Expert Q&A: How Do I Sleep Better with Fibromyalgia?
Shaun Shontae Hook first began having joint pain when she was just 13—but it wasn’t until after she gave birth to her first child, in 2002, that the pain really reared its head. “At first I thought I was just getting older,” says the 42-year-old owner of Hook Cleaning & Organization Services in Blythewood, S.C. “My doctors thought maybe it was due to having a baby. But the pain was everywhere—my hips, back, ankles, knees.”
In 2004, Hook was diagnosed with polyarthralgia, a medical condition marked by joint pain, tenderness, stiffness, and swelling. It wasn’t until 2011 that a rheumatologist finally diagnosed Hook with fibromyalgia.
A chronic disorder that causes fatigue and muscle soreness, fibromyalgia may change how the brain processes pain signals. While it’s most common in middle-aged women, it can strike either sex at any age and is estimated to affect between 2% and 6% of people worldwide, according to the National Sleep Foundation. Many people who have fibromyalgia also have other conditions such as lupus, rheumatoid arthritis, irritable bowel syndrome (IBS), migraines, and depression.
We talked with Paul Corona, MD, a family doctor based in Orange County, Calif., who specializes in fibromyalgia, chronic pain, and insomnia, to learn more about the causes of fibromyalgia—and how you can get a better night’s sleep if you have this condition.
Q: What is fibromyalgia and what causes it?
Fibromyalgia is an inflammatory condition that causes scattered pain throughout your body. It’s really a mystery illness, because there’s no diagnostic blood test or scan to diagnose it, like there is for rheumatoid arthritis or autoimmune diseases. It’s usually related to stress and mood problems caused by chemical imbalances in your nervous system, which feeds every joint and tissue in your body. It can be triggered by injuries, illness, disease, and high-stress events. Like a lot of conditions, including mood problems such as anxiety, depression, and bipolar disease, fibromyalgia tends to run in families.
Q: What are the most common symptoms of fibromyalgia?
Unlike rheumatoid arthritis or osteoarthritis, where patients feel pain in a specific area, fibromyalgia pain often doesn’t make sense since it’s often felt throughout the body—in the neck, arms, legs, and back. Because fibromyalgia pain is scattered and comes and goes, many people don’t make the connection.
People with fibromyalgia often have problems sleeping, since stress, pain, and anxiety can all cause insomnia. They may feel fatigued and have problems with thinking and memory, because persistent chronic pain and insomnia wears them out. It’s also common to experience stiffness, headaches, painful menstrual periods, and tingling or numbness in the hands and feet.
Q: Why is fibromyalgia thought to be linked to disorders like rheumatoid arthritis and depression?
Lupus, rheumatoid arthritis, osteoarthritis, IBS, migraines, and depression are all related to stress. People often don’t think about the underlying cause because they’re so focused on the pain. But stress and pain cause anxiety, which cause symptoms to worsen, which causes more anxiety, and so on. That’s why treatment focuses not just on relieving pain but on trying to get down to what might be causing fibromyalgia. How can we help improve your mood and relieve stress? Would you benefit from treatment for anxiety or depression?
Q: How is fibromyalgia diagnosed?
Since there are no lab tests for fibromyalgia, we use a rule-out diagnosis. We’ll usually start by taking blood tests to check for diagnosable autoimmune diseases, like rheumatoid arthritis. If these tests come back normal and we can rule out these conditions, we’ll look at the person’s health history for common fibromyalgia symptoms: Is there a pattern of pain in different parts of the body with tender points? How’s the person’s mood and stress levels? If symptoms match up and have been ongoing, that’s when we diagnose with fibromyalgia.
Q: What is the connection between fibromyalgia and sleep?
Insomnia is very common for people with fibromyalgia. One study found 96% of people with fibromyalgia had trouble sleeping. Anyone who’s uncomfortable and in pain won’t sleep as well. Underlying neurochemical imbalances fuel a lot of mood-related conditions, including fibromyalgia. Sleep problems linked to fibromyalgia could be caused by abnormal levels of neurotransmitters like serotonin and neuroendocrine and immune substances like growth hormone and cortisol.
Studies have also shown that people with fibromyalgia tend to have a lower threshold for pain and shorter periods of short-wave sleep [also known as deep sleep], which suggests they’re not sleeping as soundly during the most restful, non-REM [rapid eye movement] sleep.
Q: Can having trouble sleeping make fibromyalgia worse?
A good night’s sleep is so valuable. Some research has shown that women who are sleep-deprived are more likely to have a lower pain threshold. It’s a vicious cycle: The less you sleep, the more likely you are to feel foggy and tired and have a flare-up of fibromyalgia pain the next day.
Q: What type of mattress do you recommend for your patients?
A good mattress that conforms to your body and helps to relieve pressure points may make it easier for you to get a good night’s rest. We usually recommend firmer mattresses, which offer better support for your spine. Very soft mattresses can get people into bad sleep positions that can aggravate pain. We also recommend finding a good pillow for better neck support.
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Q: Can medications can help with fibromyalgia and sleep?
I often prescribe sleep medications to help people sleep better initially, but I don’t like people to be on them forever. I find that SNRIs (serotonin and norepinephrine reuptake inhibitors like Cymbalta, Pristiq, or Effexor XR) to treat depression often help with both fibromyalgia and sleep. These medications help balance norepinephrine, which seems to be the main neurochemical that links stress and pain. SSRIs (selective serotonin reuptake inhibitors like Prozac, Zoloft, and Lexapro) don’t tend to help as much because they don’t address norepinephrine.
Q: What are your other top tips for sleeping better with fibromyalgia?
First and foremost, good sleep hygiene sets you up for a good night’s sleep. Try to have a healthy dinner earlier in the night, because eating a heavy meal with lots of fat, carbs, and sugar within a couple of hours of hitting the sack can cause acid reflux that makes it harder to sleep. Don’t watch TV or use your phone or computer in the hour before you go to bed, because the blue light they emit has been shown to disturb sleep. Save the bedroom for relaxation, sex, and sleep, and keep it dark and quiet. Give yourself time to wind down. Take a bath, practice deep breathing exercises, or read a book (just skip the suspense novels!).
A healthy lifestyle can also help with both fibromyalgia and sleep. Cardiovascular exercise relieves stress, and people who exercise tend to have fewer problems with anxiety and pain in general. I recommend getting your heart rate up for 30 to 45 minutes three to four times a week. Healthy eating helps keep your weight in check, which can also help.
Otherwise, a massage, acupuncture or sitting in a Jacuzzi can help relax your muscles and help you sleep better. Over-the-counter anti-inflammatory medications like ibuprofen can relieve inflammation in the joints. And if you’re highly stressed or anxious, you might benefit from medications or therapy.
While it can be frustrating, know that there’s help out there. Start with your primary care doctor, who knows you well and can order tests as needed. He or she might refer you to a rheumatologist, psychiatrist, or other specialist. Just make sure your practitioner understands fibromyalgia and how to treat it.
Another condition that can make getting a good night’s rest difficult? Sleep apnea. Here’s how to sleep better with sleep apnea.