Insomnia is a major issue for most people with fibromyalgia. However, there are strategies to help improve this problem. 

COGNITIVE BEHAVIOURAL THERAPY FOR INSOMNIA

There are 4 components to consider in this category when the goal is to improve sleep quality in people living with fibromyalgia.

  1. Reverse Unconscious Conditioning: In order to do this you should only go to bed when you feel sleepy. It is important not to confuse feeling sleepy with feeling fatigued. They are very different. Feeling fatigued is when you have brain fog, tired muscles and can not do anything productive. When you feel fatigued, rest somewhere other than your bed. This is because you want your brain to associate being sleepy with being in bed, therefore, you should only use your bed for going to sleep. If after 20 minutes of going to bed you are still awake then get out of bed.
  2. Restrict The Amount Of Time Spent In Bed To Increase Sleep Efficiency: Sleep efficiency is the ratio of the total amount of time spent sleeping in a night versus the total  amount of time spent in bed. Quality of sleep is more important than the quantity. Efficient sleep is more compact as well as refreshing. Healthy sleep is associated with sleep efficiency of 85% or higher. To increase sleep efficiency, restrict time in bed to Total  Sleep Time plus 30 minutes. To estimate Total Sleep Time determine how much sleep you are getting each night and then determine what time you would like to wake up. To accurately determine how much you sleep each night, chart your sleep for 2 weeks and calculate your nightly sleep average. For example, if you sleep an average of 5 hours a night, add on an extra 30 minutes for the time it may take you to actually fall asleep. Therefore, TST would equal 5 1/2 hours. If you want to be awake at 6:00 a.m., you would go to bed 12:30 a.m.  The time you wake up in the morning is more important than the time you go to bed. If you have hypersomnia and require more than 9 hours of sleep, do not deprive yourself of sleep and attempt to wake earlier.
  3. Calm The Mind And Body:  The best quality of sleep is achieved when the autonomic nervous system is in a calm state.  In order to keep a calm mind and body before bed, it is important to try and limit any “constructive worries” for day time hours. This also means leaving  stressful or  “spoon draining” activities for this time as well.  If you do too much during the day beyond your energy envelope this will affect your sleep. Too much daytime activity increases your adrenaline which  remains heightened at night.Pace yourself and stay within your limits. Aim to do an activity that is enjoyable and calming before bed.  Avoid looking at blue light screens (cell phones, iPads, TV, sunshine, etc.) one hour  before going to bed. Blue light is stimulating, therefore, it does not promote  relaxation. On the other hand, exposing yourself to blue light during daytime hours helps to set your circadian rhythm. Paced breathing and mindfulness exercises promote relaxation and are of benefit to many people also.
  4. Examine Feelings of Anxiety Around Sleep/Bust Myths:
  • Myth: Spending more time in bed, even if not sleeping, will help me to feel better the next day.
  • Fact:  Spending time in bed awake is counterproductive. You want your brain to associate being asleep with being in bed. This includes making sure naps are in bed.

PLEASE NOTE: Some people do need at least 8 hours of sleep or more.  This is dependent on illness severity. If you need to nap in the daytime,  then take one.  REMEMBER: Do not deprive yourself of sleep if you have hypersomnia.  You will only experience setbacks if you are not listening to your body’s needs.

  • Myth:  Insomnia is caused by a chemical imbalance.
  • Fact:  There are many causes of insomnia, ranging from illnesses that are   that are psychiatric to neurological. Stress, medications, certain  personality traits, such as perfectionism, and other sleep disorders, such as sleep apnea are all contributing factors in developing insomnia.

 MEDICATION

Here is a list the most commonly prescribed medications that are effective for sleep in people with fibromyalgia. A doctor’s prescription is needed for all of the medications listed below.

  • Zopiclone
  • Zolpidem
  • Amitriptyline
  • Trazadone
  • Gabapentin
  • Quetiapine
  • L-Tryptophan
  • Mirtazapine
  • Sodium Oxalate

How effective the medication is, depends on the person taking it. Everyone responds differently to prescription drugs. There are other sleep medications, however, the ones mentioned in this list are generally the most helpful for fibromyalgia patients.

NATURAL SLEEP AIDS

Some people prefer to try natural alternatives, before considering prescribed medication, as an option. Sleep aids that have proven most effective for fibromyalgia are: Melatonin, L-Theanine, and 5 HTP.

CANNABIS FOR SLEEP

There are various strains of medical marijuana with different amounts of THC and CBD. The effect on sleep is dependent on the strain, components, dose, and how the cannabis is delivered. The effect on sleep has mixed results. It is highly suggested if you would like to try marijuana for sleep that you consult an expert in this field as there are thousands of variants and strains.

REFERENCES:

  • Pathways to Improvement Course: Pathway 3 – Sleep; Dr. Eleanor Stein 
  • Let Your Light Shine Through (Manual): Session #2 – Sleep (pg. 2-3 to 2-22) ; Dr. Eleanor Stein