Poor Sleep Quality, Negative Mood Can Worsen Fibromyalgia Pain
Those who have fibromyalgia talk about waking up day after day feeling exhausted and having no energy. Fibromyalgia is a medical syndrome that causes widespread pain and stiffness in the muscles and joints leading to chronic daytime fatigue. Sleep problems are very common, with over 75% of patients reporting disturbed sleep, which unfortunately can worsen symptoms. Patients may attempt to go back to sleep to ease fatigue and pain, but this could be worsening pain intensity and duration. The mood of a person is also a factor in coping with the day to day life with fibromyalgia.
Scientists at the University of Florida recruited seventy-four adult patients with fibromyalgia and observed them for 14 days. The patients completed a sleep diary describing the previous night’s sleep and rated their clinical pain every evening. The researchers here found that insomnia and decreased sleep duration did not predict which patients would have more severe pain, but the effects of poor sleep quality (fatigue, inactivity) did exacerbate symptoms. The team also found that negative mood was greatly predictive of pain intensity and duration.
Previous studies have found that patients with fibromyalgia may have alterations in sleep patterns that disturb slow wave sleep, the deepest stage of sleep. In one study, women who were deprived of this deep sleep showed a decreased tolerance for pain and increases levels of discomfort and fatigue.
Other studies have also found that negativity is tied to physical pain. Emotion, pain and cognitive control overlap in a portion of the brain known as the anterior midcingulate cortex (aMCC). In addition, about 20% of fibromyalgia patients suffer from a depression or anxiety disorder. These can cause additional muscle tension, body soreness and headaches. In the University of Florida study, the researchers found that those with higher scores in negative mood had a 36% average higher degree of clinical pain.
There are strategies to improve sleep quality and to develop better coping techniques that can improve quality of life for fibromyalgia patients.
• Establish a sleep routine that leaves you feeling as refreshed as possible the next day. Different amounts of sleep work for different people, and you may find that attempting to sleep 10 hours a night versus 7 actually worsens your symptoms rather than making them better. Excessively long times in bed is linked to fragmented and shallow sleep. Avoid daytime naps that interfere with nighttime sleep.
• Regular exercise can help with both sleep quality and with boosting the mood. Just avoid exercising within three hours of bedtime. Try yoga for a balanced mind-body exercise.
• Get proper nutrition. Avoid those foods and beverages that are known to disturb sleep, such as caffeine and alcohol. (Note that these are also linked to triggering anxiety symptoms as well.) You may also want to assess your reactions to certain acid-forming foods such as red meat which can affect sleep quality. Remember also that hunger can affect sleep, so a small nighttime snack may help.
• Relaxation techniques can help you cope more effectively with stresses that can aggravate both pain and sleep. A gentle massage or deep breathing/meditation session can be beneficial. Music Therapy has also been studied in fibromyalgia patients.
• Check with your doctor about certain medications that might help, such as a selective serotonin reuptake inhibitor (SSRI) typically used for depression and anxiety or if a pharmacological sleep aid could be right for you.
Ryan J. Anderson, Christina S. McCrae, Roland Staud, Richard B. Berry, Michael E. Robinson. Predictors of Clinical Pain in Fibromyalgia: Examining the Role of Sleep. The Journal of Pain - April 2012 (Vol. 13, Issue 4, Pages 350-358, DOI: 10.1016/j.jpain.2011.12.009)
Shackman AJ et al. The integration of negative affect, pain and cognitive control in the cingulate cortex. Nature Reviews Neuroscience 12, 154-167 (March 2011) | doi:10.1038/nrn2994
National Sleep Foundation