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Disordered sleep and fatigue are extremely common symptoms in fibromyalgia patients — and they also aggravate pain. What can you do to achieve better sleep and feel more energetic?

Although the pain and disordered sleep fibromyalgia patients suffer from aggravate each other — pain making it harder to sleep and fatigue in turn worsening your pain — better sleep does tend to lead to symptom relief. The big question is, then, how can you get a good night’s sleep if you have fibromyalgia?

The link between pain and disordered sleep isn’t yet entirely clear, but studies do show people who have just had an operation, and who are usually in pain:

  • Experience abnormal sleep patterns and get less REM sleep
  • Gradually return to their old sleep patterns as they get better again

This appears to indicate that sleep and pain have a very close relationship.

Even fibromyalgia patients who do manage to get a full night’s sleep often still feel fatigued; their sleep is non-restorative. This is because your sleep might be the wrong kind of sleep — you don’t get enough delta sleep, a deep sleep that recharges your energy. Sleep studies show for instance, that people artificially robbed of delta sleep in a lab setting start experiencing:

Do those symptoms look familiar? That’s because they are the same ones that fibromyalgia patients struggle with on an everyday basis!

Not all sleep problems are the same, though. If you have fibromyalgia, you may experience vivid dreams and restless legs syndrome, you may find it hard to fall asleep (or until early morning, in which case it is called phase shifting), you might wake up several times a night, or you may awaken earlier than planned. Some people with fibromyalgia also experience chronic oversleeping, which can actually make you feel really tired. You could feel like you’ve had a lot of energy drinks as well; though you're extremely tired, your thoughts are "hyperactive".

How can fibromyalgia patients improve their sleep?

You will want to explore some changes to your bedroom and bedtime routine in order to see if they pave the way to better sleep. Here are some tips that might help you.

Find a routine that works for you

Decide on a bedtime routine and stick to it. Start by going to sleep and waking up at the same time every day, ideally including weekends, so that your internal clock gets used to this and you automatically start feeling tired as your bedtime approaches. Your bedtime routine should further include a gradual "winding down". 

If you find it difficult to stick to your new routine, try setting an alarm in the morning and just get up when you hear it — no matter how tired you feel. This will ensure you'll be more ready for sleep the next time you go to bed. Over time, your brain will grow used to your new schedule.

Adjust your surroundings

What can you do to create a more peaceful environment in your bedroom, one that is conducive to sleep? Try:

  • Keeping your bedroom dark when you go to sleep. 
  • You may not know that most people sleep best in a bedroom that is slightly cooler than room temperature.
  • Noise — whether from the street, your neighbors, a snoring partner, or your pets — will keep you awake. If you can't control noise levels, get some ear plugs.
  • Getting a comfortable mattress will lessen your back pain and stiffness. A lot of people like using a recliner as well.

Destress your muscles

When you're stressed out, it’s likely to give make your muscles tense up too, and that can make it harder to get some rest. You can try out some relaxation techniques to help you relieve your muscle tension. These are a few that can benefit you:

  • Meditation can make you feel relaxed and help calm you down.
  • Try a nice warm bath before bed — this will relax you and your muscles.
  • Keep a journal for all your worries so you can deal with them later.

Allow yourself some "me time"

So, you've had a busy, activity-filled, day? You can't just go from that to sleeping! Even though you're probably very tired, your brain may not be ready to go to sleep yet. That's why it's important to create some "me time" during which you can separate your bedtime routine from the rest of the day. Relax! Get a book out and stay off electronics. Putting on some gentle songs has also been shown to help you fall asleep.

Stay off the caffeine!

No surprise here — loading up on the caffeine is basically begging for a bad night! If you want to sleep, you should not have anything with caffeine in it before your bedtime. Say no to coffee, chocolate, tea, soda, and energy drinks, and steer clear of alcohol and smoking before going to bed too, as they can make you feel restless. 

Napping during the day

When you nap during the day, this can obstruct your sleep during the night. Naps can lead to poor night-time sleep and may even prevent you from falling asleep for a long time. Unless naps have been a routine for you for a long time and they don't seem to interfere with your night-time sleeping, cut them out. 

Are your meds interfering with your sleep?

No single medication has been shown to universally help fibromyalgia patients get the sleep they need, and medications that may be used can lead to tolerance, which will have you taking higher and higher doses to achieve the same effect. Prescription sleep drugs are not usually advised to people with fibromyalgia because of this. If you take medication for your other fibromyalgia symptoms they may, however, interfere with sleeping. Medications may make you feel dazed when you wake up, and if they contain caffeine or antihistamines, they can obstruct your sleep.

You could try using natural and over-the-counter medicines if you feel you need something extra to get a good night's sleep. Possibilities you may wish to explore include:

  • Amino acids like L-theanine and L-tryptophan
  • Passion flower
  • Chamomile
  • Melatonin
  • Valerian
  • 5-HTP supplements 
  • Doxylamine (found in Nyquil and ZzzQuil)
  • Benadryl (Diphenhydramine)
  • Tylenol PM and Advil PM

If you've experimented with these options and still can't sleep well, discuss prescription options with your physician:

  • Trazodone
  • A tricyclic antidepressant
  • Klonopin (clonazepam)
  • Non-hypnotic drugs including eszopiclone, ramelteon or zaleplon
  • Non-steroidal anti-inflammatory drugs (NSAIDs) — because pain relief also helps you sleep better

You will, on the other hand, want to stay away from hypnotics and opioids, as hypnotics can lead to further sleep issues such as sleep walking, while opioids are addictive and may also actually interfere with sleep. 

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