I treat a number of patients with fibromyalgia syndrome. They often come to me with chronic insomnia, and difficulty staying asleep throughout the night. Even when they do manage to get a decent night of sleep, my patients with fibromyalgia tell me they still feel exhausted and worn out the next day.
The fatigue that comes with fibromyalgia affects their work lives, their social lives, and their relationships, and compromises their quality of life. So often, I hear these patients talk about needing to cut back on activities and commitments they want to pursue, because they’re tired and in pain.
I thought of these patients recently, as new research has been released with some promising news about how to treat fibromyalgia and its sleep problems. Two recently published studies show that a couple of sleep therapies I’m particularly interested in—mindfulness meditation and Vitamin D—may have particular effectiveness in helping people with fibromyalgia improve their sleep, as well as reducing the severity of other fibromyalgia symptoms.
Before we dive into the latest news on sleep treatments, let’s take a quick walk through the fundamentals of fibromyalgia.
Many of us probably know someone with this condition, which affects somewhere between 2-6 percent of the population, according to estimates. Women are significantly more likely than men to develop fibromyalgia, often during early adulthood or middle age. But this condition can occur in anyone, at any age—including during childhood.
The most prominent symptom of fibromyalgia is physical pain that’s often chronic and also comes in heightened waves, sometimes called flares. These flares can last for a few days or as long as several weeks. The pain associated with fibromyalgia can be localized at specific tender points and can also be widespread throughout the body.
But pain isn’t the only symptom of fibromyalgia. Other common symptoms include:
- Cognitive problems, including trouble with memory and clarity of thinking
- Depression, anxiety
- Mood swings, including feelings of anger and irritability
- Fatigue, which sometimes is severe and debilitating
- Low tolerance for exercise
- Tingling or numbness in hands and feet
- Irritable bowel syndrome
Sleep problems, including insomnia, restless, poor quality and unrefreshing sleep, all commonly occur among people with fibromyalgia.
Many people think of fibromyalgia as an autoimmune disorder. It’s actually not. The confusion likely comes from the similarities of fibromyalgia symptoms with several autoimmune disorders, including rheumatoid arthritis and thyroid disorders.
What causes fibromyalgia?
We don’t know for sure. Many scientists think heightened activity of the central nervous system is involved, particularly related to how the brain processes information about pain and pain perception. There often appears to be a stress-related trigger that launches the condition. That stress may be physical, such as an injury, an infection, or the onset of another condition, such as arthritis. The stress can also be emotional, whether an acute response to an event, or the cumulative effect of chronic stress and overwhelm. There appears also to be a genetic component to fibromyalgia that makes people more vulnerable to developing the syndrome.
Without a diagnostic test, physicians diagnose fibromyalgia based on a person’s symptoms, while at the same time ruling out other conditions with similar symptoms and characteristics, including hypothyroidism, rheumatoid arthritis, and lupus.
Sleep problems are a key component of fibromyalgia
It wasn’t always the case, but today, sleep problems are recognized as central characteristics of fibromyalgia. The presence of disrupted sleep and insomnia, as well as lack of restorative sleep and daytime fatigue are used as markers to diagnose the disorder, alongside physical pain, issues with mood, and cognitive symptoms.
Nearly all people with fibromyalgia experience some form of sleep problem. Their poor sleep contributes to a whole range of challenges with mental and physical health and daily functioning, including its ability to exacerbate other fibromyalgia symptoms. One study found that 99 percent of fibromyalgia patients suffered poor sleep quality that influenced how severely they experienced physical pain, fatigue, and difficulty with social functioning.
In addition to restless, unrefreshing sleep and insomnia, people with fibromyalgia are more likely to suffer other sleep disorders. Recent research found obstructive sleep apnea present in one half of a group of fibromyalgia patients. Restless leg syndrome also appears to occur at higher rates in people with fibromyalgia. One recent study found RLS occurring in more than 42 percent of fibromyalgia patients. (Recent estimates suggest restless leg syndrome occurs in somewhere between 4-29 percent of the general population.)
These are serious, sometimes debilitating sleep disorders that also carry their own risks to health and our ability to function at our best. The relationship between fibromyalgia and sleep disorders is an important area of research that needs additional attention.
Fibromyalgia’s cycle of pain and poor sleep
Pain and sleep problems frequently co-exist in a difficult cycle that can be tough to break. That’s true for everyone who experiences physical pain and discomfort. It’s particularly true for people with fibromyalgia, as well as others with conditions that involve chronic pain.
When it comes to chronic pain conditions and sleep, pinpointing cause and effect can be difficult. It’s a chicken and egg cycle—which comes first and leads to the other? But there are scientific clues emerging that sleep may play a role in the onset of fibromyalgia. A 2014 study from the United Kingdom found that non-restorative sleep—the kind where you wake feeling tired and worn out after a night’s rest—was linked to the development of widespread pain in adults over age 50. And a 2011 study by Norwegian scientists found the risk of developing fibromyalgia was higher in women who experienced sleep problems—and the more severe the women’s sleep troubles, the higher their fibromyalgia risk.
Here’s some of what else we know about the tangled relationship between fibromyalgia and sleep:
Poor sleep lowers pain thresholds, making us more sensitive to pain. For people with fibromyalgia, whose pain signaling may already be overactive, this additional sensitivity can further escalate an already painful problem.
Insufficient, unrefreshing sleep undermines our coping skills, emotional balance and emotional resilience. These skills are both critical for and challenged in people with fibromyalgia, who face psychological as well as physical distress and pain.
