Sleepless And In Pain: A Link Between Fibromyalgia And Sleep 

12/22/11 08:03 AM ET

AOL - HEALTHY LIVING

There's some important news for millions of people -- most of them women -- who suffer from the syndrome fibromyalgia: a new study suggests that sleep deprivation is associated with an increased risk of developing fibromyalgia.

The study was conducted at the Norwegian University of Science and Technology. The study included 12,350 women. At the outset of the study, all the women were free of physical impairment, musculoskeletal pain and fibromyalgia. A decade later, 327 of the women -- 2.6 percent of the study population -- had developed fibromyalgia. Researchers asked all the women in the study to report on their sleep habits and their sleep problems. They found that women who reported sleep problems were significantly more likely to have developed fibromyalgia than women without sleep problems. The researchers also found that the risk of fibromyalgia increases with a woman's age, and with the severity of sleep problems:

• Women who reported having difficulty sleeping "always" or "often" had nearly 3.5 times greater risk of fibromyalgia as women who did not have problems sleeping


• Women age 45 and older who "always" or "often" had sleep problems had more than five times the risk of developing fibromyalgia as women without sleep problems


• Younger women, ages 20 to 44, who "always" or "often" had difficulty sleeping were at three times greater risk of developing fibromyalgia than their counterparts who didn't have trouble with sleep

It's important to make clear that this study does not prove that sleep deficiencies cause fibromyalgia. What it does do -- for the first time -- is establish a strong connection between sleep problems and fibromyalgia, by showing the increased risk of fibromyalgia that is associated with lack of sleep.

What is fibromyalgia? It's a syndrome whose main characteristic is chronic pain. Pain is often felt throughout the body, in muscles, tendons and soft tissues. With fibromyalgia, the pain is often felt at certain trigger points, and radiates from those points outward. People with fibromyalgia often experience daytime fatigue, which can be severe, as well as depression, anxiety and memory problems. Women ages 20 to 50 are at the highest risk for fibromyalgia. Men do develop fibromyalgia, but women are more than 10 times as likely as men to develop the syndrome.

Fibromyalgia has a history that's both contentious and mysterious. For a long time, there was no consensus in the medical community about whether it even existed, whether it was a "real" disorder or an "imagined" one. This has changed, and the medical establishment now overwhelmingly accepts that fibromyalgia exists as a very real disorder. But much about the syndrome -- including and especially what causes it -- remains unknown. For this reason, and because there is no single test that can positively identify fibromyalgia, it remains difficult to diagnose. Since it can't be tested for, a diagnosis of fibromyalgia comes by way of eliminating other possible conditions.

There are signs of possible genetic and environmental links, since fibromyalgia seems to sometimes run in families. Researchers have explored links between fibromyalgia and other diseases and disorders, including arthritis, depression, anxiety, chronic fatigue and restless leg syndrome, but no conclusive evidence has been found to demonstrate a causal link between fibromyalgia and these conditions. That said, all of these disorders are found more often in people with fibromyalgia than in the general population.

Is sleep a cause of fibromyalgia? Again, we just don't know, and this current study doesn't answer that question. The relationship between sleep and chronic pain is complicated, and there is a lot we do not understand about cause and effect. Here's some of what we do know. The presence of chronic pain, such as with fibromyalgia, makes falling asleep and staying asleep more difficult. Sleep deprivation, in turn, can make people more sensitive to pain. Evidence that disrupted sleep can lead to a lower pain threshold includes this study. Researchers took a group of healthy, pain-free middle-aged women and disrupted their sleep cycle, depriving them of deep, slow-wave sleep, for three consecutive nights. They then tested their threshold for musculoskeletal pain, tenderness and also mood. After only a few nights of disrupted sleep, the women experienced a significantly decreased pain threshold (meaning they felt pain more quickly and intensely), as well as increased fatigue and general discomfort.

We don't need to know the root causes of fibromyalgia to know that improving sleep is at the core of a strong treatment plan for the condition. If you're struggling with sleeping because of fibromyalgia or chronic pain, keep these strategies in mind to help improve and protect your sleep:


• Emphasize your rest. People with fibromyalgia simply cannot shirk their sleep routine. Make sure sleep stays a top priority, by setting up a schedule that allows for plenty of rest, and by creating a sleep environment that is relaxing, quiet, dark and conducive for sleep.


