The Fibromyalgia Sleep Dilemma - Part II: Finding Solutionsby Karen Lee Richards Patient Advocate
The first step in finding a solution to sleep problems with fibromyalgia is understanding what is causing the problem.
Please read: The Fibromyalgia Sleep Dilemma - Part I: Identifying the Problem
Since more than 75% of people with fibromyalgia have some type of sleep dysfunction and since good quality sleep is essential for the body to repair, restore and refresh itself, finding a way to improve our sleep is key to reducing FM symptoms.
To Sleep, Perchance to Dream...
A dream (albeit a daydream) of most FM patients is to experience a good night's sleep. But just how to do that can be quite a challenge. Following are some tips on good sleep hygiene practices that are recommended by sleep experts.
Daytime and Evening Behaviors That Can Influence Sleep
Expose yourself to lots of sunlight early in the morning. The light will help set and maintain your body's circadian rhythms.
Try to get some exercise each day, but not too close to bedtime.
If possible, avoid napping during the day. If you find you really need to take a nap, limit it to no more than 30 minutes. Do not nap at all in the evening.
If falling asleep is a problem for you, avoid stimulants such as caffeinated beverages (coffee, tea, colas, etc.), chocolate and cigarettes - particularly in the evening.
Don't eat a big meal right before going to bed. If you're hungry, eat a small snack and/or a glass of milk, but stay away from foods that may cause gas or heartburn.
Keep liquids to a minimum as bedtime approaches to prevent waking up because you have to go to the bathroom.
Avoid stimulating activities, such as video games. for an hour or two before bedtime.
Avoid alcohol in the evening. While alcohol may help you fall asleep initially, when your body begins to metabolize it, it will wake you up.
It's possible that some prescription medications, over-the-counter meds or supplements you are taking could be having a stimulating effect on you. Ask your pharmacist whether anything you're taking could be contributing to your sleep problems. If so, talk with your doctor about possible alternatives.
Take a warm bath approximately three hours before you plan to go to bed rather than right before bedtime. A decrease in body temperature signals your body that it's time for sleep. The slow cooling of the body after a warm bath can serve as an excellent signal.
Maintain a regular sleep schedule. Go to bed and get up at the same times each day in order to establish a pattern and reset your biological clock.
Setting the Scene for Sleep
Ideally your bed should be reserved for sleeping and intimacy only. Nap on the sofa and sit in a chair to read. Only go to bed when you're ready to go to sleep for the night.
Invest in a comfortable mattress. When it comes to mattresses, everyone has different preferences. A few mattresses that other FM patients have recommended include memory foam, pillow top, air and water beds. If you can't afford a new mattress, try a mattress pad such as a foam pad or a feather bed.
Another good option is he Cuddle Eweâ„¢ Underquilt, which was originally developed especially for fibromyalgia patients. http://www.cuddleewe.com/
Quality bedding does make a difference. No matter how good your mattress is, if your sheets are scratchy or your pillow is lumpy, you won't sleep well. I didn't realize what a difference thread count made until I bought some 400 and 500 thread-count sheets. They are incredibly soft and comfortable. If you tend to get too cold at night, flannel sheets may be a good option for you. Another good investment is a quality pillow that won't break down after a few uses.
Make your bedroom's dÃ©cor as sleep-friendly as possible. Try to keep it as clutter-free as you can. Relegate computers and TVs to other parts of the house. Avoid bright colors on the walls and keep the decorations subtle.
Preparing to Sleep
Sleep experts recommend sleeping in a completely dark room. Complete darkness aids in the production of the neurotransmitter serotonin, which is often low in FM patients. Serotonin is crucial in making melatonin, which helps regulate the body's sleep/wake cycles. Exposure to light stops the production of melatonin. If you have trouble getting your bedroom completely dark, try blackout shades on your windows or wear a sleep mask if you can tolerate it.
Block out distracting noises like TV and traffic. If your living situation makes noise unavoidable, try wearing earplugs. On the other hand, if complete silence bothers you, try using some type of white noise such as a fan or a recording of the soothing sounds of rain, waves, wildlife, etc. There are also white noise machines available.
The temperature of your bedroom should be comfortable for you - not too hot nor too cold. Most experts say the room should be cool, but not cold.
Establish a bedtime routine you are comfortable with. That might include things like brushing your teeth, washing your face, writing in your journal, reading something light, listening to soft music, meditating or praying.
Try sipping an herbal tea that has sleep-inducing qualitites such as chamomile, lemon balm or valerian. There are also a number of herbal tea blends available that usually include the words "bedtime" or "sleep" in their names.
If you have difficulty falling asleep, try doing some relaxation exercises when you go to bed.
If you don't fall asleep after 20 minutes or if you wake up and can't get back to sleep, don't stay in bed struggling to sleep. The experts say you should get up, sit in a chair and do something calming like reading light material or listening to soft music. Keep the lights as low as possible because bright lights will only cause you to be more awake. When you being to feel sleepy, go back to bed and try again.
Most of us would prefer not to take medication for sleep unless we absolutely have to. The problem with some sleep medications is that although they do help you fall asleep, they may interfere with your ability to get the really deep sleep you need. However, sleep is essential and if you can't get it through good sleep hygiene practices and other natural methods, then medication may be your best option.
Many doctors have found that their patients actually do best using two different types of sleep medication - one to help them fall asleep and another to help them stay asleep. Cort Johnson's Phoenix Rising Web site offers a chart showing which sleep medications some of the top FM and ME/CFS doctors prefer for their patients.
Additional Sleep Aids
To learn about some of the supplements and over-the-counter medications recommended by different FM and ME/CFS specialists, see: Treating Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia: Alternative Sleep Aids
When it comes to getting quality sleep, even the type of pjs you wear can make a big difference. To learn how and why, see: Goodnighties Recovery Sleepwear
Johnson C. Treating Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia: Sleep Hygiene. Phoenix Rising. Retrieved 3/30/11.
Matallana L, Bradley LA, Silverman SL, Yunus MB. (2005). The complete idiot's guide to fibromyalgia. New York, NY: Alpha Books.