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Adrienne Dellwo

Sleep Differences Separate Fibromyalgia From Chronic Fatigue Syndrome

By November 9, 2011

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Research Brief

New research published in the journal Sleep show different sleep abnormalities between people with chronic fatigue syndrome (ME/CFS) and those with ME/CFS plus fibromyalgia (ME/CFS+FMS).

This supports the theory that FMS and ME/CFS are different illnesses, and increases knowledge of sleep abnormalities in both conditions.

Researchers found:

  • ME/CFS-only participants were more likely than healthy people to wake up from REM sleep;
  • ME/CFS+FMS participants were more likely than health people to wake from REM, stage-1 and stage-2 sleep;
  • ME/CFS+FMS participants were more likely than ME/CFS-only to wake from slow-wave and stage-1 sleep;
  • ME/CFS+FMS participants had shorter durations of stage-2 sleep than ME/CFS-only or control groups.

(Read more on the Stages of Sleep.)

Earlier research has also indicated abnormal sleep patterns in FMS and ME/CFS. These new findings shore up that body of research and also help differentiate the illnesses from each other.

Some experts believe that sleep problems play a key role in FMS and ME/CFS, and sleep-related research is important for better understanding, possible treatments and even potential diagnostic tools.

Thus far, FMS has been linked to several known sleep disorders, including sleep apnea, insomnia and restless legs syndrome. ME/CFS has been linked to abnormal sleep rhythm but no defined disorders.

Learn more or join the conversation!


Photo © Angelo Cavalli

November 9, 2011 at 7:15 am
(1) acker says:

yay, i have both, cfs more marked.
yes sleep is disrupted (like now).
yes a decent sleep makes the next day much better than one wwithout.
also please take a look at the above article about cfs being about the brain’s perception of what is…
hopefully more research can follow these lines and get to the cause of the pain, the sleep disturbance, the aggression, the head to toe ness of it all, the severity, the everything of it all so we can get some treatment at the source

November 9, 2011 at 10:20 am
(2) Damien Woodi says:

My fibromyalgia started many years ago and I didn’t know it. I always complained “my skin hurts”. The only way I could describe it was it felt like I was sunburned and the slightest touch would hurt. At the same time, I had terrible problems staying asleep. I woke up every hour. I even wrote down the times I woke up one night to give to my doctor. They put me on Trazodone and it works pretty good most nights. Then about 5 years I had an adverse affect to Simvastatin side where it caused severe muscle pain. I truly believe that’s what started my fibromyalgia. First it was in my neck, right shoulder and armpit area. I put heat on it until I was burned and ice on it until I was frostbitten but nothing worked. My doctor did about every test imaginable including EMG, and MRI. Finally I was referred to a rheumatologist and was “officially” diagnosed. I took Nurontin (3600mg daily) and Effexor XR for about a year and all that did was make me gain 60lbs. Now I’m on Lyrica, and still on Effexor. At first the Lyrica seemed like it worked but now it just takes the edge off. I just asked my doctor about vicodin which a relative takes for chronic pain and she’s looking into it. In the meantime, I just sit on the porch in the middle of the night when nobody’s around and cry because I’m so tired of the pain. Just looking for information online to learn more about the subject and chronicpainkillers.com mention that these medicines can be dangerous due to side effects, some opinion?

November 11, 2011 at 5:17 pm
(3) Randal Tucker says:

One of the very best pain relievers for fibromyalgia is Nucynta. It comes in doses of 50, 75 and 100 mg. Nucynta is more effective than hydrocodone as it acts on the central nervous system as well as norepinephrine receptors and so works through a dual action. It also appears to have a lower addiction potential than many of the other opioids. A change to this newer opioid might help a good deal with the kind of pain that you have.

November 20, 2011 at 10:52 pm
(4) lynn says:

Nucynta is for acute pain & short lasting. If one is going to take a opioid for FM, it is better to take an Extended Release one. You keep the system more even.

November 9, 2011 at 11:03 am
(5) sharon says:

Yes, yes and yes sleep is the main problem for me. I can’t get to sleep without ambien and I can’t stay asleep. I used to take (10 years ago) just a smidgen of ambien and now have to use 10mg. I tried trazodone and it makes me feel hung over and yucky the next day. Now am trying a very low dose of Prozac–5mg to increase seritonin and 100mg of gabapentin. Hopefully this will help.

