A Fibro night’s sleep
Whilst nearly everyone with Fibro complains of not sleeping properly and feeling tired all the time, few appreciate the importance of sleep and a sleep routine in combating the array of symptoms.
Sleep Disorders
Back in the 1970s Canadian researcher Dr Harvey Moldofsky took a group of healthy people and repeatedly woke them up during the night. In the morning they complained of muscle pain and fatigue, symptoms which disappeared following a night of undisturbed sleep. He also took a group of people with fibromyalgia and carried out a sleep study measuring their sleep wave patterns as they slept.
Normally when we sleep we go through various stages of what is known as the sleep cycle. The first waves to appear are alpha waves and as we fall more deeply asleep the waves become slower and slower until we reach deep sleep, characterized by very low-frequency delta waves. Dr. Moldofsky found that the majority of people with fibromyalgia had their deep delta wave sleep interrupted by the intrusion of the faster alpha waves. The alpha-delta anomaly and is one of the key reasons for the non-refreshing sleep and muscle pain that we experience.
While the alpha-delta sleep anomaly is the most common sleep disorder found in fibromyalgia patients, it isn’t the only one. Sleep apnoea, sleep myoclonus (involuntary arm and leg jerking) and teeth grinding are also common.
The lack of delta-wave sleep contributes, directly and indirectly, to many of the other symptoms we face with fibromyalgia. 80% of growth hormone produced per day is released during deep delta wave sleep. This isn’t just about making us taller, it also repairs and restores the damage that occurs to the muscles and tissues during the rough and tumble of everyday life. Without it our bodies don’t get their nightly self-exam, and a backlog of repairs accumulates. Tissues become worn-out, our immune system weakens, and tiny tears in our muscles are left unrepaired. We’re left with aching muscles and feeling totally worn out.
Excitotoxicity
The autonomic nervous system controls the things that happen in our bodies over which we have no conscious control, for example our heart rate, blood pressure, sweating, the digestion of food and breathing. It is operated by two opposing teams: the sympathetic and parasympathetic systems. The sympathetic system speeds things up and prepares us to respond to pain or danger – it’s often referred to as the ‘fight or flight’ response. The parasympathetic system works in opposition to slow things down – the ‘rest and digest’ period.
In people with fibromyalgia the autonomic nervous system is out of balance. It seems that our sympathetic nervous system is unable to switch off properly (a bit like a child with ADHD!) The immediate symptoms of this are dizziness, night sweats, abnormal temperature control, palpitations, chronic diarrhoea/constipation (IBS) and orthostatic hypotension (dizziness and fainting on standing up due to low blood pressure).
At night when we settle down for sleep the parasympathetic system normally takes over to slow everything down, reducing our heart rate and slowing our breathing. Rather than preparing to ‘rest and digest’, though, we find we are still being stimulated by an overactive ‘fight or flight’ system, causing us to toss and turn, remaining too alert to enter a deep sleep.
This tension between the two parts of our autonomic system continues in the day, too, and explains why we feel so much pain. With an overactive sympathetic nervous system the signals being sent to our brain become confused and ‘touch’ is processed as ‘pain’. The gentlest touch – something brushing past our arm for example – can be agonising. Even having clothes touching us can become too much; and a gentle hug can send us right over the edge!
This state of excitotoxicity, to give it it’s technical name, is also found in spinal cord injury, stroke, Multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, Alcoholism and Epilepsy.
Serotonin
An important component of the sleep disturbance in fibromyalgia involves serotonin, a major neurotransmitter (a chemical that helps nerves transmit their messages), which is essential for the induction of deep level, slow wave sleep.
People with fibromyalgia have been found to have low levels of serotonin in their blood and spinal fluid. Doctors may prescribe medications that increase the availability of serotonin in the body, with the ultimate goal being an improvement in the patient’s quality of sleep (more time in delta sleep) and reduced pain sensitivity.
Medication and Research
More research must be done on the relationship between prescribed medications and the alpha-delta sleep anomaly. While these medications do influence the availability of serotonin, the exact mechanism by which they operate is not understood. There are still many questions to be answered. Ironically some of the medications we take to help with the various symptoms of fibromyalgia may themselves contribute to some sleep disturbance, and many sleeping pills can interfere with deep sleep stages. There are various medications and herbal remedies you can try which may help you to get a good night’s sleep, but it is always important to discuss medication with your GP or pharmacist. You may find you cannot tolerate some medicines, or have unhelpful side effects. Some medications may leave you feeling hung-over in the morning, in which case you may need to take it as early as 6pm.
Tips for a good night
Getting the best night’s sleep you can is essential when dealing with fibromyalgia.
- Establish a regular sleeping pattern and routine: go to sleep and get up at the same time every day. As you regulate your sleep-wake patterns, you’ll likely find yourself waking up on your own at around the same time every morning.
- Take time to wind down before bed. You may find it helpful to listen to music or an audio book, have a warm bath with lavender oil, do some relaxation exercises, or read.
- Use dim or soft lighting in the evening time.
- Make your sleep environment as quiet, dark, and comfortable as possible
- Avoid going to bed feeling hungry or on a full stomach, try to eat your evening meal no later than 6pm. However, a light bedtime snack of carbohydrates, walnuts, or milk may increase serotonin, promoting sleep.
- Avoid scary films on TV and stimulating or worrisome activities just before bedtime
- If you have a lot on your mind, try writing down your worries on paper and make a ‘to do’ list. Then put it aside for tomorrow and think of something pleasant.
- Ensure that your bed and pillow are comfortable and supportive, and that you stay warm during the night and avoid being near any drafts from open windows.
- Cut down your caffeine intake, avoiding it completely in the afternoon and evening
- Reduce or eliminate fluid intake after 6pm, especially if you have a need to urinate during the night. Medications such as diuretics that get rid of excess fluid should be taken earlier in the day whenever possible, in consultation with your GP
- If possible try to be in bright light (either outdoors or by an east facing window) in the earlier part of the morning to help keep the sleep-wake pattern established.
- Develop a programme of aerobic exercise, but avoid exercising in the evening. Exercise regularly at least 20-30 minutes three times a week, before 6pm.
- Actively deal with problems that interfere with sleep (pain and discomfort, crying baby, uncomfortable mattress or pillow, snoring spouse, concern about safety issues, etc.).
- Seek treatment for depression, anxiety and/or stress if you are experiencing these.
- Avoid taking a nap late in the day. If you must nap, keep it to less than an hour and before 3pm
- Don’t work in your bedroom. Use your bedroom only for sleeping and being physically close to your partner
- If it takes longer than 30 minutes to fall asleep, get up and go to a different room for a quiet activity such as reading, listening to soft music, or a relaxation technique. Then try to go to sleep again. This also applies if you wake up in the middle of the night.
When you get a good night’s sleep it is much easier to face the day and cope with the nagging pain and fatigue. It is certainly worth persisting with good sleeping habits and various medications to achieve the best night’s sleep you can.
