Fibromyalgia & Deep Restorative Quality Sleep

Some of the hallmarks of fibromyalgia are fatigue, feeling un-refreshed in the morning, and chronic widespread pain that affects muscles and joints.  Recent research out of the United Kingdom found that non-restorative sleep is tied to these fibromyalgia symptoms.  This was especially prevalent in adults over the age of 50.  Additionally, it was found that older adults with poor physical health, cognitive impairment, and anxiety were at greater risk of developing widespread pain.  The study was done out of the Arthritis Research UK Primary Care Centre at Keele University in Staffordshire and was published in Arthritis & Rheumatology.

From age 65 on, musculoskeletal pain seems to become a more common problem.  Musculoskeletal refers to anything that affects bone, nerves, and muscles.  In fact, about 4 out of 5 people over the age of 65 report having this type of pain on a daily basis.

This kind of widespread pain is not just limited to those over 65, however.  As mentioned, it is a common symptom of fibromyalgia, a condition that is also accompanied with excessive fatigue and long-term tender point pain all throughout the body.  Additionally, fibromyalgia patients have tenderness in joints, tendons, muscles, and other soft tissues.

Current estimations suggest that there are about 5 million Americans over the age of 18 that have fibromyalgia, and for some unknown reason the majority of them are women.  Fibromyalgia still affects men and children, however, just not as extensively.

Several factors have been linked to widespread pain development, this new study finds.  The research team out of Keele University identified key factors that increase risk and exacerbation of widespread pain such as that found in fibromyalgia and other musculoskeletal pain conditions in older adults.  There were over 4300 adults aged 50 and older that were analyzed in this study.  These patients did not have widespread pain at the beginning of the study, and 2700 people reported having some areas of pain, though not widespread.

Patients were asked to fill out questionnaires that asked them about their pain levels, physical health, mental health, lifestyle behaviors, underlying medical problems, and socio-economical status.  These patients were followed for a period of three years and then re-assessed to look for widespread pain using the American College of Rheumatology Criteria.  Statistical tools were then used to analyze the data and look for factors that were most prominent in those who had the onset of widespread pain.

The results of this study found that 19% of patients had new widespread pain at the three-year follow-up visit.  This included 8% of patients who had no pain at the start of the study and 25% of patients who had some pain at the start of the study.

There is evidence in this study that links poor sleep to widespread pain.

Poor sleep refers to feeling un-refreshed in the morning, waking up frequently, having a hard time falling asleep, and suffering daytime fatigue and sleepiness as a result of poor sleep.  Occasional restless nights are common; however, it becomes a problem if you are experiencing this several nights a week over a long period of time.

The researchers that analyzed the data found that those who had either some pain or no pain, decreased quality of life due to physical complaints, anxiety, some cognitive impairment, and non-restorative sleep were the ones who reported new-onset widespread pain at the end of the study.

However, the most prevalent link to widespread pain was poor quality sleep.

This study out of Keele University, however, was not able to establish cause and effect, so it is impossible for the researchers to say that poor quality sleep causes fibromyalgia, or at least effects the symptoms.  However, as a physician who has treated fibromyalgia patients for nearly two decades, I can say without doubt that poor sleep absolutely has a negative impact on fibromyalgia.  Every patient who comes to me gets asked the same first question, “how is your sleep?”  Many of my patients actually feel several times better when we fix their sleeping pattern because that leads to better mood, higher pain threshold, and more energy.

I am happy that this study provides a clinical link to poor sleep and fibromyalgia.  There are many studies that have concurred these findings as well.  For example, Medical News Today reported in 2011 a study out of Norway that found women who had poor quality sleep were at increased risk of suffering from fibromyalgia.  This gives a deeper understanding to conventional physicians who are being overwhelmed with the increasing number of over-stressed patients presenting with symptoms so vague as to suggest they are psychosomatic.  This is a dangerous assumption, so perhaps these studies will add further understanding into the problem of fibromyalgia.

We are not able to determine which comes first, the poor sleep or the fibromyalgia; however, we do know that they are absolutely linked to each other because restoring sleep patterns immensely benefits fibro patients. 

Sleep disturbance, pain, and anxiety all combine to form a vicious cycle that repeats itself indefinitely until at least one part of the problem is fixed and breaks the wheel.

The medical director of the above study states that “research has also shown that aerobic exercise improves fitness and reduces pain and fatigue, and should also improve sleep and wellbeing.”  While this is true, restoring stress-coping hormones, serotonin levels, and all other hormonal and nutrition deficiencies will also be beneficial to anyone who is having trouble with sleep.

Let’s briefly review what we know about stress and sleep:  We know that inadequate sleep creates health problems and worsening symptoms of fibromyalgia and chronic fatigue syndrome.  It creates conditions such as anxiety, depression, fatigue, cognitive problems, headaches, etc.  We also know that all forms of stress can lead to medical conditions as well because the body is constantly in fight-or-flight mode, which depletes all the essential chemicals, hormones and nutrients from the body.

As I have discussed in previous posts, we are all born with a stress-coping savings account that includes chemicals like serotonin, dopamine, cortisol, norepinephrine, HGH, DHEA, and many others.  These chemicals help us deal with stress and keep the body functioning properly.

