If you or a loved one live with fibromyalgia, you know how exhausting it can be. Sleep problems are common among those with fibromyalgia.1 Most people with fibromyalgia report experiencing a range of sleep symptoms that make it difficult to get a good night’s rest, resulting in daytime fatigue.
In this article, we’ll look closer at the link between fibromyalgia and sleep problems and review tips on how to improve sleep with fibromyalgia.
Is Fibromyalgia a Sleep Disorder?
Fibromyalgia is not a sleep disorder but rather a complex chronic pain syndrome that can cause sleep problems. In fact, 60 to 80% of those with fibromyalgia report having trouble sleeping.1 Frequent nighttime awakenings are the most common sleep disturbance, followed by trouble falling asleep.2 According to a survey of those with fibromyalgia, many report tossing and turning at night to find a comfortable, pain-free sleeping position.2
Central sensitization, a key feature of fibromyalgia, may be partly responsible for sleep disturbances experienced by those with fibromyalgia.3
Why Central Sensitization Relates to Sleep Deprivation
Central sensitization is when your central nervous system is over-responsive to stimuli.4 As a result, individuals who have central sensitization are more sensitive to pain or touch than those without it. In those with fibromyalgia, this results in widespread pain with a heightened sensitivity to painful and non-painful stimuli.
With central sensitization, your body is always on high alert to stimuli, even when sleeping. Especially if you haven’t reached the deep sleep phases, this causes more frequent awakenings or even makes falling asleep challenging. As a result, your body doesn’t get enough deep, restorative sleep.
Research suggests a bidirectional link between poor sleep and fibromyalgia pain severity.1 This means poor sleep worsens fibromyalgia pain, and fibromyalgia pain prevents you from getting a good night’s sleep.
Fibromyalgia and Sleep Symptoms
Most individuals with fibromyalgia report having insomnia (a sleep disorder), making it harder to fall asleep, stay asleep, or both.1 And those with insomnia tend to experience non-restorative sleep.
Non-restorative sleep means your body doesn’t spend enough time in the third and fourth phases of sleep, also known as deep sleep and REM (rapid eye movement) stages. During these phases, your body builds bones and muscle, strengthens your immune system, and helps with cognitive functions such as learning and memory.
Furthermore, polysomnography testing supports disrupted sleep patterns in those with fibromyalgia.5 A polysomnography records your brain waves, oxygen level, heart rate, and breathing during sleep to help diagnose sleep problems. Fibromyalgia sleep patterns from polysomnography results show5:
- Decreased sleep duration
- Altered sleep quality with more time spent in light sleep than in deep sleep
- Increased number of nighttime wakings
The link between the lack of restorative deep or REM sleep and fibromyalgia may explain why those with fibromyalgia wake up feeling tired, sluggish, or non-restored no matter how much sleep they get.2 This, in turn, can cause fibromyalgia sleep deprivation, resulting in daytime fatigue, making it difficult to get through your day.1 It can also result in difficulty with cognitive function, which people refer to “brain fog” or “fibro fog.”
Differences in Fibromyalgia and Common Sleep Disorders
You might be wondering whether your fatigue is caused by fibromyalgia, or something else, further complicating getting a good night’s rest. Those with fibromyalgia may also have other medical conditions that also affect their sleep.
Read on to learn more about other sleep disorders, and how they may differ from fibromyalgia symptoms.
Chronic Fatigue Syndrome vs Fibromyalgia
Chronic fatigue syndrome (CFS) is a complex medical condition that causes profound fatigue. Unfortunately, CFS is not relieved with sleep or rest; this is in contrast to fibromyalgia, where periods of quality sleep can help improve fatigue.
Most individuals with CFS report pain, but their pain differs from fibromyalgia pain. CFS pain is commonly reported as headaches or deep muscle or joint pain. In comparison, fibromyalgia pain is described as a dull, aching feeling throughout the body that lingers. While CFS can cause pain, it isn’t part of the CFS diagnostic criteria, unlike in fibromyalgia, where widespread pain is the hallmark symptom and must be present for at least three months for a diagnosis.
Sleep Apnea vs Fibromyalgia
Sleep apnea is a sleep disorder that causes breathing to start and stop while asleep. These episodes generally last no longer than 10 seconds. These interruptions are often due to an obstruction in the airway (obstructive sleep apnea) or when the brain doesn’t properly send signals to the body to breathe (central sleep apnea).
Regardless of the cause, these interruptions occur throughout the night, causing the individual to awaken partially as they try to catch their breath. Those with sleep apnea will likely not remember these episodes when they wake up.
Based on a 2017 study, complaints of morning fatigue and sleep disturbances were equally present among those with a fibromyalgia sleep disorder and those with obstructive sleep apnea.6 So, it may not come as a surprise that half of those with fibromyalgia in this study also had obstructive sleep apnea.6
Polysomnography results showed that those with fibromyalgia take longer to fall asleep than those with obstructive sleep apnea.6 Experts believe this was due to difficulty finding a pain-free sleeping position.6
Those with fibromyalgia can also have sleep apnea, further contributing to sleep problems. However, if you’re wondering if fibromyalgia can cause sleep apnea, there has not been quality research to determined any connection as of yet.
