Unrefreshing Sleep in Fibromyalgia

Unrefreshing sleep has long been noted as a feature of fibromyalgia, and it's one that may be linked to many of our symptoms. One study reports that as many as 95 percent of people with fibromyalgia report unrefreshing sleep.

A growing body of research is leading to a better understanding of unrefreshing sleep in this condition, its features, its effect on us, and how it may be alleviated.

Unrefreshing sleep, also called nonrestorative sleep, is not the same thing as insomnia (which can also be present in fibromyalgia). It's not tied to how hard it is to get to sleep or to how long you sleep.

Instead, unrefreshing sleep is more about the quality of your sleep. It's light, and even after sleeping for a full night, you wake up feeling exhausted and as if you've hardly slept. However, the impact of unrefreshing sleep can go well beyond feeling tired.

While unrefreshing sleep and other sleep-related problems are considered a symptom of fibromyalgia, research shows that they're tied to abnormalities in brain chemistry and the immune system in a complex way and, according to a 2012 Spanish study, may serve as "both a cause and a consequence of fibromyalgia."

Research links this poor-quality sleep to multiple symptoms of fibromyalgia, including:

• Increased tenderness
• Lack of overnight recovery from pain
• No morning feelings of well-being
• Cognitive impairment (fibro fog)
• Poor performance of tasks
• Morning achiness
• Stiffness
• Fatigue
• Psychological distress

So far, it's not well understood why sleep is generally unrefreshing in people with this condition.

The most obvious explanation is that it's hard to sleep when you're in pain, and many people with fibromyalgia report significant pain from simply lying down on their tender muscles. The tendencies to get chilled or become overheated and sweat excessively may also contribute to sleep problems.

Research shows that dysfunction in the autonomic nervous system (ANS) may play a key role, as well.

The ANS is separated into two parts—the sympathetic (fight-or-flight mode) and parasympathetic (rest-and-digest mode.) According to an emerging theory of fibromyalgia, the sympathetic nervous system appears to be stuck "on," preventing the body from truly relaxing and being able to sleep.

This state is similar to "sleeping with one eye open," such as new parents do when they're alert to a baby's every cry, or like you might experience when you're especially worried about oversleeping and therefore wake up and check the clock over and over.

Some research suggests that heart-rate variability, which is a measure of autonomic function, was abnormal during sleep in participants with fibromyalgia. This supports the theory of increased sympathetic activity that disrupts sleep.

Because pain disrupts sleep and poor sleep leads to pain, it can become a self-perpetuating cycle.

Research suggests that several medications may be able to improve sleep quality in fibromyalgia. These include:

• Lyrica (pregabalin)
• Cymbalta (duloxetine), Savella (milnacipran) and other SNRIs
• Elavil (amitriptyline)
• Xyrem (sodium oxybate)

Lyrica, Cymbalta, and Savella are FDA-approved for this illness. Elavil is a tricyclic antidepressant, and Xyrem is a narcolepsy drug that's strictly controlled.

Some people with fibromyalgia report success with other prescription or over-the-counter sleep aids as well.

Research suggests that melatonin supplementation may improve sleep and pain in fibromyalgia.

If your sleep is unrefreshing, you should talk to your doctor about what options may be right for you.