People give me advice about good sleep hygiene, we all know what that is and I do follow the rules. But this is bigger than just not having caffiene–I gave that up, going to bed at a certain time and getting up at the same time everyday.

I know what you mean about being up at night and crying. I try to do my lamenting and breast beating in private because my family is already concerned for me and I don’t want to worry them any more. I try to put on my happy face during the day.

I just hang in there knowing that someday there will be an answer.

Until then, more stomach breathing and ‘Frazier’ reruns.

November 9, 2011 at 5:39 pm
(6) Rachael says:

Histamines are mainly connected with allergic responses, but also with digestive disorders, joint pain, inflammation, fatigue and depression/anxieties and insomnia. Histamines are produced as a part of the inflammatory process and this release takes place in disorders of the immune system.

High histamine levels could be a contributing factor in CFS and FM and problems with sleep. Elevated levels of histamine in the body are associated with damage to nerve cells and the central nervous system. Histamine also plays an important role in normal cycles of sleep and wakefulness called circadian rhythms that govern our twenty-four hour day. If levels of histamine don’t fall off in the evening deep restorative sleep will be hard to come by.

Antidepressants, (at low dose), like amitriptyline help many fibro and CFS patients. Amitriptyline contains a very potent antihistamine, that may help regulate sleep and immune response. Also, some over-the-counter antihistamines may be beneficial for some CFS and FM sufferers.

November 9, 2011 at 9:22 pm
(7) Andrew says:

If you suffer from fibromyalgia, check your medical records to see if you were ever prescribed a fluoroquinolone like cipro avelox levaquin. I was young and healthy up until taking Ciprofloxacin. After the Cipro I had “brain fog” for the first time in my life. Cipro damaged my brain and I have been suffering with muscle pains and fatigue. Very hard to believe but it’s true. Cipro caused my fibromyalgia, Cipro has taken away the “old me”.

November 11, 2011 at 7:31 am
(8) Mindy says:

Andrew, I am sorry you are suffering. May I ask what makes you think it was the Cipro? What condition did you take the medication for? I am a nurse and also have Fibro and CFS. Just trying to make sense of this. Did your MD agree that the Cipro caused your fibro? Thank you for your time and I hope you find help. Mindy

November 12, 2011 at 2:56 pm
(9) shosh says:

Hi Mindy and Andrew. read this site and see that Andrew is very probably correct. I have no idea what this drug is called in South Africa, I might have taken it as well. http://www.antibiotics.org/

November 10, 2011 at 3:35 pm
(10) Abot Bensussen says:

For the last five years I have been taking Xyrem for sleep. I take it in two doses, one at about 10pm and another when I awake at about 2-3 am. While getting the “good”sleep, the deep and restorative sleep. I also use a Vpap machine. My sleep Dr., a psychiatrist, literally saved my life as I was so desperate for sleep that I overdoses on pain pills one time.

With deep sleep I have much less pain, more energy, and I can read and drive again. Am back in community college classes and having an active and pleasant life. I owe this to good sleep. I wish all of us fibromyalgia sufferers could use this, too.

November 11, 2011 at 7:36 am
(11) Mindy says:

Abot, I have Narcolepsy and Fibro and CFS. I can sleep most of the time, or cannot sleep at all. Did you ever have a time before Xyrem you slept but it was not refreshing? Does it put you in a better quality sleep? That is what I need. Thanks!

November 11, 2011 at 4:38 pm
(12) Abot Bensussen says:

Mindy, before I had Xyrem for sleep, I was an insomniac and suffered greatly. Bedridden, isolated, and with a lot of pain. Finally I was referred to the sleep specialist and had sleep studies done. I wasn’t getting any deep sleep at all. (My father had been the same way). If I did sleep, I woke up quickly, could hear any sounds, and was so tired during the day I could do nothing but stay in bed and watch TV.

Xyrem is used off label for Fibro. It’s used for narcolepsi, which also involves poor sleep. My mind began to heal after sleeping the 3rd and 4th stages again. I remembered things from my past that had laid dormant in my mind. My personality lightened, and I began to rebuild my life.

