CFS & Fibromyalgia Fibromyalgia Unrefreshing Sleep in Fibromyalgia By Adrienne Dellwo Adrienne Dellwo LinkedIn Adrienne Dellwo is an experienced journalist who was diagnosed with fibromyalgia and has written extensively on the topic. Learn about our editorial process Updated on January 24, 2023 Medically reviewed by Marissa Sansone, MD Medically reviewed by Marissa Sansone, MD LinkedIn Marissa Sansone, MD, is a board-certified doctor of internal medicine and a current fellow in rheumatology at Yale University. She actively teaches rheumatology to medical residents and students, and peer-reviews abstracts in the journal Rheumatology. Learn about our Medical Expert Board Print 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. PeopleImages / Getty Images 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. Overview 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." Impact of Unrefreshing Sleep 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 Why Sleep Is Unrefreshing in Fibromyalgia 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. Treatment 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) Medical cannabis 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 healthcare provider about what options may be right for you. 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. Clauw DJ. Perspectives on fatigue from the study of chronic fatigue syndrome and related conditions. PM & R: the journal of injury, function, and rehabilitation. 2010;2(5):414-30. Hussain SA, et al. Adjuvant use of melatonin for treatment of fibromyalgia. Journal of pineal research. 2011;50(3):267-71. doi:10.1111/j.1600-079X.2010.00836.x Moldofsky H, et al. Effects of sodium oxybate on sleep physiology and sleep/wake-related symptoms in patients with fibromyalgia syndrome: a double-blind, randomized, placebo-controlled study. Journal of rheumatology. 2010;37(10):2156-66. Moldofsky H, et al. Effects of bedtime very low dose cyclobenzaprine on symptoms and sleep physiology in patients with fibromyalgia syndrome: a double-blind randomized placebo-controlled study. The Journal of rheumatology. 2011;38(12):2653-63. Prados G, Miro E. Fibromyalgia and sleep: a review. Revista de neurologia. 2012;54(4):227-40. Abstract referenced, article in Spanish. By Adrienne Dellwo Adrienne Dellwo is an experienced journalist who was diagnosed with fibromyalgia and has written extensively on the topic. 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