• Exercise. Regular exercise can help manage pain itself. It will also strengthen your sleep-wake cycle, and help you sleep better. Schedule exercise earlier in the day, and outdoors in sunlight if you can.


• Use relaxation techniques. Meditation, massage and mind-body exercise are also powerful tools for pain management and for sleep as well. One study found that after three months of regular Tai Chi practice (two, hour-long sessions per week), pain and depression among fibromyalgia patients had declined, and sleep had improved.


• Avoid alcohol, tobacco and caffeine. These chemicals may make you feel "better" in the very short term, but they disrupt sleep and increase stress, among other negative consequences. With fibromyalgia, your body is coping with enough stress without exposing it to taxing chemical stimulants and depressants.

There is so much that we still need to learn about fibromyalgia itself, as well as the relationship between chronic pain and sleep. One thing that's not in question? Sleep is powerful healing tool. It costs nothing and doesn't require a prescription. Make sure you're using it to its greatest effect.

Sweet Dreams,
Michael J. Breus, PhD 
The Sleep Doctor™ 
www.thesleepdoctor.com

DIAGNOSING FIBROMYALGIA: COMMON MISDIAGNOSES

The symptoms of fibromyalgia are similar to many other diseases.

By Jeanie Lerche Davis

WebMD Feature

Reviewed by Matthew Hoffman, MD

Jackie Yencha hit the wall at age 22. "I couldn't handle the pain any more," she says. "I was terribly fatigued, not feeling well, not sleeping well." But it took Yencha seven years to get an accurate diagnosis of fibromyalgia.

Her first diagnosis -- reflex sympathetic dystrophy -- resulted in experimental surgery that did nothing to relieve her pain. In fact, numerous surgeries followed to correct the problems from that procedure. Years went by. Yencha was still in pain, still getting little sleep.

"I became desperate ... the pain never got better," Yencha tells WebMD. That's when she headed to the Cleveland Clinic, where comprehensive testing showed she had fibromyalgia.

"You need to find a doctor who will listen and who really knows fibromyalgia," says Yencha, who is now vice president of National Fibromyalgia Partnership, a nonprofit organization that fosters education about this disorder.

"A lot of doctors out there don't know much about it," she explains. "We hear from people all the time ... people in small towns who say no one here has ever heard of this."

What Is Fibromyalgia?

Fibromyalgia is a chronic condition that causes disabling pain all over the body -- as well as stiffness and tenderness in muscles, tendons, and joints, experts say. It is most common among women ages 35 to 55.

Although it's one of the most common muscle problems, the cause is a mystery, fibromyalgia researchers say. There is no inflammation or joint damage, as occurs with arthritis. There is no damage to internal body organs, as with rheumatoid conditions like lupus. It is called fibromyalgia syndrome because it is identified by a collection of symptoms.

Indeed, the list of possible fibromyalgia symptoms is a long one:

Chronic muscle pain 
Muscle spasms or leg cramps
Sleep problems
Severe fatigue
Anxiety
Depression
Morning stiffness
Headaches
Difficulty concentrating
Skin sensitivities
Irritability
Intestinal problems

But these are also common to liver disease, lupus, Lyme disease, thyroid dysfunction, heart disease, arthritis, degenerative joint disease, chronic fatigue syndrome, irritable bowel syndrome, and other disorders -- and therein lies the difficulty in diagnosing fibromyalgia.

How fibromyalgia develops is also a mystery. "The onset can be fairly abrupt, triggered by a motor vehicle accident or a mishap at work," says Steven Berney, MD, chief of rheumatology at Temple University Health System in Philadelphia. "Very quickly the condition sets in. You feel bruised for the next couple of days, but there's the expectation that whatever is disrupted will heal. When the pain doesn't wear off, it becomes clear something else is going on."

More typically, there is a gradual onset, Berney tells WebMD. "The pain becomes more severe over time. That's more difficult to diagnose. You're looking for something that set this off, and you can't find it."

Fibromyalgia research shows that the disorder seems to run in families. Recent studies show that genetic factors may predispose some people to fibromyalgia. An illness or injury that causes trauma to the body can make subtle fibromyalgia symptoms more apparent -- and more troublesome, according to the National Fibromyalgia Association.