I’ve lost many friends during the illness, not being able to explain why I couldn’t go out and see them. Always saying “no”. This last year I lost my oldest son. This tragedy has brought about many changes, and just thank G-d that I can rely on good nights sleep. I’ve met so many supportive friends, I consider myself very lucky in such a difficult and saddening world.

to answer your question: yes, I woke up unrefreshed, as if I’d had no sleep at all. Finally went to see my rheumatologist in the morning instead of the afternoon and that’s when the sleep studies started. Good luck to you, without good sleep there is no good quality of life.

November 12, 2011 at 11:41 am
(13) sharon says:

Can you share with me the name and location of your sleep doctor?

November 11, 2011 at 7:27 am
(14) Mindy says:

I have Fibro, CFS and Narcolepsy. Sleep disorders of Alpha wave sleep intrusion and the Narcolepsy. Talk about Hypersomulence! I literally can and have slept 20 hours out of a day and I never wake refreshed. I am in my late 40s and seldom in my adult life have awakened feeling good. My pain is pretty well under control, but the sleepiness even with Provigil sucks. MY favorite saying is I just do what I have to do. In my next life I want to come back as a high endurance athlete. I would love to have the energy to go hiking, rafting, comping, running, ect. Not just work and come home and go to bed. Gotta go back to dreamland. Great article! Love your work!

November 11, 2011 at 4:11 pm
(15) Andrew Porter says:

One EEG and one blood test proved to be significant in establishing the reason for my lack of restorative sleep, a classic symptom of M.E.

Very low delta wave, or slow wave sleep, therefore I was not entering the deep sleep stages of sleep. The blood test showed very low levels of growth hormone release for my age. The blood test was wholly consistent with the EEG results.

Sedating antidepressants do not restore the correct sleep pattern and can cause insomnia. as I found out. Xyrem, however does induce deep sleep and does so without a hangover effect the following day

November 11, 2011 at 4:39 pm
(16) Abot Bensussen says:

You are so correct!! Kudos for getting prescription Xyrem. It’s a life changer. Mazel-tov!!

November 12, 2011 at 12:47 pm
(17) sharon says:

My fibro doctor says I would only be able to get xyrem if I were able to pay for it myself, since it is only prescribed for narcolepsy. I think right now it costs $4000 per month.

This is why I was wondering if you could share the name and location of your sleep specialist,Ii would like to make an appointment with him or her.

November 12, 2011 at 12:45 am
(18) Kim I. says:

Andrew, my sleep doctor told me there are three ways in which to increase growth hormone in our system: restorative sleep, vigorous exercise, and growth hormone injections (which he said are very expensive). BTW, I was diagnosed with non-restorative sleep. He recommended the vigorous exercise (this was when Xyrem was working for me.), especially on an elliptical machine, as it does not stress the knees as badly as other machines. Since the Xyrem stopped working, I am taking a combination of SEVERAL low dose sleep medications. Somehow with this combination and the use of a CPAP machine, I am getting adequate 3 and 4 stage sleep (which a second sleep study confirmed). If you can find a doc who, like Dr. Teitelbaum, gets the concept of several low dose sleep meds, then you’re fortunate. Now I am focusing on getting the vigorous exercise, when my blood sugar isn’t crashing on me.

November 11, 2011 at 5:24 pm
(19) Donna says:

I am wondering if anyone sleeps better during the day than they do at night. I go up to bed at 9 pm. watch TV until 11 pm and then read until 2 am. I sleep on and off during the night but once morning comes I tend to get in to a deeper sleep and don’t wake up until around 1 pm. I talked to my Dr. about this and she said since I don’t work and don’t have little kids do whatever works for me.

November 11, 2011 at 6:17 pm
(20) Mog says:

Donna, that is exactly my pattern too. Also, during bad spells, if I have an afternoon nap (about 2 hours after I’ve got up!), I find I sleep much better during that nap, and it can last at least 2 hours , and I always feel like it’s been a better sleep than I’ve had during the night.

November 12, 2011 at 12:51 am
(21) Kim I. says:

If you have adrenal problems associated with your CFS/ME/Fibro, then our cortisol is higher than it should be at night and lower than it should be in the morning. We are feeling better and more active in the evening, and more sluggish in the daytime. This is backward. If you want to know more about this, I suggest you read Dr. Wilson’s book, “Adrena Fatigue”, he makes more sense (other than Dr. Teitelbaum) than any one else I know who is supposed to help us. Dr. Teitelbaum recommends a sleep aid called Sleep Tonight, I think by Enzymatic Therapy, which since I have been using, has assisted me(along with my prescription regimen) in falling asleep tonight. It has ingredients which help counteract the higher cortisol level we have in the evening.

