Abnormal Sleep Cycles

As a person with living with fibromyalgia or a friend, family member or spouse of a diagnosed individual, you know that sleep problems are a major symptom of the syndrome. It is often difficult to tell which is worse, the stress from not being able to sleep because of chronic pain or the stress from knowing that you need sleep but you simply cannot get it. People with fibromyalgia, like those with chronic fatigue syndrome, do not have the same restful sleep as the rest of us. As a matter of fact unrefreshing sleep is now one of the major diagnostic symptoms in both fibromyalgia and chronic fatigue syndrome. 1,2

Sleep disturbances, including interrupted or abnormal sleep cycles, are often a result of extended periods of chronic pain or bouts of acute pain. However, when people do not get enough sleep their pain threshold tends to also decrease, which leads to a vicious cycle. The more you feel pain the less effective and efficient your sleep will be, and the less that you sleep the higher the pain you experience.

Normal sleep cycles are required for the brain and body to rejuvenate, heal and come back into balance or homeostatis to be able to function correctly the next day. Normal sleep cycles include both non-rapid-eye-moment or NREM sleep and REM. NREM is divided into three different sub-categories.  REM or rapid-eye-movement sleep is the sleep period during which deep dreams, memory and emotional sorting and storage, as well as the unlearning of unnecessary information occurs. This is a process similar to defragmenting a hard drive where unnecessary, damaged or inaccurate files of information are deleted from the system.

Research into just how this works has also provided some fascinating insight into memories we may intentionally be trying to forget. During one experiment subjects were given pairs of words, one which they were to remember and one which they were to try to forget or suppress. When subjects were tested after NREM and REM sleep it was found that in general the sleep increased the recall of both pairs, but those that went into REM sleep actually could recall the words they attempted to suppress better than the people that were only in NREM sleep. In other words, the more you may want to forget specific issues, such as pain or specific memories, the more that REM sleep may provide the ability of the brain to retrieve them when you are awake. 3

Sleep Interruptions

People do not sleep through one sleep cycle a night, rather most adults will experience three to five different cycles. Only about 25% of your total sleep time is in the deep restorative REM sleep, but researchers indicate this is the most essential component for waking refreshed and energized. If you stop to calculate the total amount of time that the average person sleeps, let’s choose 7 hours, then the total amount of time in REM is approximately 105 minutes that is split between three to five REM cycles per night.

In a very recent study researchers intentionally interrupted subjects in the REM and NREM parts of the sleep cycle and tested pain responses the next day. The research clearly showed that interruption of sleep in both phases of the cycle increased pain responses. In fact those that had interrupted REM cycles had the highest pain response increase, leading to the understanding that interrupted REM sleep and lower total amount of sleep per night leads to a hyperalgesic (increased  sensitivity to pain) effect even when all other variables remained the same. 4

The linkage between pain and sleep disturbances needs to be carefully considered when developing an effective way to manage the pain of fibromyalgia and also deal with the additional complication of sleep deprivation through abnormal sleep cycles. Studies have shown that people with fibromyalgia have interupted NREM sleep. Often the very positions that people attempt to maintain to alleviate the pain results in problems in getting into REM sleep or in achieving NREM sleep that allows the brain waves to slow to prepare for REM sleep.

Tips and Ideas for a Better Sleep

Getting a better night of sleep when you have fibromyalgia may be difficult and it will involve a trial and error approach to options you may want to consider. Some doctors try a two pronged approach, treating both the pain and the sleep disorder at the same time. For some people this causes an increase in the “fibro fog” types of cognitive dysfunction reported with the condition due to the combination of medications.

Other options that may be helpful for patients with fibromyalgia who need to achieve one or more uninterrupted and normal sleep cycles per night include the following:

  • Warm baths, spas or time spend in a circulating or hot tub prior to turning in for the  night. Research also shows that warm water exercise during the day in the form of aquatic exercise can be very beneficial in lowering pain levels and providing a more restful sleep. 5
  • Set a schedule for going to bed and getting up. Do not stay in bed longer in the morning to try to make up for lost sleep, this will only create greater problem in sleeping that evening.
  • Limit noise, light and changes in temperature in the room in which you sleep. While you may not hear the furnace or air conditioner turning on and off, your brain and body responds in sleep and this can disturb normal progression of the sleep cycles.
  • Carefully limit any naps during the day and try to exercise prior to three hours before your desired time to go to bed.
  • Avoid using the computer or watching television for one hour before sleeping as this triggers you brain into different response modes. Instead try reading, listening to music or doing relaxation exercises or breathing exercise to calm the brain and prepare it for sleep.

Various herbal supplements, including chamomile tea, may be beneficial to some people with fibromyalgia. Avoiding alcohol and caffeine before bed is also essential as this will decrease the ability to fall asleep.

References

1 Chronic Fatigue Syndrome (CFS). (n.d.). Retrieved from Centers for Disease Control and Prevention: www.cdc.gov/cfs/general/symptoms/

2 Fibromyalgia. (n.d.). Retrieved from Centers for Disease Control and Prevention: www.cdc.gov/arthritis/basics/fibromyalgia.htm

3 Fischer, S., Diekelmann, S., & Born, J. (2011). Sleep’s role in the processing of unwanted memories. Journal of Sleep Research , 267-274.

4 Roehrs, T., Hyde, M., Blaisdell, B., et al. (2005). Sleep Loss and REM Sleep Loss are Hyperalgesic. Journal of Sleep , 132-139.

5 Tomas-Carus, P., Gusi, N., Hakkinen, A., et al. (2008). Eight Months of Physical Training in Warm Water Improves Physical and Mental Health in Women with Fibromyalgia: A Randomized Controlled Trial. Journal Of Rehabilitative Medicine , 248-252.on of medication which results from reading this site.

This article was originally published on July 11, 2012 and last revision and update of it was 9/7/2015