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Insomnia & Fibromyalgia

Common Bedfellows

By

Updated December 17, 2012

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

A lot of people with fibromyalgia also have the best-known sleep disorder around: insomnia. Sometimes called a symptom, while other times referred to as an overlapping condition, insomnia is prevalent enough that the American College of Rheumatology included the disorder in its 2010 revised diagnostic criteria for fibromyalgia.

What is Insomnia?

Insomnia is defined as the inability to get enough sleep to feel rested. You may lay awake in bed, unable to get to sleep, or you may wake up frequently. For a diagnosis of insomnia, this has to happen even when you have the opportunity for sleep, and it must impair your functionality.

You may have insomnia if:

  • It takes you 30 minutes or more to fall asleep,
  • OR you can't sleep more than 6 hours a night,
  • AND have one of the above symptoms 3 or more nights a week.

Insomnia Symptoms vs. Fibromyalgia Symptoms

It can be hard to distinguish insomnia symptoms from fibromyalgia symptoms. They can both cause:

  • Fatigue
  • Headache
  • Attention/concentration problems
  • Low energy
  • Lack of motivation
  • Anxiety or other mood problems

The major distinguishing factor, therefore, is the regular inability to sleep through the night.

When Fibromyalgia & Insomnia Join Forces

When you consider that fibromyalgia pain can be enough to keep you awake at times, you may wonder whether that's what's really behind the inability to sleep. In fact, sleep problems are common in pain conditions. However, a 2009 study showed that while people with rheumatoid arthritis had more insomnia symptoms than healthy people, those with fibromyalgia were even more likely to have sleep problems than those with rheumatoid arthritis. Studies also suggest that sleep problems in fibromyalgia are independent of depression.

Additionally, insomnia is believed to make fibromyalgia symptoms more severe, which means treating your sleep problems may have the secondary effect of improving pain, fibro fog and more.

We don't know exactly why fibromyalgia and insomnia occur together so frequently, but it may be due to some common physiology. Fibromyalgia is linked to dysregulation of the neurotransmitter serotonin, which plays an important role in regulating the sleep cycle.

Treating Insomnia in Fibromyalgia

Because many fibromyalgia treatments increase serotonin activity in your brain, they may improve your insomnia symptoms. It's also fairly common for people with both conditions to take conventional sleep medications, but many of those have not been studied in relation to fibromyalgia.

Drugs that are shown to improve sleep in fibromyalgia include:

People with fibromyalgia commonly take supplements that improve sleep, such as melatonin and valerian. Research on melatonin's effectiveness is split, however, and almost no research has been done on valerian in fibromyalgia. Anecdotal evidence suggests that these supplements may work for some people, but not others.

A type of psychological counseling called cognitive behavioral therapy (CBT) has shown promise in some studies. Based on the premise that beliefs and behaviors contribute to sleep problems, the goal of CBT is to change attitudes and eliminate detrimental habits. Stress management may also be beneficial.

Limited evidence also suggests that acupuncture may help alleviate insomnia in fibromyalgia.

More Resources

For more information on sleep problems related to fibromyalgia, see:

Sources:

Arnold LM, et al. Arthritis research & therapy. 2011 Jun 13;13(3):R86. Improvement in multiple dimension of fatigue in patients with fibromyalgia treated with duloxetine: secondary analysis of a randomized, placebo-controlled trial.

Belt NK, Kronholm E, Kauppi MJ. Clinical and experimental rheumatology. 2009 Jan-Feb;27(1):35-41. Sleep problems in fibromyalgia and rheumatoid arthritis compared with the general population.

Bennett RM, et al. BMC musculoskeletal disorders. 2007 Mar 9;8:27. An internet survey of 2,596 people with fibromyalgia.

Brown MA, Guilleminault C. Current pharmaceutical design. 2011;17(15):1430-5. A review of sodium oxybate and baclofen in the treatment of sleep disorders.

Carette S, et al. Arthritis and rheumatism. 1994 Jan;37(1):32-40. Comparison of amitriptyline, cyclobenzaprine, and placebo in the treatment of fibromyalgia. A randomized, double-blind clinical trial.

Carney CD, et al. Journal of psychosomatic research. 2007 Feb;62(2):179-88. Beliefs about sleep in disorders characterized by sleep and mood disturbance.

Citera G, et al. Clinical rheumatology. 2000;19(1):9-13. The effect of melatonin in patients with fibromyalgia: a pilot study.

Edinger JD, et al. Archives of internal medicine. 2005 Nov 28;165(21):2527-35. Behavioral insomnia therapy for fibromyalgia patients: a randomized clinical trial.

Lundeberg T, Lund I. Acupuncture in medicine. 2007 Dec;25(4):184-97. Did 'The Princess on the Pea' suffer from fibromyalgia syndrome? The influence on sleep and the effects of acupuncture.

Miro E, et al. Journal of health psychology. 2011 Jul;16(5):770-82. Cognitive-behavioral therapy for insomnia improves attentional function in fibromyalgia syndrome: a pilot, randomized controlled trial.

Moldofsky H, et al. Journal of rheumatology. 2011 Dec;38(12):2653-63. Effects of bedtime very low dose cyclobenzaprine on symptoms and sleep physiology in patients with fibromyalgia syndrome: a double-blind randomized placebo-controlled study.

Parish JM. Chest. 2009 Feb;135(2):563-72. Sleep-related problems in common medical conditions.

Reiter RJ, Acuna-Castroviejo D, Tan DX. Current pain and headache reports. 2007 Oct;11(5):339-42. Melatonin therapy in fibromyalgia.

Roizenblatt S, Neto NS, Tufik S. Current pain and headache reports. 2011 Oct;15(5):347-57. Sleep disorders and fibromyalgia.

Russell IJ, et al. Sleep medicine. 2009 Jun;10(6):604-10. The effects of pregabalin on sleep disturbance symptoms among individuals with fibromyalgia syndrome.

Spaeth M, et al. Annals of the rheumatic diseases. 2012 Jun;71(6):935-42. Sodium oxybate therapy provides multidimensional improvement in fibromyalgia: results of an international phase 3 trial.

Staud R. Drugs. 2010;70(1):1-14. Pharmacological treatment of fibromyalgia syndrome: new developments.

Staud R. Expert opinion on pharmacotherapy. 2011 Aug;12(11):1789-98. Sodium oxybate for the treatment of fibromyalgia.

Theadom A, Cropley M. Sleep medicine. 2008 May;9(4):376-81. Dysfunctional beliefs, stress and sleep disturbance in fibromyalgia.

Ware MA, et al. Anesthesia and analgesia. 2010 Feb 1;110(2):604-10. The effects of nabilone on sleep in fibromyalgia: results of a randomized controlled trial.

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