November 11, 2011 at 7:03 pm
(22) Cristi says:

I have been diagnosed with all three…sleep apnea, insomnia and restless leg syndrome. On top of not being able to sleep I have to wear a CPAP all night!

November 12, 2011 at 9:07 am
(23) Sandy Birkenmaier says:

Thanks so much for the link to the Stages of Sleep article (and everything else you do), Adrienne. From that article, I went to one listed at the bottom of the page on The Stages of Sleep (http://longevity.about.com/od/sleep/a/sleep_stages.htm).

The final sentence of the second article answered the question I have had for as long as I can remember. I have never understood how I can start dreaming immediately after falling asleep, whether I’m in bed at night, or dozing off during a car ride, since REM sleep happens as the last stage in the sleep sequence. I’ve had several people who “understand” sleep tell me that it can’t happen – somehow I’m imagining that I’m dreaming.

The last sentence of Mark Stibich’s article says, “If a personís REM sleep is disrupted, the next sleep cycle does not follow the normal order, but often goes directly to REM sleep until the previous nightís lost REM time is made up.”

Clearly, I’ve been suffering from sleep disruption for most of my life.

November 12, 2011 at 11:25 am
(24) Barbara says:

I have FM and Post-Polio Syndrome and my sleep patterns seem to change all the time. Although I take 100mg of Trazone, I still have disturbed sleep. My latest problem has been waking up 3-4am and not able to fall back asleep. I just read an article on FM that said that research has found that this problem is caused by low blood sugar! And I always felt hungry when I woke up, but didn’t want to start snacking in the middle of the night!! It suggested a protein snack before bed to eliminate this problem AND it works for me. Some turkey and mild cheese does the trick and I have no problem falling back asleep @3-4am. Whatever works is my mantra!

February 13, 2012 at 11:46 am
(25) Bev says:

I know this is an old thread but I`ll post anyway incase some of you are still reading it. Especially to Damien Woodi. I too was given Effexor to help with my Fibro/arthritis/neurological pain. Evil stuff! Took it for three days before the shooting brain zaps nearly made me crazy. Anything that makes you feel so sick just cant be that good for you. Lyrica I dont know about. I know Vicodin is strong but highly addictive. As is Effexor. Almost impossible to get off it without going through extreme withdrawal.
Please everyone suffering with Fibro/CFS, look into starting LDN which has the be the least toxic of all the useful drugs. Just Google LDN and begin the research and then try to find a doctor to prescribe it to you. This will be the most useful non toxic drug you can take without the awful side effects. Low dose NALTREXONE – LDN.

February 29, 2012 at 5:20 am
(26) Ann says:

I totally agree with what you said about Effexor. I’ve been taking it for 15 yrs. It was given to me because I was depressed about the death of a best friend. Effexor (venlafaxine, desvenlafaxine) should NEVER be Rx’d for short-term depression. I found it impossible to get off of. I tapered too fast (under direction of a psychiatrist), from 75mg, lowering down by 1/4 pill each week. I had mild brain zaps during the wean — dreamed I was being hit in the face by lightning, but I just thought it was scientifically curious –, some nausea, but not too bad. First day after the last 1/4 pill, I was manic. That was great! Love that confidence and energy! Then I sank to a “mild” depression (no interest in life, etc.), then on day 5 I was hit by a flood of rage. I had the rage (so had to stay away from people) for 3 months, and then the depression turned suicidal. I had never been that suicidal in my life. I got to where I was afraid I might actually do it, so went back on venlafaine, starting at 1/4 pill, waiting to see if that would put me back on a semi-functional level, then had to add another 1/4, then another, and finally fack to 75mg. THIS MEDICINE WAS DEVELOPED BY THE DEVIL!! Don’t take my word for it, go to ssrisex@yahoogroups.com. The people there are there because in addition to the symptoms above and others, they’ve lost their sexuality. Two people in the group killed themselves while I was reading their posts. They talk about all SSRI’s (venlafaxine is an SNRI), and there’s another group whose lives have been ruined by venlafaxine/Effexor at http://www.topix.com/forum/drug/effexor/ . I tried to tell all my doctors about the impossible withdrawal, but only one (a rheumatologist) believed me.

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