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Fibromyalgia & Sleep Apnea

The Relationship Between Fibromyalgia & Sleep Apnea, and How to Live With Both

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Updated July 25, 2011

Fibromyalgia and abnormal sleep breathing commonly go together. Sleep apnea is considered a possible cause or contributing factor for FMS, and FMS may increase your risk of sleep apnea.

Any sleep disorder can make FMS symptoms worse, so treating sleep disorders is often a big help in managing FMS. Sleep apnea is one of the more serious sleep disorders because it can lead to life-threatening conditions.

What is Sleep Apnea?

People with sleep apnea frequently stop breathing while asleep. The need for air can wake them up or bring them out of deep sleep. It's not uncommon for this to happen every few minutes, resulting in poor quality sleep.

The most common type of sleep apnea is called obstructive sleep apnea (OSA), in which the airway gets blocked at one of several possible sites. The obstruction can be from excess tissue in the air passage or nasal passages, or a large tongue or tonsils. When the tissues relax during sleep, they block the airway. Obesity increases the risk of OSA.

When sleep apnea stops your breathing, your blood oxygen levels drop, your heart beats faster, you get a burst of stress hormones, and your body rouses you to restart breathing. Some people have no idea this is going on, but some awaken with a gasp.

Sleep apnea carries an increased risk of several other health conditions, some of which are serious and potentially life threatening. Associated conditions include:

  • Stroke
  • Heart disease or heart failure
  • High blood pressure
  • Heartburn and reflux
  • Diabetes
  • Erectile dysfunction
  • Depression
  • Sudden death

Treatment can help lower your risk of developing these problems.

Why Do Fibromyalgia & Sleep Apnea Go Together?

So far, we don't know why fibromyalgia and sleep apnea go together. It's possible that apnea-caused sleep deprivation contributes to the development of FMS. It's also possible that lax connective tissues associated with FMS may make airway obstructions more likely.

Diagnosing Sleep Apnea

Sleep apnea is diagnosed by a polysomnogram, or sleep study. These are done at a sleep lab, where you're hooked up to electrodes and monitored throughout the night by a technician.

Your doctor may refer you for a sleep study if you report symptoms of sleep apnea or other sleep disorders. Most people with FMS are not given a sleep study, but some doctors and researchers say sleep studies should be done more often to help identify and treat sleep disorders that exacerbate FMS.

Symptoms of Sleep Apnea & Fibromyalgia

Some symptoms of fibromyalgia and sleep apnea are similar, which can make it harder for you to detect and for your doctor to diagnose. Shared symptoms include:

  • Unrefreshing sleep & excessive daytime sleepiness
  • Difficulty concentrating
  • Personality changes
  • Depression
  • Insomnia

Sleep apnea symptoms that aren't associated with FMS include:

  • Episodes of obstructed breathing during sleep
  • Loud snoring
  • Dry mouth upon waking
  • Snorting, gasping or choking that wakes you up
  • High blood pressure

If you have FMS and notice these symptoms, you should talk to your doctor about the possibility of sleep apnea.

Treating Sleep Apnea - CPAP

The most common treatment for OSA is a machine that provides what's called Continuous Positive Airway Pressure, or CPAP. The continuous pressure keeps your airway from becoming obstructed.

Once you're diagnosed with sleep apnea, the doctor will likely send you to a medical-equipment provider, who will fit you with a CPAP mask to wear while you sleep and give you a custom-programmed CPAP machine.

Not everyone can tolerate CPAP and FMS can make it harder, especially if you have head, face or jaw pain. CPAP can also make it harder for some people to fall asleep.

My personal experience with CPAP, however, has been very positive. I get better sleep, and I actually find the machine to be somewhat soothing. My daytime fatigue dropped off significantly and my energy level came way up as soon as I started using it.

If you find it hard to adjust to CPAP, talk to your doctor or equipment provider to see if they can help you. You may also want to consider other treatment options. Leaving sleep apnea untreated is a poor option, both because of the impact on your FMS and because of the associated serious health risks -- remember, some of them can kill you.

Treating Sleep Apnea - Other Options

Other sleep apnea treatments include:

  • Losing weight. While it's easier said than done, it can greatly improve the condition.
  • Dental devices. If jaw position is responsible for the obstruction, wearing a device to bed can be effective.
  • Surgery. This may be the only treatment option for some people who can't tolerate CPAP; however, be sure to take into account that surgery carries serious risks, FMS can slow your recovery rate, and surgery can cause your symptoms to flare up. Here's more information on possible sleep apnea surgeries from About.com Sleep Disorders Guide Brandon Peters: Surgery Options for Obstructive Sleep Apnea

General anesthesia and sleep apnea can be a dangerous combination. Read Sleep Apnea & Surgery

Living With Sleep Apnea & Fibromyalgia

Sleep apnea and FMS can be a tough combination to live with, both because poor sleep makes FMS worse and because FMS makes CPAP especially hard to use. However, with proper treatment from your doctor and diligence on your part, it's possible to feel better and minimize sleep apnea's impact on your life.

Also see:

Sources:

Gender Medicine. 2007 Dec;4(4):329-38. "Gender-specific differences in a patient population with obstructive sleep apnea-hypopnea syndrome."

Rheumatology International. 2007 Nov;28(1):69-71. "Obstructive sleep apnea syndrome as an uncommon cause of fibromyalgia: a case report."

Journal of Clinical Sleep Medicine: 2005 Jul 15;1(3):291-300. "Menopause related sleep disorders."

Journal of Clinical Rheumatology. 2006 Dec;12(6):277-81. "Sleep-disordered breathing among women with fibromyalgia syndrome."

Arthritis Research and Therapy. 2008;10(3):R56. "Sleep structure and sleepiness in chronic fatigue syndrome with or without coexisting fibromyalgia."

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