Coping With Insomnia and Fibromyalgia

A lot of people with fibromyalgia also have the best-known sleep disorder around: insomnia. Sometimes called a symptom and 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 six hours a night
• AND have one of the above symptoms three 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:

• Fatigue
• Headache
• 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. But...

When Fibromyalgia and Insomnia Join Forces

Now consider that fibromyalgia pain can be enough to keep you from getting to sleep or to wake you up during the night, so you might not know what's really behind your inability to sleep.

Sleep problems, in general, are common in all pain conditions. However, a study published in Clinical and Experimental Rheumatology showed that while people with rheumatoid arthritis had more insomnia symptoms than healthy people, those with fibromyalgia had even more than those with rheumatoid arthritis.

Studies also suggest that sleep problems are present in fibromyalgia regardless of whether the person is depressed.

We don't know for certain why fibromyalgia and insomnia occur together so frequently, but it may be due to some common physiology. A prime candidate is neurotransmitter serotonin, which plays an important role in regulating the sleep cycle, and is deficient in many cases of fibromyalgia. The most common treatments for fibromyalgia involve increasing the amount of serotonin that's available to your brain.

Treatments

Insomnia—along with poor sleep in general—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.

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. (Also, valerian is only considered effective for occasional insomnia and is less effective when taken every night.) Anecdotal evidence suggests that these supplements may work for some people, but not for 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.

If you suspect you have insomnia, talk to your healthcare provider about treatment options. He/she may want you to have a sleep study to confirm the diagnosis or check for other common sleep problems in us, such as sleep apnea.

A Word From Verywell

A lot of different things can impact your sleep quality, including the common symptom of unrefreshing sleep and other types of sleep dysfunction.

You may want to try creating better sleep habits and creating a more comfortable bed and sleep environment.