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:
- 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:
- Cymbalta (duloxetine)
- Lyrica (pregabalin)
- Xyrem (sodium oxybate>
- Flexeril (cyclobenzaprine)
- Elavil (amitriptyline)
- Cesamet (nabilone)
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.
For more information on sleep problems related to fibromyalgia, see:
- Unrefreshing Sleep
- Understanding Sleep Dysfunction
- Create Better Sleep Habits
- What Could Be Keeping You Awake
- Getting Comfortable in Bed
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