Morning Symptoms of Fibromyalgia

A swollen face and hands in the mornings is a common symptom of fibromyalgia. When you have fibromyalgia, you may also experience other morning symptoms like exhaustion, stiffness, and aches. Not everyone with fibromyalgia has these morning symptoms, but they're common.

This is one of those areas medical research hasn't yet explained. They also don't know a lot about how to relieve these symptoms, other than what can be learned through trial and error.

This article discusses morning symptoms of fibromyalgia, including swollen face and hands.

A woman in bed awake
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Swollen Face and Hands

Some people with fibromyalgia wake up with puffiness in their hands and feet or around their eyes. Again, science can't say for sure why. The puffiness is generally believed to be the result of excess fluid, not inflammation. (Some cases of fibromyalgia may involve inflammation, though.)

Other Causes of Swollen Hands

  • Arthritis: There are more than 100 types of arthritis, all of which involve swelling and inflammation in joints. According to the Centers for Disease Control and Infection, fibromyalgia is considered a form of arthritis. Others include osteoarthritis, rheumatoid arthritis, and gout.
  • Carpal tunnel syndrome: This condition develops when a nerve in the wrist called the median nerve becomes compressed. It can cause the sensation of swollen fingers, although the swelling is not visible.
  • Diet: Foods high in sodium, especially processed foods, and table salt can cause swelling throughout the body, including in the hands.
  • Injury: Broken bones, sprains, or other injuries to the hands cause swelling when blood and fluid flow to the area as part of the healing process.
  • Kidney issues: One job of the kidneys is to remove excess fluid from the body. If the kidneys are not working properly, that fluid can get backed up in the body and cause swollen hands, ankles, and feet.
  • Lymphedema: This is an accumulation of lymph fluid, which carries white blood cells and other substances throughout the body as part of the immune system, in fatty tissue. It may be caused by removal of the lymph nodes—as cancer treatment, for example—or damage to the lymph nodes due to injury, infection, or a genetic mutation.
  • Medications: Some medications cause puffiness as well, so be aware of possible side effects and discuss them with your healthcare provider.
  • Pregnancy: Throughout pregnancy, the amount of blood in a pregnant person's body increases steadily to as much as 48% by the end of the third trimester.

Morning Exhaustion

It's pretty simple to sum up why people with fibromyalgia are exhausted first thing in the morning—they don't sleep well.

Fibromyalgia is linked to multiple sleep disorders, including:

Research also shows some people with fibromyalgia have abnormal sleep patterns that interrupt deep sleep. They may also have sleep that is generally unrefreshing.

Any one of these problems can leave you tired the next day. If you have several of them in combination, it's even harder to get good-quality sleep.

Other fibromyalgia symptoms can make this worse. Pain can certainly keep you awake or wake you up periodically. Anxiety makes it difficult to relax. Sensitivity to noise and light can make seemingly minor things jar you awake, possibly with a big shot of adrenaline.

For people with a pain type called allodynia, even the brush of a sheet against your skin or a wrinkle in their pajamas can cause searing pain. Some people refer to fibromyalgia as the "princess and the pea" syndrome because people with the condition can be disturbed by small things.

A lot of people with this condition complain of getting too hot and/or sweaty to sleep well. Temperature sensitivity is common in this disorder, and not just sensitivity to heat. A hand sticking out of the covers may get chilled to the point of discomfort or even severe pain, and can it take a long time to warm up. They are also prone to excessive sweating.

Depending on your symptoms, your healthcare provider may recommend a sleep study to diagnose sleep disorders. The findings could lead to treatments such as medications or a CPAP machine for sleep apnea, or to suggested lifestyle changes for improving sleep. Pain management and anxiety treatment can be an important part of helping you sleep better as well.

Morning Stiffness

It's fairly normal for people with fibromyalgia to wake up feeling stiff and achy all over or to have a hard time standing up straight for a while.

For many, the achiness tends to be different from other fibromyalgia pain. It's often more like the muscle pain a healthy person would feel the day after really strenuous activity or possibly a minor car accident.

It's not clear why their bodies are like this in the mornings. While they may feel pretty sedentary most of the time, people watching them often say that they are fidgety.

What happens is that a position makes something start to hurt, so they'll shift a little. Then something else starts hurting, so they shift again. It's possible that they're stiff in the morning because they haven't shifted around enough all night.

Some people find relief from morning soreness with a hot bath, possibly with Epsom salt, before bed. Others try simple yoga or other stretches before sleep or before getting out of bed. Medication, either for pain or sleep, may also help. Ask your healthcare provider for ideas and talk about things you'd like to try to make sure they're safe.

Fibromyalgia Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

Treatment and Coping

Sometimes, people say it helps to eat such foods as cucumbers that help relieve fluid retention. Others say they're helped by massage therapy, especially a specific type of massage called manual lymph drainage. Again, each person has to figure out what works best for them.​​


Many people with fibromyalgia experience morning symptoms. A puffy face and hands are common. So is morning exhaustion and stiffness. Unfortunately, these symptoms aren't well understood, so there aren't yet any standard ways to treat them.

Finding relief for your morning symptoms is an individual process. Some people find taking a hot bath before bed can help. Others get relief from massage therapy. It is a good idea to talk to your healthcare provider about your symptoms and what might work for you.

A Word From Verywell

While these symptoms may cause problems waking up in the morning, they're not usually among the worst symptoms of fibromyalgia. Also, they're called morning symptoms for a reason—they generally clear up as the day goes along.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  3. Poluha RL, Grossmann E. Does pregabalin improve sleep disorders in fibromyalgia? Br J Pain. 2018;1(2). doi:10.5935/2595-0118.20180031

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Additional Reading

By Adrienne Dellwo
Adrienne Dellwo is an experienced journalist who was diagnosed with fibromyalgia and has written extensively on the topic.