"The pain is very real and markedly impedes their lives," Berney says. "People who were very active become disabled by pain and fatigue. 'I want my life back' becomes the charge."

The symptoms of fibromyalgia are similar to many other diseases. 

The Tender Points of Pain With Fibromyalgia

While it's not clear what exactly triggers fibromyalgia, researchers are homing in on the basic mechanisms. Fibromyalgia patients have higher levels of two substances -- a nerve chemical called substance P, and nerve growth factor in the spinal fluid. They also have lower than normal levels of the brain chemical serotonin, as is also true with people suffering from depression and anxiety.

All this produces a dysfunction in the body's ability to process pain -- and creates supersensitive nerves throughout the body, explains Andrew J. Holman, MD, a rheumatology specialist at the University of Washington in Seattle. To make things worse, people with fibromyalgia have difficulty getting a good night's sleep -- so they constantly wake up feeling fatigued.

The result: Everyday sensations of discomfort and pain are amplified beyond the norm. Slight bumps and touches can cause disabling pain if you have fibromyalgia. This pain can be aggravated by outside factors -- noise, weather changes, and stress.

To figure out what's going on, doctors diagnose fibromyalgia by examining specific "tender points" on the body. "There are 18 specific tender points -- specific locations that are tender for everyone," Holman tells WebMD. "But for people with fibromyalgia, these points are significantly more tender. People are more sensitive at those points. A dysfunction in the central pain processing amplifies their sensations."

Tenderness or pain in at least 11 of these 18 points is the hallmark of fibromyalgia, says Holman. Also, the pain is widespread on both sides of the body -- neck, buttocks, shoulders, arms, upper back, and chest. Tender points are around the elbows, shoulders, knees, hips, back of the head, and the breast bone.

Doctors test these tender points to make the fibromyalgia diagnosis. Yet it's not always so clear-cut what the widespread pain indicates. It takes a careful ear to discern what's really going on, explains Martin Grabois, MD, chairman of physical medicine and rehabilitation at Baylor College of Medicine in Houston.

"Physicians are used to diagnoses like a herniated disc, where there's pain in a specific location," Grabois tells WebMD. "That's not so with fibromyalgia. Some pain is above the waist, some below the waist, at the shoulders, etc., and there are sleep disturbances, fatigue. These are symptoms of a number of diseases. They are not isolated to fibromyalgia."

The muscle pain can range from mild discomfort to severe enough that it limits a person's everyday life -- including work and social activities. The pain is often described as burning, gnawing, throbbing, stabbing, or aching. When the person relaxes, the pain may be more noticeable -- and less so when they're active.

Sleep Dysfunction Affects Pain Sensitivity

The sleep problems associated with fibromyalgia -- insomnia and fragmented sleep -- may be the root of the pain, says Holman. It deprives people of stage IV deep sleep, the non-rapid-eye-movement sleep that helps us feel refreshed in the morning.

Fibromyalgia research is showing that an automatic arousal is triggered in the brain during sleep, Holman tells WebMD. "The basic fight or flight response is activated at night while you're sleeping. The hormones epinephrine and adrenaline are released as the body becomes vigilant, aware. That causes the transition from deep restorative sleep into light sleep."

These disruptions rob the person of restorative processes that occur during deep sleep, he explains. "It's during deep sleep that most growth hormone is produced. Muscles regenerate and heal, and neurotransmitters are replenished in the brain. The body's ability to recuperate from the day's stresses -- including small pain sensations -- is believed to occur during deep sleep."

The brain has a "pain threshold," Holman adds. "During the day, low signals in the brain can be ignored and you continue doing what you're doing. But if the system is overwhelmed, at night the normally nonpainful stimuli become painful. Lack of deep sleep amplifies all sensations -- what we call central pain amplification."

"When people finally get deep restorative sleep, fibromyalgia improves substantially," Holman says. "But the best strategy to treat the sleep is not a sleeping pill. The strategy is to turn off the arousal in the brain stem that's interrupting the sleep. We want to allow people to sleep."

Fibromyalgia - What You Need To Know 


Difficulty Diagnosing Fibromyalgia

As with chronic pain, sleep problems are common -- and it's not always easy diagnosing fibromyalgia syndrome as the problem.

