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Morning Symptoms of Fibromyalgia

Facing the First Problems of the Day


Updated May 28, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Do you frequently wake up exhausted, stiff and achy, with puffiness in your hands and feet or around your eyes? These are all part of morning symptoms when you have fibromyalgia.

Not everyone with fibromyalgia experiences morning symptoms, but they are quite common. This is one of those areas medical research hasn't yet explained, so we can't say why we get them. We also don't know a lot about alleviating them, other than what we learn from each other.

Morning Exhaustion

It's pretty simple to sum up why we feel exhausted first thing in the morning, when healthy people feel refreshed and energized - we don't sleep well.

Fibromyalgia is linked to multiple sleep disorders, including insomnia, obstructive sleep apnea, restless legs syndrome and bruxism (teeth grinding). Research also shows that some of us have abnormal sleep patterns that result in interrupted deep sleep.

Any one of these problems can disrupt your sleep and make you tired the next day. If you have several of them in combination, it's even harder to get good-quality sleep.

Then you add other fibromyalgia symptoms to the equation. Pain can certainly keep us awake or wake us up periodically. Anxiety makes it difficult to relax. Sensitivity to noise and light can make seemingly minor things jar us awake.

For those of us with a pain type called allodynia, even the brush of a sheet against your skin or a wrinkle in your pajamas can be unbearable. Some people refer to fibromyalgia as the "princess and the pea" syndrome because we will bothered by even the tiniest thing.

A lot of people with fibromyalgia complain of getting too hot and/or sweaty to sleep well. Temperature sensitivity is common in this disorder, and not just sensitivity to heat. A hand sticking out of the covers may get chilled to the point of discomfort or even severe pain, and we can take a long time to warm up.

Our sleep problems can be tough to tackle. Depending on your symptoms, your doctor may recommend a sleep study to diagnose sleep disorders. The findings could lead to treatments such as medications or a CPAP machine for sleep apnea, or to suggested lifestyle changes for improving sleep. Pain management and anxiety treatment can be an important part of helping you sleep better as well.

Morning Stiffness

It's fairly normal for us to wake up feeling stiff and achy all over or to have a hard time standing up straight for a while.

For many of us, the achiness tends to be different from other fibromyalgia pain. It's often more like the muscle pain a healthy person would feel the day after a really strenuous activity or possibly a minor car accident.

It's not clear why our bodies are like this in the mornings, but some experts suggest that it could simply be inactivity. While we may feel pretty sedentary most of the time, people watching us often say that we're fidgety. What's happening is that our position will make something start to hurt, so we'll shift a little. Then something else starts hurting, so we shift again. It's possible that we're stiff in the morning because we haven't shifted around enough all night.

Some people say they're less stiff and sore in the mornings if they take a hot bath, possibly with Epsom salt, before bed. Others get relief by doing simple yoga or other stretches before getting out of bed. It may also be medications, either for pain or sleep, that make the difference. As with everything else, we need to experiment to find what works. (It's always a good idea to ask your doctor for ideas and talk about things you'd like to try so you can make sure they're safe.)

Morning Puffiness

Some of us wake up with puffiness in our hands and feet or around our eyes. Again, we can't say for sure why.

One small study suggests a connection between fibromyalgia and fluid retention syndrome (FRS), which is also called idiopathic edema. However, it's not clear how common this condition is in FMS or whether FRS is behind all cases of puffiness in us.

Regardless, the puffiness is generally believed to be the result of fluid retention, not inflammation. However, many doctors report that diuretics haven't helped this symptom in their patients. Elevation generally isn't effective, either. Some experts hypothesize that our bodily secretions may be thick and sluggish and therefore don't flow properly, which could explain why they'd pool with inactivity.

Sometimes the puffiness doesn't cause problems, but sometimes it may be uncomfortable or painful. Common problems include pain putting weight on a puffy foot first thing in the morning, or clumsiness due to temporary loss of dexterity in the fingers. Using puffy hands to put makeup on puffy eyes can definitely be a challenge as well.

Sometimes, people say it helps to eat such foods as cucumbers that help relieve fluid retention. Others say they're helped by massage, especially a specific type of massage called manual lymph drainage. Again, we each have to figure out what works best for us.

Some medications cause puffiness as well, so be aware of possible side effects and discuss them with your doctor.


Besteiro González JL,et. al. Psicothema. 2011 Aug;23(3):368-73. Sleep architecture in patients with fibromyalgia.

Dauvilliers Y, Touchon J. Clinical neuropsychology. 2001 Feb;31(1):18-33. Sleep in fibromyalgia: review of clinical and polysomnographic material.

Deodhar AA, et. al. British journal of rheumatology. 1994 Jun;33(6):576-82. Fluid retention syndrome and fibromyalgia.

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