Restless Leg vs Fibromyalgia
Restless leg syndrome (RLS) is characterized by having uncomfortable sensations in the legs and, less commonly, the arms, causing an urge to move. These sensations are described as achiness, throbbing, crawling, creeping, or itching, often occurring on both sides of your body.
RLS symptoms most frequently occur in the late afternoon or evening but can occur at any time when you’re sitting for an extended time (for example, on a long car ride or when binge-watching your favorite Netflix series).
Often, RLS symptoms are the most intense at night when sleeping, with a symptom-free period in the morning. In contrast, the severity of fibromyalgia symptoms varies throughout the day and doesn’t have a defined symptom-free period.
Both RLS and fibromyalgia make it challenging to find a comfortable sleep position. But movement relieves RLS symptoms; this contrasts with fibromyalgia, where movement often doesn’t immediately relieve the pain (although research does support consistent, daily physical activity for chronic pain associated with fibromyalgia).4
Improving Sleep with Fibromyalgia
Before jumping into options for improving your sleep, you may be wondering: How much sleep do fibromyalgia patients need? According to the National Heart, Lung, and Blood Institute, adults should aim to get 7 to 9 hours of quality sleep per night.
Remember that as you go through these treatment options for improving your sleep, you may not notice results immediately. Be sure to stick with your plan, though. It may take a couple of weeks for your body to adjust to the changes you made and to notice results.
Sleep Habits with Fibromyalgia
One of the best ways to improve your sleep is to look at your sleep habits and sleep environment.
A good place to start is by looking at your sleep environment. Try to create a calming sleep environment by:
- Removing distractions in the bedroom, such as a TV or computer
- Hanging blackout curtains or shades to keep the room dark
- Adjusting the temperature to keep it between 60 to 68 degrees fahrenheit
Other suggestions for improving your sleep habits include:
- Setting a sleep schedule and sticking to it
- Avoiding long naps during the day
- Watching your caffeine consumption, especially in the hours leading up to bedtime
- Quitting smoking, as nicotine can stimulate your body
- Participating in regular movement
- Limiting heavy meals, alcohol, or stimulating activities before bed
- Practicing mindfulness meditation, such as yoga or body-scan meditation
Stanza for Fibromyalgia
Another way to improve your sleep quality is through cognitive behavioral therapy (CBT).4 This type of treatment focuses on changing negative thoughts, feelings, and beliefs.4 As you learn to reframe your negative emotions through CBT, you are better able to handle stress more effectively. And stress management in those with fibromyalgia has a positive ripple effect on other fibromyalgia symptoms such as pain and sleep.4
Stanza is a digital behavioral therapy for treatment of fibromyalgia symptoms that teaches Acceptance and Commitment Therapy, a type of CBT. It is clinically proven to improve fibromyalgia symptoms, overall well-being, and quality of life. Over 70% of Stanza users report improved sleep quality and overall well-being.
Daily Stanza treatments take as little as 15 minutes and are available on your smartphone. Treatments vary from day to day but include lessons for learning new skills for managing symptoms, mindfulness activities, and journaling.
You need a prescription from a healthcare provider to use Stanza. Check here to see if there is a Stanza provider near you. If there isn’t a Stanza provider in your state, you may still be able to work with our providers who specialize in fibromyalgia. To begin, take our free assessment.
Medications and Supplements
There are several pharmaceutical options available that may help improve your sleep. Some of these options are FDA-approved to treat fibromyalgia symptoms, while the evidence for others comes from research studies.
Medications, such as tricyclic antidepressants (TCA), are not FDA-approved for treating fibromyalgia.7 Yet, they have been shown to effectively manage sleep difficulties in those with fibromyalgia; sedative TCA medications, like amitriptyline, help regulate sleep patterns, thus improving overall sleep quality.7
There are three medications FDA-approved to manage fibromyalgia symptoms, including sleep:
- Duloxetine (Cymbalta)
- Pregabalin (Lyrica)
- Milnacipran (Savella)
A 2022 study showed amitriptyline was better at improving sleep in those with fibromyalgia compared to the three FDA-approved medications.8 Pregabalin had moderate improvements in sleep, with milnacipran showing the least improvement.8 However, all are appropriate options for managing fibromyalgia symptoms.