"The primary care doctor is at somewhat a disadvantage," Berney tells WebMD. "There are no specific tests for fibromyalgia diagnosis. To make a diagnosis, one has to make sure it's not something else -- lupus, thyroid dysfunction, rheumatoid arthritis. The list of possible diseases associated with these symptoms is fairly extensive. It's the vagueness of the symptoms that delays the diagnosis."

"You won't necessarily have all of the symptoms of these disorders, but you can have a component of each," says Grabois. "Patients often go to a lot of doctors trying to figure out what's wrong. The doctors are not familiar with fibromyalgia syndrome so they don't necessarily know the diagnostic criteria for it -- and they don't necessarily check for it."

Also, the level of misery is different for each patient, he points out. "Some have pain worse than others." For some, the pain is continuous. For others, it comes and goes. Some people wake up feeling like they have been exercising all night.

Getting a Correct Diagnosis

If you have seen several doctors -- yet still don't have relief -- see a specialist, Grabois advises. The National Fibromyalgia Association provides a list of specialists who understand the disease -- experts in pain management, rheumatology, and neurology.

Prepare for your appointment. Before meeting with the doctor, prepare to accurately communicate your symptoms. Think about these:

What your symptoms are -- and when they started. 
How long they've been going on -- and whether it's been continuous, or off and on.
Have you noticed any triggers for your symptoms?
How do your symptoms affect you? Is pain sharp, a dull ache, does it cause nausea?
How do symptoms affect your feelings? Does pain make you depressed or anxious?
How do symptoms affect your work or home life? Are you very fatigued and can't do normal activities?
What drugs, herbal remedies or supplements are you taking?
What surgeries have you had?
What current treatments has another doctor or specialist prescribed?

Getting a Correct Diagnosis continued... Keep a pain journal. "Doctors will listen more if you keep a daily record of how you feel -- even if it's just for one month or for three months," says Yencha. In your pain journal, make note of intensity of pain (on a scale of 1 to 10), what you were doing at the time, and how you felt emotionally. It will help you and your doctor see patterns in the pain, she says.

There are no lab tests or scans that can help doctors diagnose fibromyalgia. But various blood tests can help them rule out other medical conditions. Some patients need to have respiratory problems checked or get a sleep apnea study, Berney says. "On occasion, the problem is sleep apnea or snoring, both of which disturb sleep."

Find the right doctor. It's important to find a doctor who cares about you -- and wants to help you, says Mary Rose, PsyD, clinical psychologist and behavioral sleep specialist at Baylor College of Medicine in Houston. "It's very common, physicians having very little time. Sometimes they don't really hear everything a patient says."

Never stay with a physician you don't like or trust, Rose tells WebMD. "It's not all in your head -- and while you may be depressed, depression is not the whole picture of fibromyalgia. We see depression with cancer, cardiac disease, and we know those are real. Pain is very frustrating. In the medical community, we probably don't have the empathy for pain that we should."

Get emotional support. A therapist's support can be helpful when you're dealing with fibromyalgia, Rose notes. "Fibromyalgia has such a stigma. Sometimes it is really helpful to see a therapist -- not because you're crazy, but because you have to deal with pressure and stigma. It's nice to have someone objective to talk to."

Reviewed on October 02, 2007  Original Article Link

NEW DEVELOPMENTS IN THE DIAGNOSIS OF FIBROMYALGIA

New developments in the diagnosis of fibromyalgia syndrome: 
Say goodbye to tender points?

WILLIAM S. WILKE, MD*

Department of Rheumatic and Immunologic Diseases, Orthopaedic and Rheumatologic Institute, Cleveland Clinic; member, Fibromyalgia Criteria Study Group

ABSTRACT
The Symptom Intensity Scale score can be used to identify and quantify fibromyalgia syndrome from information supplied by a simple questionnaire. In this paper, the author describes how this test was developed and argues in favor of its use in clinical practice in diagnosing fibro- myalgia syndrome.

