve with treatment.

Sleep improvement and resolution of sleep problems to a greater extent also is associated with patients’ overall impression of improvement of their condition.

Sleep deprivation as a cause of fibromyalgia

There is presence of another hypothesis. Some researchers have found that healthy persons who have been sleep-deprived may develop symptoms similar to fibromyalgia. This makes it a possibility that sleep disruption may be a cause of fibromyalgia-like symptoms rather than the other way round.

Researchers have found that among healthy volunteers, sleep deprivation led to increases in musculoskeletal pain or muscle pain, mood disturbances along with decreases in pain threshold after a period of sleep disruption or deprivation.
They also performed poorly on cognitive skill tests. Thus all three criteria for fibromyalgia – muscle pain, daytime fatigue, and cognitive problems were met by causing sleep deprivation in healthy persons.

Further nearly 33% of fibromyalgia patients suffer from restless leg syndrome. In this the patient experiences an uncontrollable urge to move his or her legs. This may disrupt sleep significantly.

Patients with fibromyalgia also often have sleep-disturbed breathing like sleep apnea, snoring and inspiratory airflow limitation to an extent of 96%. This also contributes to impaired and disturbed sleep among patients with fibromyalgia.

Reviewed by , BA Hons (Cantab)

Further Reading

Last Updated: Jul 31, 2013

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