It’s a busy and stressful world, and most people experience sleep deprivation or report poor quality sleep at various stages of their lives. But within the fibromyalgia community, sleep disturbances are pervasive and long-term and observed in most FM patients.
For example, in a study of six hundred FM patients (Bigatti, et al. 2008) the researchers identified 96% of the study sample as “problem sleepers”. Furthermore, the authors demonstrated a strong correlation between poor quality sleep and the participant’s experience of pain, fatigue, depression, and diminished physical functioning. (1)
This should come as no surprise - individuals who are depressed or in pain will have greater difficulty attaining quality sleep and people who are functioning on too little sleep can’t perform at their best.
In this two-part blog, we’ll review some of the studies that shed light on how fibromyalgia is believed to disrupt sleep patterns. A subsequent blog will then explore concrete steps that we folks with FM can take to interrupt the vicious cycle between poor quality sleep and our diminished health and well-being.
The Connection Between Fibromyalgia and Sleep Disturbances
We know that fibromyalgia affects various physiological systems, including the nervous and endocrine systems, which play a critical role in regulating sleep. Sleep disturbances in fibromyalgia patients are characterized by non-restorative sleep, frequent awakenings, and difficulty falling and staying asleep. Researchers have identified underlying mechanisms that contribute to this phenomenon.
Altered Sleep Cycle
In addition, fibromyalgia patients often experience an alteration in their sleep stages and cycle. Research shows that individuals with FM may spend less time in the deeper stages of sleep, which is crucial for restorative sleep. It’s during deep sleep that our muscles and tissues are regenerated and repaired (due to an increase in the growth hormone secretion) and toxic waste products are cleared from the brain. It makes sense that a lack of deep sleep could lead to fatigue, brain fog, and muscle aches— which sounds like common fibromyalgia symptoms, right? In a study by Roizenblatt et al. (2001), fibromyalgia patients were found to have a significantly reduced level of deep sleep (also called slow-wave sleep), leading to non-restful sleep. (2)
Increased Alpha-Delta Sleep Anomaly
One prevalent sleep abnormality in fibromyalgia patients is called the alpha-delta sleep anomaly. This phenomenon is created by the intrusion of alpha waves (usually present during wakefulness) into delta waves (which are dominant during deep sleep). This intrusion disrupts the restorative nature of deep sleep, leaving patients feeling fatigued even despite a full night’s sleep. Moldofsky et al. (1975) were among the first to identify this anomaly, referring to fibromyalgia as a “non-restorative sleep syndrome”. (3) Abnormal “awake” brain waves have remained a hallmark of sleep disturbances in fibromyalgia.
Hypervigilance and Sleep Perception
Fibromyalgia is often characterized by heightened pain sensitivity and hypervigilance which is an increased state of alertness that can make it difficult for individuals to relax and fall asleep.
This heightened state of alertness is often accompanied by a negative perception of sleep, where patients feel they haven’t slept well, even if objective sleep studies show otherwise. A study by Riemann et al. (2012) suggests that this hypervigilance may be related to dysregulation of the central nervous system, leading to persistent sleep difficulties. (4)
Neurotransmitter Imbalances
Neurotransmitter imbalances, particularly involving serotonin and norepinephrine, are also implicated in the sleep disturbances experienced by fibromyalgia patients. Both neurotransmitters play a key role in mood regulation and sleep. Studies have shown that fibromyalgia patients frequently have lower levels of serotonin, which can lead to reduced sleep quality and increased pain perception.
Moreover, serotonin is a precursor to melatonin, the hormone responsible for regulating the sleep-wake cycle. Low serotonin levels can thus result in decreased melatonin production, further disrupting sleep.
Frequent Arousals and Micro-Arousals
People with fibromyalgia often experience frequent arousals or micro-arousals throughout the night, which can fragment sleep and prevent them from reaching deeper, more restful stages of sleep. (5)
Obstructive Sleep Apnea Syndrome (OSAS)
Up to 50% of people with FM have obstructive sleep apnea, distributed between mild OSAS (33%), Moderate (25%) and Severe (42%). Symptoms include loud snoring and periodic pauses in breathing for 10 - 20 seconds, after which breathing resumes with a snort.
Aside from the oxygen deprivation caused by intermittent breathing (an obvious problem), OSAS creates a highly disrupted environment for the brain. When breathing stops and oxygen levels drop the brain is briefly awakened (aroused) to ensure breathing resumes. These interruptions can occur 5 to 100 times per hour, and the constant “emergency” responses required of the brain make a deep and restful sleep impossible. (6)
Restless Leg Syndrome (RLS)
Approximately one-third of people with FM experience restless leg syndrome, which involves numbness and tingling in the lower limbs and restless, twitching legs. A study conducted by Viola-Saltzman et al. confirmed the high prevalence of RLS within the FM community and also determined that the symptoms and effects of RLS were experienced more strongly by the FM group versus the control. (7)
Conclusion
As we saw, the role of FM in creating sleep disturbances is very complex. The main takeaway is that if you have FM, the quality of your sleep is almost certainly being affected - most likely a lot. Because of the many ways FM can impact sleep, a multifaceted and highly customized approach is often necessary to improve sleep quality. Better sleep quality will go a long way in reducing the severity of your FM symptoms, making this a high-payoff priority in your FM wellness journey.
In our follow-up blog on getting better sleep for people with FM, we’ll discuss some of the options you may want to discuss with your healthcare providers, as well as a few simple changes in habits and sleep environment that you can try on your own. You will also find a checklist to help focus your efforts as you work on getting better, more restful sleep.
Citations and References
Bigatti, S.M., Hernandez, A.M., Cronan, T.A. and Rand, K.L. (2008), Sleep disturbances in fibromyalgia syndrome: Relationship to pain and depression. Arthritis & Rheumatism, 59: 961-967. https://doi.org/10.1002/art.23828
Roizenblatt, S., et al. (2001). "Alpha sleep characteristics in fibromyalgia." Arthritis & Rheumatism, 44
Moldofsky, H., Scarisbrick, P., England, R., & Smythe, H. (1975). "Musculoskeletal symptoms and non-REM sleep disturbance in patients with 'fibrositis syndrome'." Psychosomatic Medicine, 37(4), 341-351.
Riemann, D., Spiegelhalder, K., Espie, C., Pollmächer, T., Leger, D., Bassetti, C., & Van Someren, E. J. (2012). "Chronic insomnia: clinical and research challenges--an agenda." Journal of Sleep Research, 20(4), 388-395.
Chervin, R. D., Teodorescu, M., & Kushwaha, R. (2009). Sleep disturbances and sleep disorders in fibromyalgia. Current Treatment Options in Neurology, 11(5), 315-323.
Köseoğlu Hİ, İnanır A, Kanbay A, Okan S, Demir O, Çeçen O, İnanır S. Is There a Link Between Obstructive Sleep Apnea Syndrome and Fibromyalgia Syndrome? Turk Thorac J. 2017 Apr;18(2):40-46. doi: 10.5152/TurkThoracJ.2017.16036. Epub 2017 May 1. PMID: 29404158; PMCID: PMC5783078.
Viola-Saltzman M, Watson NF, Bogart A, Goldberg J, Buchwald D. High prevalence of restless legs syndrome among patients with fibromyalgia: a controlled cross-sectional study. J Clin Sleep Med. 2010 Oct 15;6(5):423-7. PMID: 20957840; PMCID: PMC2952743. 8m
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