People with fibromyalgia spend less time in deep, slow-wave sleep. Their heightened brain activity appears to keep them in lighter stages of sleep, where they may wake twice as often as people who don’t have the condition. Deep, non-REM sleep is essential for the brain and body to repair and refresh at a cellular level. This lack of restorative deep sleep can help to explain the fatigue, physical pain, and “brain fog” that so many people with fibromyalgia experience.
Exercise is considered one of the most important therapies for managing fibromyalgia. It’s also among the very best habits for sleep. Lack of high-quality sleep makes us less likely to engage in regular exercise. Their sleep deprivation can aggravate fatigue and an already low tolerance for exercise, keeping people with fibromyalgia from taking advantage of the benefits of exercise in improving their condition and quality of life.
Ready for some encouraging news about how we can address sleep problems that occur with fibromyalgia syndrome? Two brand-new studies point in some promising directions.
Vitamin D may help boost sleep quality in people with fibromyalgia
You’ve heard me talk about the science that’s emerging about the importance of Vitamin D for sleep. Our levels of Vitamin D appear to affect both the quality and the quantity of sleep. When we’re low on Vitamin D (and many of us are, without knowing it) we’re more likely to sleep poorly and sleep less overall.
New research suggests that Vitamin D can help improve sleep in people with fibromyalgia. The study investigated the effects of Vitamin D used in combination with a low-dose antidepressant to treat fibromyalgia symptoms, in people who are deficient in Vitamin D.
The study participants were divided into two groups. For a period of 8 weeks one group was given a low dose of the anti-depressant trazodone and Vitamin D, and the other group was given trazodone and a placebo.
Scientists evaluated the effects on a range of fibromyalgia symptoms, including physical pain, mood, and sleep. Both groups experienced improvements to their symptoms. But the group that combined anti-depressant medication with Vitamin D saw more significant improvements, including:
- Less morning tiredness
- Less pain and stiffness
- Decreased anxiety and depression
- Better sleep quality
- Less daytime fatigue
The possible link between Vitamin D deficiency and fibromyalgia has been of interest to scientists for several years, and studies have returned mixed results. Among its important roles in the body, Vitamin D helps to regulate the musculoskeletal system and help control inflammation. Vitamin D deficiency has been linked to joint pain, muscular hypersensitivity, to chronic pain. Those are hallmark symptoms of fibromyalgia.
A 2017 analysis of a dozen studies that examined the possible association between fibromyalgia and Vitamin D showed that:
- A majority of those studies found people with fibromyalgia had lower Vitamin D levels than healthy individuals in control groups
- Several studies found significant correlations between a lack of Vitamin D and higher pain intensity in people with fibromyalgia.
This study appears to be among a handful of its kind (a randomized, controlled trial) to investigate the effects of Vitamin D on fibromyalgia. But other research has shown benefits for fibromyalgia from Vitamin D. A 2014 study found women with fibromyalgia who were deficient in the vitamin experienced less chronic pain and less morning fatigue when they took supplemental Vitamin D.
There’s still a lot we need to learn about the role Vitamin D deficiency may play in fibromyalgia, and how the vitamin may be useful as a therapy. With as many as 50 percent of Americans deficient in Vitamin D, we all need to be more cognizant of our risk for deficiency. If you have fibromyalgia, talk with your healthcare provider about your Vitamin D levels, and whether adding a Vitamin D supplement makes sense for your individual needs.
Mindfulness mediation can soothe fibromyalgia-related sleep problems
A new study by sleep scientists in Spain shows mindfulness meditation (also called “flow” meditation) can improve disrupted, poor quality sleep in people with fibromyalgia.
This study focused specifically on the effects of mindfulness training for women. (Women make up 70-90 percent of people with fibromyalgia.)
A total of 39 women were randomly assigned to one of two groups. One group received 7 weeks of mindfulness therapy and training, including mindfulness meditation and guided body scans. The other group was put on a waiting list and served as a control group.
Scientists found women who underwent mindfulness training experienced significant improvement to their sleep compared to women on the waiting list. Mindfulness meditation reduced insomnia and improved sleep quality.
This isn’t the first study to show improvements for fibromyalgia from mindfulness therapy. A series of studies in the past few years have shown benefits of mindfulness exercises in treating fibromyalgia, including:
- Reducing depression, anxiety, and feelings of anger
- Reducing pain
- Increasing quality of life and social functioning
Other studies have shown mindfulness has specific benefits for sleep in people with fibromyalgia. Studies point to mindfulness therapy’s ability to reduce sleep disturbance and lessen fatigue in fibromyalgia patients. That’s consistent with a strong and growing body of research that shows mindfulness is a highly effective therapy in improving sleep quality and sleep efficiency, helping us sleep more soundly and with fewer interruptions.
Particularly good news here? The latest study out of Spain, as well as several earlier studies, show the benefits of mindfulness therapy is lasting, with benefits continuing for at least 3 months.
I’m a big fan of mindfulness meditation and other mind-body exercises and therapies as natural, low-cost, easy to use methods for improving sleep. I’ve seen countless times in my patients what a difference mindfulness treatments can have over sleep itself, and our attitudes about sleep. I also know firsthand that mindfulness meditation is easy to learn and to integrate into a daily (and nightly routine). I use it myself, every day, and it makes a big difference in my outlook, my focus, and my ability to relax and sleep at the end of a long day.
Michael J. Breus, PhD, DABSM
The Sleep Doctor™