You may also be wondering if prescription sleep medications will help. Those with fibromyalgia and sleep medications prescribed, such as zolpidem (Ambien), may see an improvement in sleep quality but not in pain intensity or interference.1
Research on a new sleep aid, suvorexant (Belsomra), has some preliminary evidence to address pain and sleep problems. A very small 2020 study showed suvorexant improved sleep duration and lessened pain in those with fibromyalgia compared to those taking a placebo.1
Besides prescription medications, different supplements may help you sleep better. Melatonin is a hormone produced by your body that regulates your sleep-wake cycle. Taking a melatonin supplement before bed can signal your body that it’s time to sleep. As a result, you may fall asleep faster and stay asleep throughout the night. However, melatonin may have limited effectiveness in restoring sleep in those with fibromyalgia.5
You may have also heard specific vitamins, such as magnesium or vitamin D, may help improve your sleep quality. Magnesium helps relax muscles, reduce pain, and improve sleep in those with or without fibromyalgia.3 However, more research is needed into the benefits of taking magnesium or vitamin D supplements in those with fibromyalgia.
In existing studies, most participants who benefitted from magnesium supplements were also on other interventions to help manage fibromyalgia symptoms.3 In a study on vitamin D, individuals with fibromyalgia saw an improvement in their sleep when given trazodone, a prescription antidepressant, in combination with a vitamin D supplement.9 So, it is hard to say whether the improvement was from the trazodone, vitamin D, or the combination.
Remember – everyone is different, and what helps one person get a good night’s rest may not work for you. Because of this, it is hard to say what the best sleep aid for fibromyalgia is. Therefore, speaking with your healthcare provider about your sleep difficulties is essential. Together, you can personalize your treatment plan and find the right treatment options to manage your sleep difficulties and fibromyalgia symptoms.
Finding Specialists on Fibromyalgia and Sleep Symptoms
If you or someone you know has fibromyalgia, you can access fibromyalgia specialists in several states through virtual visits with Swing Care, with services covered by major insurance plans. A fibromyalgia specialist can discuss your symptoms in more detail, as well as advise you on treatment options. Visit www.swing.care to learn more and to check your insurance benefits.
If you are experiencing symptoms of fibromyalgia, this fibromyalgia self-test based on a standardized diagnostic tool may help you determine whether you may need professional evaluation for fibromyalgia from a physician. However, this is not a diagnosis, and Swing Care clinicians are available for a consultation to discuss your symptoms and history, as well as other potential diagnoses.
Medically reviewed by Dr. Andrea Chadwick, MD, MSc, FASA
References
- Roehrs T, Withrow D, Koshorek G, Verkler J, Bazan L, Roth T. Sleep and pain in humans with fibromyalgia and comorbid insomnia: double-blind, crossover study of suvorexant 20 mg versus placebo. J Clin Sleep Med. 2020;16(3):415-421. doi:https://doi.org/10.5664/jcsm.8220
- Martin S, Chandran A, Zografos L, Zlateva G. Evaluation of the impact of fibromyalgia on patients’ sleep and the content validity of two sleep scales. Health Qual Life Outcomes. 2009;7:64. doi: https://doi.org/10.1186/1477-7525-7-64
- Boulis M, Boulis M, Clauw D. Magnesium and Fibromyalgia: A Literature Review. J Prim Care Community Health. 2021;12. doi: https://doi.org/10.1177/21501327211038433
- Volcheck MM, Graham SM, Fleming KC, Mohabbat AB, Luedtke CA. Central sensitization, chronic pain, and other symptoms: Better understanding, better management. Clevel Clin J Med. 2023;90(4): 245-254. doi: https://doi.org/10.3949/ccjm.90a.22019
- Maugars Y, Berthelot JM, Le Goff B, Darrieutort-Laffite C. Fibromyalgia and Associated Disorders: From Pain to Chronic Suffering, From Subjective Hypersensitivity to Hypersensitivity Syndrome. Front Med (Lausanne). 2021;8. doi: https://doi.org/10.3389/fmed.2021.666914
- Köseoğlu Hİ, İnanır A, Kanbay A, Okan S, Demir O, Çeçen O, İnanır S. Is There a Link Between Obstructive Sleep Apnea Syndrome and Fibromyalgia Syndrome? Turk Thorac J. 2017;18(2):40-46. doi: https://doi.org/10.5152/TurkThoracJ.2017.16036
- Wichniak A, Wierzbicka A, Walęcka M, Jernajczyk W. Effects of Antidepressants on Sleep. Curr Psychiatry Rep. 2017;19(9):63. doi: https://doi.org/10.1007/s11920-017-0816-4
- Farag HM, Yunusa I, Goswami H, Sultan I, Doucette JA, Eguale T. Comparison of Amitriptyline and US Food and Drug Administration–Approved Treatments for Fibromyalgia: A Systematic Review and Network Meta-analysis. JAMA Netw Open. 2022;5(5):e2212939. Doi: https://doi.org/10.1001/jamanetworkopen.2022.12939
- Mirzaei A, Zabihiyeganeh M, Jahed SA, Khiabani E, Nojomi M, Ghaffari S. Effects of vitamin D optimization on quality of life of patients with fibromyalgia: A randomized controlled trial. Med J Islam Repub Iran. 2018;32:29. doi: https://doi.org/10.14196/mjiri.32.29