KEY POINTS
The Symptom Intensity Scale questionnaire consists of two parts: a list of 19 anatomic areas in which the patient is asked if he or she feels pain (the total number of yes answers being the Regional Pain Scale score), and a visual analogue scale for fatigue. According to the Survey Criteria, a diagnosis of fibromyal- gia can be entertained if the Regional Pain Scale score is 8 points or higher and the fatigue visual analogue scale score is 6 cm or higher. The number of tender points, a surrogate for diffuse pain, does not fully capture the essence of fibromyalgia syn- drome, in which accompanying fatigue is often severe and nearly always present. The Symptom Intensity Scale is an accurate surrogate mea- sure for general health, depression, disability, and death. Fibromyalgia syndrome diagnosed with this instrument implies that this illness carries increased medical risk. 


This is a very intensive and extensive article that we highly recommend reading. You can read it in its' entirety by clicking on the link below.

New Developments Article

FIBROMYALGIA PAIN LINKED WITH CENTRAL NERVOUS SYSTEM DISORDER
SOURCE:AMERICAN PAIN SOCIETY
May 29, 2008


( an older article but an important one )

Newswise — Fibromyalgia is a chronic pain condition that causes widespread pain and tenderness throughout the body. A University of Michigan study, published in The Journal of Pain, shows that fibromyalgia is associated with central nervous system abnormalities evidenced by patients’ elevated sensitivity to auditory and pressure sensations. The Michigan researchers studied 31 subjects to determine if there is a global central nervous system problem underlying sensory processing in fibromyalgia patients. They noted that few studies have employed different stimuli in consistent ways and levels of intensity to measure pain sensitivities in this patient group. In this study, fibromyalgia patients and normal subjects were exposed to random auditory and pressure stimuli. Consistent with prior research, the fibromyalgia subjects in the study showed greater sensitivity to auditory tones and reported higher sensitivity to daily sounds. Further, significant associations were observed between the auditory and pressure responses and support the claim that such abnormalities maybe related to a common pathophysiological mechanism. They also noted that fibromyalgia subjects perceived auditory stimuli to be of the same intensity as felt by control subjects, even though their actual intensity levels were lower. The authors concluded their findings show that fibromyalgia is associated with a central nervous deficit in sensory processing. Further research is needed to examine mechanisms governing these perceptual abnormalities.
[Source]

FIBROMYALGIA PAIN AT NIGHT - WHAT CAUSES SLEEPLESSNESS?


By Jeanie Lerche Davis
Reviewed by Brunilda Nazario, MD
WebMD Feature

Do you toss and turn at night because of fibromyalgia pain or discomfort? "People with fibromyalgia tend to have very disturbed sleep," says Doris Cope, MD, director of Pain Management at the University of Pittsburgh School of Medicine. "Even if they sleep 10 hours a night, they still feel fatigued, don't feel rested." Research shows that with fibromyalgia, there is an automatic arousal in the brain during sleep. Frequent disruptions prevent the important restorative processes from occurring. Growth hormone is mostly produced during sleep. Without restorative sleep and the surge of growth hormone, muscles don’t heal and neurotransmitters (like the mood chemical serotonin) are not replenished. The lack of a good night’s sleep makes people with fibromyalgia wake up feeling tired and fatigued. The result: The body can't recuperate from the day's stresses -- all of which overwhelms the system, creating a great sensitivity to pain. Widespread pain, sleep problems, anxiety, depression, fatigue, and memory difficulties are all symptoms of fibromyalgia. Insomnia takes many forms -- trouble falling asleep, waking up often during the night, having trouble going back to sleep, and waking up too early in the morning. Smoothing out those sleep problems -- and helping people get the deep sleep their bodies need -- helps fibromyalgia pain improve significantly, research shows. Medications can help enhance sleep and relieve pain. But doctors also advocate lifestyle changes to help sleep come naturally.

Tips to Get Better Sleep With Fibromyalgia
Creating a comfort zone at home is key to better sleep, whether you have fibromyalgia or not. It's all about easing into bedtime feeling relaxed -- and staying relaxed so you sleep through the night.