Whenever we are exposed to any form of stress – whether it be chemical, emotional, physical, or mental – we withdraw from this stored-up account.  Over time, without adequate deposits, we are completely exhausted of these essential stress-coping chemicals.

Think of it literally as a bank account.  If you are constantly spending by using a debit card, but you aren’t putting any money into the account, what will happen?  You will overdraw and owe money to the bank!  The same sort of thing happens in the body with these chemicals. Under stress, your body naturally takes out stress-coping hormones, which are usually then re-deposited by healthy diet, exercise, and restorative sleep.

Interestingly, withdrawal from this account can be triggered by just about anything from odors to noises to bright or irritating lights.  You may have already noticed that the longer you have had your illness, the less tolerant you are of these external factors.  It’s like using a credit card when you have no income coming in to pay it off at the end of the month.

During prolonged emotional stressful situations, the body releases excess amounts of the stress hormones adrenaline, cortisol, and insulin.  These trigger the brain to release the feel-good hormone, serotonin, on an almost constant basis.  Therefore, prolonged stress and poor dietary and lifestyle habits will completely deplete the body’s serotonin stores and levels.  FMS and CFS occur when these stores are overdrawn and you don’t make adequate deposits.

How are you making withdrawals?

By simply being awake.  Some everyday situations that cause stress include:

• Traffic jams
• Pollution and environmental irritants
• Poor or inadequate sleep
• Long work hours
• Stress at work
• Mental disorders
• Medical problems
• Financial problems
• Relationship or family problems

According to MSN Health

“During 2010, between one in 20 and one in 10 adults took a sleeping pill in the United States … Those who were prescribed up to 18 doses a year were 3.6 times more likely to die … Those taking the highest doses were also at greater risk of developing several types of cancer, including esophagus, lymphoma, lung, colon and prostate cancers.”

Over an average of 2.5 years, the death rate for those who did not use sleeping pills was 1.2%. It was 6.1% for people with sleeping pill prescriptions. Even those prescribed 18 or fewer sleeping pills a year had a 3.6-fold higher death risk.

Based on these findings, Kripke and colleagues estimate that sleeping pills are linked to 320,000 to 507,000 U.S. deaths each year.

“We think these sleeping pills are very dangerous. We think they cause death. We think they cause cancers,” Kripke says. “It is possible but not proven that reducing the use of these pills would lower the U.S. death rate.”

Sleeping pills linked to these risks included:

• Benzodiazepines:
  • Dalmane
  • Doral
  • Estazolam
  • Flurazepam
  • Halcion
  • Lorazepam
  • Midazolam HCL
  • Prosom
  • Restoril
  • Temazepam
  • Triazolam
  • Alprazolam
  • Ativan
  • Chlordiazepoxide
  • Clorazepate
  • Diazepam
  • Librium
  • Lorazepam
  • Oxazepam
  • Serax
  • Tranxene SD
  • Tranxene T
  • Valium
  • Xanax
  • Xanax XR
  • Clonazepam
  • Klonopin
• Benzodiazepines including Ambien, Lunesta, and Sonata
• Barbiturates, and Sedative antihistamines

How can you make deposits?  Healthy eating habits, proper exercise, supplementation, and deep, restorative sleep!

During delta-wave sleep, the body automatically restores various life-sustaining chemicals and hormones like HGH, serotonin, DHEA, dopamine, cortisol, GABA, vitamins, minerals, antioxidants, norepinephrine, and many others. The more stress you’re under, the more deep sleep you will need to restore those chemicals because your body is using more of them during the stressful time.  This can become a vicious cycle:  Stress can actually cause poor sleep due to lower serotonin levels and poor sleep can lead to more stress.  So what gives?

You will need to be diligent and make sure you have adequate serotonin levels and are making constant deposits into your stress-coping savings account.  Sound impossible?  It’s not.

For the last 18 years, I have worked with fibromyalgia and chronic fatigue patients who have been suffering for years with worsening symptoms and a frustratingly long list of prescription medications that don’t seem to help very much or for very long.  I have found that once these patients are able to get a good night’s sleep on a regular basis, it’s much easier to control their other symptoms such as diffuse pain, depression, fatigue, and cognitive dysfunction.

You may be asking at this point, where do I start? 

The good news is that you don’t need to take yourself off any of your current medications.  My goal is to make it so you need less of them in the future, but taking you off them cold turkey is extremely dangerous.  You will find, however, that by introducing supplements like a high-quality multivitamin and mineral supplement, 5-HTP, and if needed adrenal supplements to your daily regimen will go a long way to helping you sleep better and feel good again.

Bottom line is that you need to replenish serotonin levels in order to get better sleep.  During waking hours, you can take measures like deep breathing exercises, yoga, proper eating habits, etc.  These are essential practices to reducing stress levels.  Replacing serotonin levels by supplementing with amino acids like tryptophan with the use of 5-HTP is a good place to start to assist with the chemical restoration.

It may take a few months for your body to start to normalize, especially if you have gone many years without adequate sleep, but you will most certainly feel and see the difference, sometimes in a matter of days, other times it may take a little more time.  Have patience, and remember that it will be worth it in the end.