Solutions for Sleep
By Bruce Campbell
(Note: From the series Treating CFS and Fibromylgia.)
Sleep problems are one of the most common complaints among people with fibromyalgia and Chronic Fatigue Syndrome. With both conditions, poor sleep is a major source of intensified symptoms. Patients may spend a night in bed, but wake up as tired as when they went to bed. Other sleep problems are common as well, such as difficulty getting to sleep, waking in the middle of the night or early in the morning, and over sleeping.
It is widely believed that a major cause of sleep problems for people with FM and CFS is an insufficient amount of the deepest and most restorative type of sleep, called delta sleep. Patients with CFS and fibromyalgia often get less delta sleep than they need, and thus don't feel refreshed when they get up in the morning. When healthy volunteers in a research experiment were deprived of delta sleep, they developed symptoms of fibromyalgia in a few days.
Treating sleep is especially challenging because there is no single medication that has proven helpful in solving sleep problems for people with CFS and fibromyalgia. Also, many people taking sleep medications develop drug tolerance, so that a medication becomes less effective over time. For both these reasons, sleep problems can benefit from a flexible, experimental approach that utilizes a variety of strategies.
Medications commonly used to treat sleep problems include over the counter products like melatonin and valerian; antihistamines such as Benadryl; clonazepam (Klonopin); trazadone; tricyclic antidepressants, such as amitriptyline (Elavil); benzodiazepines, such as Halcion;and the hypnotic drug Ambien. Often a combination of two drugs is prescribed, one to initiate sleep and another to maintain sleep. If you think medications might improve your sleep, a reasonable approach is to find a physician willing to work with you to find what helps in your unique situation.
Improving Sleep Environment and Habits
Sleep can be disturbed by factors like irregular hours, a noisy environment, an uncomfortable bed or a noisy sleeping partner. You may be able to improve your sleep by changing your sleep environment and your sleep habits. Here are five ideas to consider.
1. Have a Comfortable Environment: Provide yourself with an environment conducive to good sleep by using a good mattress, and by exercising control over light, noise and temperature. (Note: Noise includes snoring by your sleep partner. Snoring can be a symptom of sleep apnea; see discussion on apnea at end of article.)
2. Establish a Routine: Go through the same routine each night and have a consistent bedtime. Prepare for sleep by gradually reducing your activity level in the several hours before bedtime and by having "going-to-bed" rituals you do consistently at the same time each night. Things like brushing your teeth or doing light reading every night before retiring can help you wind down and get ready psychologically for sleep.
3. Get Up at the Same Time: Setting an alarm so that you get up at the same time each day can help you adjust gradually back to more normal hours. Usually, you don't need to compensate by changing your bed time to an earlier hour; your body will adjust itself.
4. Limit Daytime Napping: Often, daytime napping interferes with night time sleep. If you nap during and day and find that you have trouble falling asleep, or your sleep is worse than usual when you nap, you might consider sleeping only at night. (On the other hand, if napping does not disturb your nighttime sleep, you may need more rest.)
5. Use Relaxation or Distraction to Fall Asleep: It may be easier to fall asleep if you listen to quiet music or distract yourself in some other way, such as by counting or watching your breath. Relaxation techniques can help you fall asleep.
Additional Sleep Aids
Looking for more ideas? Here are four additional approaches that may help you sleep better.
1. Pacing: Being too active can create a sense of restlessness sometimes called the "tired but wired" feeling. Pacing can be an antidote. By keeping your activity level within the limits imposed by your illness, and by having a quiet period to wind down before going to bed, you can avoid having your sleep affected by edgy, hyper-alertness.
2. Controlling Stress and Worry: Stress often leads to muscle tension, which makes falling asleep more difficult. Practicing relaxation methods can help you ease tense muscles. Try relaxation procedures like those described in the articles in the stress management archive or soak in a hot tub or bath before going to bed.
If you have difficulty falling asleep because you are preoccupied with problems and lie awake with thoughts running through your head, consider setting aside a "worry time" each night before going to bed. Take a half hour to write down all your worries and what you'll do about them. If worries come up as you are trying to go to sleep, tell yourself "I've dealt with that. I don't have to worry because I know what I'm going to do."
3. Avoiding Caffeine, Alcohol & Tobacco: Consuming too much caffeine, drinking alcohol and smoking can make getting good rest more difficult. Avoid products containing caffeine, like coffee, tea, soft drinks and chocolate, for several hours before going to bed. Avoid alcohol before bedtime; it can create restless and uneven sleep. The nicotine in tobacco is a stimulant, thus smoking is a barrier to falling asleep.
4. Check Your Meds: Some sleep medications that are effective when used occasionally can produce poor sleep if used frequently. Also, some drugs produce side effects, like a feeling of grogginess in the morning. Medications taken for other problems may interfere with sleep if they contain substances like antihistamines or caffeine.
Other Sleep Problems
Some patients have one or more additional sleeping problems besides insufficient delta sleep. Two of the most common are sleep apnea and restless legs syndrome.
Sleep Apnea: Apnea, meaning absence of breathing, occurs when a person's airway becomes blocked during sleep and he or she stops breathing. An episode can last from a few seconds to a few minutes. The person then awakens, gasps for air and falls asleep again. This can occur many times a night, leaving the person exhausted in the morning. Sleep apnea deepens the fatigue experienced by people with CFS and fibromyalgia.
Apnea is a treatable condition. A common remedy is the use of a CPAP (continuous positive airway pressure) machine to keep the airway open. The patient wears a mask through which a compressor delivers a continuous stream of air, keeping the airway open and thus allowing uninterrupted sleep. Other treatments are also used for this condition. If you are excessively tired in the morning or have trouble staying awake during the day, you may have apnea. Consult with your doctor, who may refer you to a sleep specialist.
Restless Legs Syndrome: Restless legs syndrome (RLS) involves "twitchy limbs," strong unpleasant sensations in the leg muscles that create an urge to move. The problem is often at its worst at night. Self-management techniques that may help include reducing consumption of caffeine and other stimulants, establishing a regular sleep pattern, doing exercise that involves the legs, distracting yourself by immersing yourself in activity, using hot or cold baths or showers, and taking supplements to counteract deficiencies in iron, folate and magnesium.
Several categories of medications may also help, including sedatives, drugs affecting dopamine, pain relievers and anticonvulsants. Two of the more commonly used medications are Requip and Mirapex. Check with your doctor if you believe you might have this condition.