These 10 tips can help people sleep better:

• Enjoy a soothing (warm) bath in the evening.
• Brush your body with a loofah or long-handled brush in the bath.
• Ease painful tender points with a self-massage device (like a tennis ball).
• Do yoga and stretching exercises to relax.
• Listen to calming music.
• Meditate to tame intrusive thoughts and tension.
• Sleep in a darkened room. Try an eye mask if necessary.
• Keep the room as quiet as possible (or use a white-noise machine).
• Make sure the room temperature is comfortable.
• Avoid foods that contain caffeine, including teas, colas, and chocolate.
• Therapies to Treat Insomnia When You Have Fibromyalgia

If you're still having sleep problems, several therapies can help, including biofeedback, relaxation training, stress reduction, and cognitive therapy. A psychologist who specializes in sleep disorders can discuss these therapies with you. The therapies help people handle stress better, which helps control fibromyalgia episodes, Cope says. "Fibromyalgia comes and goes," she tells WebMD. "When you're stressed out, that's when it's worse." That's when you're most likely to have insomnia, too. Medications can also help ease fibromyalgia pain at night, or directly treat insomnia. Medications to ease fibromyalgia at night include antidepressants, anticonvulsants, prescription pain relievers, and sleep aids.  No one therapy will control fibromyalgia pain 100%, Cope adds. "Medications help some. Exercise helps some. Stress reduction helps some. Cognitive behavior therapy helps some... If you can get restful sleep, you're going to function better when you're awake."

SOURCES:
Doris Cope, MD, director of Pain Management at the University of Pittsburgh Medical School.
Tiffany Field, PhD, director of the Touch Research Institute at the University of Miami School of Medicine.
WebMD Feature: Diagnosing Fibromyalgia.
WebMD Medical Reference in collaboration with The Cleveland Clinic: Sleep and Chronic Illness. WebMD Feature: Good Sleep: Can It Still Be Simple? 
Reviewed on April 29, 2008

This excerpt is from a wonderful website I urge you to visit. It is THE FIBROMYALGIA CENTER and is all about Fibromyalgia, every aspect is covered. This is just a taste of what you can expect to see there.

FAQ ABOUT FIBROMYALGIA SLEEP

SYMPTOMS of FIBROMYALGIA

Most patients with fibromyalgia say that they ache all over. Their muscles may feel like they have been pulled or overworked. Sometimes the muscles twitch and at other times they burn. More women than men are afflicted with fibromyalgia, but it shows up in people of all ages.

Pain - The pain of fibromyalgia has no boundaries. People describe the pain as deep muscular aching, burning, throbbing, shooting and stabbing. Quite often, the pain and stiffness are worse in the morning and you may hurt more in muscle groups that are used repetitively.

Multiple Tender Areas - (muscle and joint pain) on the back of the neck, shoulders, sternum, lower back, hip, shin, elbows and knees.

Chronic headaches - Recurrent migraine or tension-type headaches are seen in about 50% of fibromyalgia patients and can pose a major problem in coping for this patient group.

Fatigue - This symptom can be mild in some patients and yet incapacitating in others. The fatigue has been described as "brain fatigue" in which patients feel totally drained of energy. Many patients depict this situation by saying that they feel as though their arms and legs are tied to concrete blocks and they have difficulty concentrating.

Sleep Disturbances - Most fibromyalgia patients have an associated sleep disorder called the alpha-EEG anomaly. This condition was uncovered in a sleep lab with the aid of a machine which recorded the brain waves of patients during sleep. Researchers found that fibromyalgia syndrome patients could fall asleep without much trouble, but their deep level (or stage 4) sleep was constantly interrupted by bursts of awake-like brain activity. The sleep pattern for clinically depressed patients is distinctly different from that found in FMS or CFS.

Body Aches

Reduced Exercise Tolerance

Irritable Bowel Syndrome - Constipation, diarrhea, frequent abdominal pain, abdominal gas and nausea represent symptoms frequently found in roughly 40% to 70% of fibromyalgia patients.

Chronic Facial Muscle Pain or Aching

Other Common Symptoms - Painful menstrual periods (dysmenorrhea), chest pain, morning stiffness, cognitive or memory impairment, numbness and tingling sensations, muscle twitching, irritable bladder, the feeling of swollen extremities, skin sensitivities, dry eyes and mouth, frequent changes in eye prescription, dizziness, and impaired coordination can also occur.

Aggravating factors - Changes in weather, cold or drafty environments, hormonal fluctuations (premenstrual and menopausal states), stress, depression, anxiety and over-exertion can all contribute to symptom flare-ups.

 
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TRIGGER POINTS OF FIBROMYALGIA  - ILLUSTRATION OF TRIGGER POINTS ! 

This is an excellent illustration of the 18 trigger points of Fibromyalgia.

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